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Purpose: To identify the retinal vessel vasculature parameters associated with birdshot chorioretinopathy (BSCR). Methods: This retrospective observational study included 28 prevalent cases of BSCR with a median time from diagnosis of 6 years and 28 controls matched for age, arterial hypertension, diabetes and refraction. Forty‐five‐degree fundus images of both dilated eyes were acquired with a fundus camera (Canon CR‐2, Tokyo, Japan). The summary diameter of the arterial retinal vessels (central retinal artery equivalent, CRAE), venous retinal vessels (central retinal vein equivalent, CRVE), vascular tortuosity and fractal dimension (FD) were measured using VAMPIRE software. Retinal vasculitis was characterized using fluorescein angiography and active choroiditis using indocyanine green angiography. Results: At baseline, BSCR was associated with lower FD compared with matched controls (mean difference, −0.04; 95% confidence interval [CI], −0.06 to −0.02, p < 0.001). No other VAMPIRE parameters (CRAE, CRVE, arterial and venous tortuosity) differed. Among BSCR patients, retinal vein vasculitis was associated with higher CRAE (mean difference, 21 μ; 95% CI, 2.6–40, p = 0.03), venous tortuosity (geometric mean ratio, 1.79; 95% CI, 1.18–2.72, p = 0.007) and FD (mean difference, −0.04; 95% CI, −0.06 to −0.01, p = 0.007). Resolution of retinal vein vasculitis during follow‐up was paralleled by decrease in CRAE, CRVE and venous tortuosity values and increase in venous FD, respectively. Conclusion: BSCR is associated with lower FD value, suggesting that chronic retinal inflammation induces microvascular remodelling. Efficient treatment of retinal vasculitis may reverse changes in retinal vascular parameters. Changes in retinal vascular parameters could be potentially useful for assessing patients with BSCR disease. [ABSTRACT FROM AUTHOR]

Purpose: Mice carrying pathogenic variants in the microphthalmia transcription factor (Mitf) gene show structural and functional changes in the retina and retinal pigment epithelium. The purpose of this study was to assess the vascular changes in Mitf mice carrying pathogenic variants by determining their retinal vessel diameter. Methods: Mice examined in this study were: B6‐Mitfmi‐vga9/+ (n = 6), B6‐Mitfmi‐enu22(398)/Mitfmi‐enu22(398) (n = 6) and C57BL/6J wild type mice (n = 6), all 3 months old. Fundus images were taken with a Micron IV camera after intraperitoneal injection of fluorescein salt. Images were adjusted to enhance contrast and a custom written MATLAB program used to extract the mean vascular diameter at a pre‐defined distance from the optic disc. The number of vessels, mean diameter and mean total diameter were examined. Results: The mean diameter of retinal veins in Mitfmi‐enu22(398)/Mitfmi‐enu22(398) mice was 18.8% larger than in wild type (p = 0.026). No differences in the mean diameter of the retinal arteries were found between the genotypes. Mitfmi‐enu22(398)/Mitfmi‐enu22(398) mice have 17.2% more retinal arteries (p = 0.026), and 15.6% more retinal veins (p = 0.041) than wild type. A 24.8% increase was observed in the mean combined arterial diameter in mice with the Mitfmi‐enu22(398)/Mitfmi‐enu22(398) compared to wild type mice (p = 0.024). A 38.6% increase was found in the mean combined venular diameter in mice with the Mitfmi‐enu22(398)/Mitfmi‐enu22(398) pathogenic variation as compared to wild type (p = 0.004). The mean combined retinal venular diameter in the Mitfmi‐vga9/+ mice was 17.8% larger than in wild type (p = 0.03). Conclusion: An increase in vascularization of the retina in Mitfmi‐enu22(398)/Mitfmi‐enu22(398) mice was found, indicating an increased demand for blood flow to the retina. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effects of vitrectomy (Vy) with or without same time cataract surgery and membrane plus internal limiting membrane peeling (MP+ILMP) on retinal oxygenation and choroidal volume and their role on postoperative outcome. Methods: Thirty‐two eyes were included in this prospective clinical study. All patients received 23 gauge Vy+MP+ILMP without endotamponade. Additional cataract surgery was performed in 14 patients. Follow‐up visits were scheduled at day 1, week 1, month 1 and month 3. At each visit, best corrected visual acuity (BCVA) using ETDRS charts (except at day 1), oxygenation of retinal vessels using the Oxymap T1, and optical coherence tomography (OCT, Heidelberg Spectralis) was performed. Results: Mean BCVA increased significantly from 73 ± 11 letters to 77 ± 7 letters at month 3 (p = 0.02). Mean central retinal thickness (CRT) decreased from 456 ± 84 µm at baseline to 418±58µm (p = 0.01 baseline versus month 3). In the cataract surgery group, CRT was higher at month 3 than in the group without (400 ± 58 µm versus 441 ± 51 µm; p = 0.007). There was no statistically significant difference in choroidal volume or oxygenation of retinal vessels between groups (additional cataract surgery versus vitrectomy alone). Oxygenation of retinal arteries tended to decrease at day 1 followed by an increase, but the changes did not reach the level of significance (p = 0.29 baseline versus month 3). Oxygenation of retinal veins increased significantly (p = 0.02 baseline versus month 1; p = 0.04 baseline versus month 3, accordingly). There was a significant negative correlation (Spearman correlation coefficient rs = −0.35, p = 0.047) between visual acuity and oxygenation of retinal veins at month 3. No statistically significant correlation was found between CRT and oxygenation of neither retinal arteries nor veins. Choroidal volume (CV) of the central mm did not change significantly during the study period (baseline: 0.203 ± 0.04 mm3, median: 0.206, month 3: 0.205 ± 0.04 mm3, p = 0.54). There was no statistically significant effect of choroidal volume at baseline on postoperative clinical outcomes (change in BCVA estimate [95% CI]: 7 [−76; 90], p = 0.86; change in CRT: 147 [−577; 871], p = 0.68). Conclusion: Oxygen saturation may affect the visual acuity outcome but not the CRT in patients after vitrectomy for epiretinal membrane. Choroidal thickness had no statistically significant influence on the study outcomes. Further studies are needed to evaluate if the measurement of retinal oxygenation may be helpful in the decision for surgery. [ABSTRACT FROM AUTHOR]

Purpose: To compare retinal vascular parameters between high‐risk and low‐risk pregnant women over time during pregnancy. Methods: In a longitudinal study, we included pregnant women with normal blood pressure and normal body mass index (BMI, group 1), pregnant women with systemic hypertension and/or overweight (group 2) and age‐matched nonpregnant healthy women (group 3). Using the dynamic vessel analyser (DVA) we investigated flicker‐induced vasodilation in retinal arteries (FLA) and veins (FLV), central retinal arterial and vein equivalent (CRAE, CRVE), arterio‐venous ratio (AVR) and retinal arterial and venous oxygen saturation (SartO2, SveinO2). Study visits were scheduled 2nd trimester (TP 2), 3rd trimester (TP 3) and postpartum (PP). Results: Data from 29 women in group 1, 25 women in group 2 and 33 women in group 3 were included for analysis. FLA, FLV, CRAE, CRVE, AVR and SveinO2 were altered in group 2 (p‐values between < 0.001 and 0.009). At TP 3 the differences between groups were most pronounced. In contrast, there were only minor differences between group 1 and 3. Changes in retinal parameters were independently associated with systemic blood pressure and BMI. Conclusions: The present analysis indicates that flicker‐induced retinal vasodilation, retinal vessel diameters and retinal oxygen saturation are altered in high‐risk pregnant women. Hence, these parameters are candidate biomarkers for pregnancy complications, a hypothesis that deserves further study. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the safety and feasibility of robot‐assisted retinal vein cannulation with Ocriplasmin infusion for central retinal vein occlusion. Methods: Prospective phase I trial including four patients suffering from central retinal vein occlusion (CRVO). Diagnosis was confirmed by preoperative fluo‐angiography and followed by a standard three‐port pars plana vitrectomy. Afterwards, a custom‐built microneedle was inserted into a branch retinal vein with robotic assistance and infusion of Ocriplasmin started. Primary outcomes were the occurrence of intra‐operative complications and success of cannulation. Secondary outcomes were change in visual acuity, central macular thickness (CMT) and venous filling times (VFT) during fluo‐angiography two weeks after the intervention. Results: Cannulation with infusion of ocriplasmin was successful in all four eyes with a mean total infusion time of 355 ± 204 seconds (range 120–600 seconds). Best corrected visual acuity (BCVA) remained counting fingers (CF) in case 3 and 4, increased in case 1 from CF to 0.9LogMAR and decreased in case 2 from 0.4 to 1.3 LogMAR. CMT and VFT both showed a trend towards significant decrease comparing preoperative measurements with two weeks postintervention (1061 ± 541 μm versus 477 ± 376 μm, p = 0.068) and 24 ll 4 seconds versus 15 ± 1 seconds, p = 0.068, respectively). In one eye a needle tip broke and could be removed with an endoforceps. There were no other intervention‐related complications. Conclusion: Robot‐assisted retinal vein cannulation is feasible and safe. Local intravenous infusion with Ocriplasmin led to an improved retinal circulation. [ABSTRACT FROM AUTHOR]

Aims/Purpose: Neurovascular dysfunction and inner retinal layer thinning are among the earliest detectable retinal changes in diabetes, and both worsen during development and progression of diabetic retinopathy (DR). However, direct interactions between these features have not been investigated so far. Therefore, we aimed to analyse associations between the retinal functional hyperaemic response and thickness of the individual neuroretinal layers in eyes with non‐proliferative DR. Methods: Thirty patients with Type 1 diabetes featuring mild (n = 15) or moderate (n = 15) non‐proliferative DR and 14 healthy subjects were included in this cross‐sectional study. Retinal vessel diameters were measured before and during illumination with flickering light using a dynamic vessel analyser. Individual retinal layer thickness in the macula was analysed from spectral domain optical coherence tomography. Results: Flicker light‐induced vessel dilation was significantly reduced in diabetes patients compared to healthy controls (veins: 3.0% vs. 6.1%, p < 0.001; arteries: 1.3% vs. 5.1%, p = 0.005). Univariately, the response in retinal veins of diabetes patients correlated significantly with ganglion cell layer (GCL) thickness (r = 0.46, p = 0.010) and inner plexiform layer thickness (r = 0.40, p = 0.027), and negatively with haemoglobin A1c (HbA1c) levels (r = −0.41, p = 0.023) and age (r = −0.38, p = 0.037), but not with baseline diameters, glucose levels, or diabetes duration. In a multiple regression model only HbA1c (p = 0.027, β = −0.40) and GCL thickness (p = 0.030, β = 0.39) remained significantly associated with the vascular flicker light response. Conclusions: The results indicate that thinner GCL and worse glycaemic control both contribute to reduced neurovascular coupling in patients with clinical signs of DR. Progression of neurovascular dysfunction in DR might be related to structural degeneration of the neurovascular complex in the inner retina. [ABSTRACT FROM AUTHOR]

Aims/Purpose: Branch retinal vein occlusion (BRVO) occurs when a branch of the retinal vein becomes obstructed. The aim of this study case was to provide insights into the potential role of Lipoprotein (Lp) (a) in the pathogenesis of BRVO. Methods: Case of a 47‐year‐old woman with no significant ophthalmological or general medical history, except the use of oral contraception and smoking habits. Presented to the emergency care after 5 days of experiencing a sudden vision loss in her right eye. Results: The ophthalmological examination revealed a visual acuity of 10/10 on the left (OS) and VBLM/10 on the right eye (OD). Slit lamp and Fundus examination showed on OD a relative afferent pupillary defect and the classic features of acute retinal branch vein occlusion, including tortuous veins, capillary occlusion, papillary and macular oedema and haemorrhages. While all was normal in OS. A comprehensive ophthalmic examination was conducted, including fluorescein angiography and optical coherent tomography that showed no abnormal vessel growth at this stage. Then, the indication for a dexamethasone intravitreal implant has been made along with panretinal photocoagulation (PRP) in the ischaemic areas. More, discontinuing oral contraception, the serum concentrations of specific antibodies, as anticardiolipin and antiphospholipids, as well as homocysteine and Lp (a) levels. The blood tests yielded negative results except for the abnormal plasma level of lipoprotein (a), which was measured at 900 mg/L. After 2 months of follow‐up. The visual acuity in OD was measured at 9/10. Moreover, the restoration of normal macular thickness after 4 months. However, at 6 months follow‐up, the appearance of a neovascularization adjacent to the previously laser‐treated area. As a result, a series of closely spaced PRP was performed along with an intravitreal anti‐vascular endothelial growth factor. After 1 month, a complete disappearance of the neovascularization was observed. Conclusions: Identification of independent and highly predictive risk factors for BRVO is still a big challenge. The main goals are the preservation of visual acuity and the prevention of relapses. This case report emphasizes the importance of incorporating a systematic Lp (a) testing into clinical practice, even in young individual. [ABSTRACT FROM AUTHOR]

Aims/Purpose: We present a rare case of a patient who presented with bilateral retinal haemorrhage after cardiopulmonary resuscitation (CPR). Methods: A 37‐year‐old man, with a medical history of allergic bronchial asthma and a BMI >35, was referred to our emergency department from the cardiology clinic. He complained of sudden, painless, monocular visual acuity reduction after cardiac arrest and CPR because of an acute myocardial infarction (right coronary). He underwent a complete ophthalmic examination, as well as multimodal imaging and he was under close monitoring for the following months. Results: In his initial ophthalmic examination, best corrected visual acuity was 0.1 in his right eye and 1.0 in his left eye (Snellen's chart). Intraocular pressure was 14 mmHg and 15 mmHg in his right and left eye, respectively. Dilated fundus examination showed bilaterally scattered sub‐retinal, intraretinal and pre‐retinal haemorrhages in the posterior pole, with involvement of the right fovea. After the resolution of the haemorrhages, a fluoroangiography was performed which revealed delayed central retinal vein filling in the right eye. 2 months later, during follow‐up examination, visual acuity in the right eye was 0.7 and in the left eye 1.0. The haemorrhages have been absorbed bilaterally, leaving in the right eye a sub‐foveal photoreceptor and RPE disruption. Conclusions: Retinal haemorrhages can be observed after CPR. According to the literature, there have been reports of retinal haemorrhages in infants after CPR. Meanwhile, there is only one published case of an adult with associated comorbidities with this clinical presentation. The underlying pathophysiology of this clinical entity is still unclear, although a potential relationship between the increase in central venous pressure during CPR, and sequential retinal venous stasis is suspected. [ABSTRACT FROM AUTHOR]

Aims/Purpose: This cohort study investigates how the static and dynamic vessel parameters differ in patients with vascular occlusions and if there are any variations between the different types of vessel occlusion. Methods: Patients with the diagnosis of branch retinal artery obstruction BRAO, central retinal artery obstruction CRAO, branch retinal vein obstruction BRVO, central retinal vein obstruction CRVO, anterior ischaemic optic neuropathy AION and any combination of these Combo were included in our study. During their inpatient stay for cardiovascular diagnostics all patients were examined via static and dynamic vessel analysis (IMEDOS Health GmbH, Jena) to obtain the arteriovenous ratio (AVR), the central retinal artery equivalent (CRAE), the central retinal vein equivalent (CRVE) and the flicker light induced dilation of the retinal arteries (FLA) and veins (FLV). The vessel density was determined via OCT angiography (Heidelberg Engineering GmbH, Heidelberg). Results: 34 patients (70% male; 30% female; mean age 69.6 ± 11.3 years) with 9 (26.5%) CRVO, 8 (23.5%) AION, 5 (14.7%) BRAO and 4 (11.8%) CRAO, BRVO and Combo each have been included. The best visual acuity (BCVA) of the diseased eye differed significantly between the groups (AION 0.41 ± 0.61, CRAO 2.40 ± 0.20, BRAO 0.16 ± 0.05, CRVO 0.81 ± 0.86, BRVO 0.18 ± 0.10, Combo 1.53 ± 0.68; p < 0.001) whereas the BCVA of the healthy eyes were comparable. The CRVE showed a significant difference between the groups CRAO – CRVO (p = 0.008), CRAO – Combo (p < 0.001) and BRAO–Combo (p = 0.026). The FLV of the diseased eye was significantly higher in patients with AION than in the CRAO group (p = 0.049). The parameters of the static vessel analysis of the healthy eyes were comparable. Conclusions: Preliminary analysis shows significant differences of individual parameters of the retinal vessel analysis between different types of vascular occlusion. The diagnostic and research benefit for the individual patient remains to be further evaluated. [ABSTRACT FROM AUTHOR]

Aims/Purpose: Patients with rheumatoid arthritis (RA) have a high risk of developing cardiovascular diseases due to endothelial dysfunction, which is a risk factor for cardiovascular events. The retinal Vessel Analyzer (RVA, IMEDOS Systems) can capture retinal vessels non‐invasively in real‐time and analyse their dynamic responses to stimuli. Methods: In order to assess the structural and functional changes in the retinal microvasculature, a non‐invasive Retinal Vessels Analyzer (RVA) was used to study 44 patients with RA (mean age 57.4 ± 13.2 years) and compare them to a control group of 44 age‐matched healthy individuals. The RVA was used to measure various parameters, including the Central Retinal Artery Equivalent (CRAE), Central Retinal Vein Equivalent (CRVE), and Arterio‐Venous Ratio (AVR), as well as the response of the retinal vessels to flickering light. After a 50 s baseline, rectangular shape, monochromatic flickering light (530–600 nm) of 12.5 Hz for 20 s was applied three times. The dilation of retinal vessels after flicker light stimulation was analysed. Results: The results of the study showed that patients with RA had significantly higher CRVE and lower AVR compared to the control group (p = 0.04 and p = 0.01, respectively), indicating structural changes in the retinal microvasculature. The patients with RA also had a significantly stronger arterial dilation response to flickering light compared to the control group (n = 43), indicating functional changes in the retinal microvasculature. In patients with moderate to high disease activity according to the Disease Activity Score (DAS‐28 > 3.2) (n = 9), there was a negative significant correlation between the maximum arterial diameter (aMAX) and interleukin‐6 (IL‐6). Conclusions: These findings suggest that RVA can be a useful tool for detecting structural and functional changes in the retinal microvasculature of patients with RA and that the disease activity and inflammation in RA may be related to these changes. However, the study notes that a larger cohort with a wider range of disease activity is needed to fully understand the effect of chronic inflammatory diseases on endothelial function. [ABSTRACT FROM AUTHOR]

In this case, the multimodal imaging workup of a unilateral macular oedema in a young woman showed a macular branch retinal vein occlusion as the cause and revealed a closely associated deep ODD conglomerate that was not detected by biomicroscopy. GRAPH: Video S1 (3:14 minutes, 106 MB) Aligned sequence of the corresponding images of the branch retinal vein occlusion in relation to a deep optic disc drusen conglomerate by multimodal imaging and visualization of OCT imaging data by animated three-dimensional rendering. [Extracted from the article]

Purpose: To investigate the frequency of primary angle closure (PAC) and primary angle closure glaucoma (PACG) in patients with retinal vein occlusion (RVO) based on a hospital population. Methods: A total of 375 consecutive cases newly diagnosed with RVO by fluorescein fundus angiography at a single eye centre in Peking were reviewed. Gonioscopy was performed in all patients. Glaucoma was diagnosed according to the criteria of the International Society of Geographical and Epidemiological Ophthalmology. Retinal vein occlusion was classified as central retinal vein occlusion (CRVO), hemicentral retinal vein occlusion (HRVO), or branch retinal vein occlusion (BRVO), and as arteriovenous crossing RVO (AV‐RVO), optic cup RVO (OC‐RVO), optic nerve RVO without optical nerve head swelling (NONHS‐RVO), or RVO with optical nerve head swelling (ONHS‐RVO) based on the site of venous occlusion. Percentage of PAC or PACG for each type of RVO were calculated. Results: PACG had a frequency of 4.1% [95% confidence interval (CI) 2.2–6.9%] in 317 RVO patients [5.3% (95% CI 2.0–11.2%) in CRVO, 8.8% (95% CI 1.9–23.7%) in HRVO, and 1.9% (95% CI 0.4–5.4%) in BRVO]. Primary angle closure (PAC) had a frequency of 2.9% (95% CI 1.4–5.5%) in RVO. PAC/PACG had a frequency of 11.5% (95% CI 6.3–18.9%) in CRVO, 8.8% (95% CI 1.9–23.7%) in HRVO and 3.1% (95% CI 1.0–7.1%) in BRVO. PAC/PACG was significantly more prevalent in NONHS‐RVO [18.9% (95% CI 9.4–32.0%)] than in ONHS‐RVO [6.5% (95% CI 2.1–14.5%)], AV‐RVO [3.1% (95% CI 0.9–7.8%)], and OC‐RVO [2.3% (95% CI 0.1–12.3%)]. Conclusion: The overall frequency of PAC/PACG was much higher in patients with RVO (especially CRVO) than that in the general population. Eyes with PAC/PACG may undergo mechanical changes in the lamina cribrosa of the optic disc, resulting in RVO. Angle‐closure conditions should be borne in mind when investigating Chinese patients with RVO. [ABSTRACT FROM AUTHOR]

Purpose To describe a new robot-assisted surgical system for retinal vascular bypass surgery ( RVBS) and to compare the success rate with freehand RVBS. Methods A robot-assisted system for retinal microsurgery was constructed to include two independent robotic arms. A 23-gauge light probe and an intraocular forceps were affixed to the arm end effectors to perform the intraocular manipulation. Harvested porcine eyes were introduced to be established animal models of closed-sky eyeballs after that pars plana vitrectomy using temporary keratoprosthesis was performed by a skilful surgeon. Retinal vascular bypass surgery (RVBS) was performed by an inexperienced ophthalmologist to test the ease of use. A stainless steel wire (45- μm pipe diameter) was used as an artificial vessel. Before RVBS, the wires were prepositioned at the retinal surface of the eyes. The Control group ( n = 20) underwent freehand RVBS, and the Experimental group ( n = 20) underwent robot-assisted RVBS. To create the simulated bypass, the distal end of the wire was inserted into the selected vessel and advanced ~4 mm away from the optic disc. If successful, then the proximal wire end was inserted and advanced ~2 mm towards the optic disc. The difference in the success rate for the freehand and robot-assisted procedures was analysed by the chi-square test. Results The success rate for the freehand RVBS was 5% (1/20 eyes). In contrast, the robot-assisted success rate was 35% (7/20) of eyes (p < 0.05). Conclusion This study demonstrated the feasibility of robot-assisted RVBS in ex vivo porcine eyes. The robotic system increased the accuracy and stability of manipulation by eliminating freehand tremor, leading to a higher surgical success rate. [ABSTRACT FROM AUTHOR]

Purpose Birdshot chorioretinopathy ( BCR) is a potentially blinding ocular disorder involving the retinal vasculature and choroid without any systemic manifestations. The objective of the study was to describe vascular calibre changes in BCR and analyse the possibility of this optical biomarker for staging and monitoring disease activity in BCR. Methods This retrospective case-control study at a tertiary referral eye centre in the UK included 33 eyes from 21 patients with BCR and equal number of eyes from control subjects. Diagnosis of BCR was confirmed on fundus fluorescein and indocyanine green angiography. Vascular calibres were measured using validated semiautomated software. Results Patients with BCR had smaller retinal venular calibres central retinal venular equivalent ( CRVE) than controls (211.3 versus 227.9 μm, p = 0.008). After adjusting for variables, the difference between the two groups for CRVE at baseline was statistically significant based on two different analysis methods. Central retinal venular equivalent (CRVE) was lower at the 6-month follow-up visit (206.2 versus 213.8 μm, p-value = 0.03), and arteriole-to-venule ratio was larger (0.74 versus 0.71, p = 0.04) in subjects with BCR. Arteriolar calibre ( CRAE) remained the same. Conclusion This study provides novel insight into the pattern of vascular involvement in BCR. There was significant difference in the CRVE in patients with BCR. More studies are needed to correlate this data with visual function and treatment outcome and to validate the findings. [ABSTRACT FROM AUTHOR]

Purpose To investigate the prevalence of lipoprotein (a) [Lp(a)] and other thrombophilic disorders among retinal vein occlusion ( RVO) patients with regard to age and various risk factors. Methods We retrospectively reviewed the medical records of 100 patients with central, hemicentral or branch RVO who had undergone routine thrombophilia screening. Data were compared with 100 controls. Both cohorts were divided into three subgroups (≤45 years, >45-≤60 years or >60 years), depending on the patients' age at the time of the RVO or a previous thromboembolic event. Results Elevated Lp(a) plasma levels were significantly more prevalent among RVO patients than among controls (p < 0.0001; OR: 4.8). Moreover, we determined age ≤60 years by the time of the first thromboembolic event as a strong predictor of elevated Lp(a) (p = 0.0002). The coincidence of elevated Lp(a) with other coagulation disorders further increased the OR for RVO to 9.3 (95% CI 2.1-41.8). Multivariate analysis revealed the presence of cardiovascular risk factors ( OR: 3.1, p = 0.0004), elevated lipoprotein (a) levels ( OR: 5.2, p = 0.0001) and increased factor VIII activity ( OR: 5.9, p = 0.001) as independent risk factors for the development of RVO among patients. Conclusion Our results indicate that elevated plasma levels of Lp(a) are associated with the development of RVO. Selective screening of young patients and subjects with a personal or family history of thromboembolism may be helpful in identifying RVO patients with elevated Lp(a). [ABSTRACT FROM AUTHOR]

Purpose To investigate the serum heparanase concentration and heparanase activity of the patients with central retinal vein occlusion ( CRVO) or branch retinal vein occlusion ( BRVO). Methods This prospective study included 23 CRVO patients, 13 BRVO patients and 28 control subjects. Serum heparanase concentration was measured by ELISA. Serum heparanase activity was determined using a heparan degrading enzyme assay kit (Mountain View, CA, USA). Multivariate logistic regression was used to adjust for the possible confounding factors when comparing the difference in serum heparanase concentration and activity between patients with RVO and control subjects. Results Patients with CRVO (3.963 ± 0.816 U/l) or BRVO (3.371 ± 1.522 U/l) had significantly higher levels of heparanase protein compared to controls (1.055 ± 0.902 U/l). This significance remained after adjusting for aforementioned confounding factors ( CRVO versus control, p = 0.000, 95% CI: 2.450-4.488; BRVO versus control, p = 0.006, 95% CI: 0.776-4.050). Patients with CRVO (0.3587 ± 0.1498 U/ ml) or BRVO (0.3616 ± 0.0570 U/ ml) had significantly higher levels of heparanase activity compared to controls (0.1449 ± 0.0952 U/ ml). The significance was maintained after adjusting for the aforementioned confounding factors ( CRVO versus control, p = 0.012, 95% CI: 0.036-0.275; BRVO versus control, p = 0.000, 95% CI: 0.150-0.395). There was no significant difference in serum heparanase protein levels and activities between CRVO and BRVO groups before and after confounding factor adjustment. Conclusion Our study provides the first direct clinical link between systemic heparanase protein levels and heparanase activity with RVO, suggesting a critical role for heparanase in the pathophysiology of RVO. [ABSTRACT FROM AUTHOR]

Purpose Elevated intra-ocular pressure ( IOP) has been identified as a major risk factor for glaucoma. Additionally, extensive literature depicts a vascular dysfunction to exist in these patients. However, a large ocular blood flow-oriented trial to integrate these findings in the clinical setting is lacking. This study would likely help to identify which of these vascular data can be used as a clinical tool for screening and disease stratification. Method Prospective, cross-sectional, case-control hospital-based study. Patients with primary open-angle glaucoma ( POAG), normal-tension glaucoma ( NTG), ocular hypertension ( OHT), glaucoma suspects and healthy volunteers were recruited. In addition to a comprehensive ophthalmological examination, a vascular-oriented questionnaire was completed and ocular blood flow assessment (colour Doppler imaging of retrobulbar vessels, retinal oximetry, dynamic contour tonometry, optical coherent tomography enhanced-depth imaging of the choroid) were performed. Statistical analysis was based on multiple imputation to account for missingness. Results A total of 614 subjects (291 males) were recruited between March and December 2013 ( POAG: 214, NTG: 192; OHT: 27; glaucoma suspect: 41; healthy controls: 140). Glaucoma groups (NTG and POAG) were age and gender matched with the control group (p > 0.05). Glaucoma groups were paired in terms of functional and structural parameters (p > 0.08). Mean ocular perfusion pressure was higher in the glaucoma groups than in controls (p < 0.001). Glaucoma groups had lower retrobulbar velocities, higher retinal venous saturation and choroidal thickness asymmetries when compared to the healthy group, in line with the current literature. Conclusions The Leuven Eye Study stands as one of the largest clinical trials on ocular blood flow in glaucoma. The creation of this vast database may help integrate the vascular aspects of glaucoma into the clinical practice of glaucoma. [ABSTRACT FROM AUTHOR]

Purpose To examine the association between dietary patterns and retinal vascular calibre in children and adolescents with type 1 diabetes. Methods A hospital-based cross-sectional study of 83 children and adolescents with type 1 diabetes was conducted over an 8-month period. Dietary patterns were extracted using principal components analysis from completed food frequency questionnaires. Retinal vascular calibre was measured by a trained grader using a standardized protocol and later summarized as central retinal artery equivalent ( CRAE) and central retinal vein equivalent ( CRVE) using a semi-automated computer program. Results Three major dietary patterns were identified as follows: (1) processed foods, (2) plant-based foods and (3) vegetable/fish avoidance pattern. The processed pattern had high component loadings for processed meats and high fat takeaway foods. The plant-based pattern had high component loadings for a number of fruits including, but not limited to, pineapple, grapes oranges and mangos as well as a smaller number of vegetables, including beans and leeks. The vegetable and fish avoidance pattern had high inverse component loadings for canned and fresh fish as well as a number of vegetables including, but not limited to, pumpkin, green beans, broccoli, sweet potato and cabbage. Adjusted regression analysis revealed the 'vegetable/fish avoidance' dietary pattern was associated with a wider CRVE (ExpB = 3.67, 95% CI = 0.11/7.24, p = 0.039). After multivariable adjustments, a vascular risk profile that included: older age, higher BMI, higher systolic blood pressure, greater gestational age, longer screen viewing time, lower maternal education level, lower physical activity levels and lower high-density lipoproteins concentrations were more likely to display narrower CRAE (ExpB = −2.43, 95% CI = −4.92/0.06, p = 0.041). Conclusions This study provides the first evidence for a diet-calibre relationship in children and adolescents with type 1 diabetes. This outcome has potential public health implications, as promotion of healthy eating patterns in children and adolescents might attenuate changes in microvasculature that have been related to an increased risk of microvascular disease, such as retinopathy, in adulthood. Additional studies are warranted to explore and validate this novel finding. [ABSTRACT FROM AUTHOR]

Purpose: To asses the importance of multimodality imaging in successive examinations of patients with retinal branch vein occlusion in order to evaluate possible unexpected complications. Methods: We present a descriptive study (case report). We have performed a multimodal imaging study of a patient with an inferior temporal branch vein thrombosis. The best corrected visual acuity (BCVA) is taken in a patient who received 5 intravitreal injections of Ranibizumab. Posteriorly the patient presented with a decrease in visual acuity and the angiographic study showed a venous vasculitis involving the inferior temporal branch retinal vein, resembling frosted branch angiitis. Optical coherence tomography (OCT) showed inflammatory cystic macular edema with neurosensory detachment. To perform angiography and OCT, we use the Heidelberg Spectralis. Results: Serial evaluation with OCT allowed the observation of a cystic macular edema with neurosensory detachment that was treated with intravitreal Dexamethasone implantation achieving a BCVA of 0.3 to a BCVA of 0.7 after 2 months. Angiography showed a perivenular infiltration that reminded us of frosted branch angiitis. General laboratory tests and serology for cytomegalovirus and Epstein–Barr virus were requested, and the patient was referred to the internal medicine department to rule out systemic diseases. Conclusions: Serial multimodality imaging is very useful in the follow‐up of patients with venous occlusions. It allows us to observe atypical complications such as vasculitis found in the context of a patient who suffered a venous branch occlusion. Vasculitis can be found in the context of an ocular disease or associated with diseases such as Bechet's disease, Sarcoidosis, Multiple Sclerosis, Lupus, Polyarteritis nodosa, Sjogren's disease, Relapsing polychondritis, Antiphospholipid antibodies, Syphilis, Whipple's disease, Cytomegalovirus infection, leukaemia or lymphomas. Despite the growing popularity of OCT, we cannot ignore the importance of fluorescein angiography for the follow‐up of these cases. [ABSTRACT FROM AUTHOR]

Purpose: To report a case of combined retinal artery and vein occlusion in a young patient. Methods: A case report. Results: A 37‐year‐old gentleman presented to the Emergency Department with a central scotoma in his right eye for 1 day. He was known to have right amblyopia but had no known past medical illness. He was a chronic smoker. Best corrected visual acuity was 6/45 in the right eye and 6/7.5 in the left eye. His intraocular pressure was 19 (right) and 18 (left) mmHg. Anterior segment examination was normal. His right eye fundus examination revealed retinal ischaemia and edema in the macula area supplied by cilioretinal artery. The inferotemporal vessels were also tortuous, with flame and dot haemorrhages. His left eye was normal. Optical coherence tomography showed inner retinal hyperreflectivity and edema. Fundus fluorescein angiography showed delayed filling of the cilioretinal artery and inferotemporal retinal vein corresponding to the clinical findings. He was diagnosed with a right eye combined cilioretinal artery and inferotemporal branch retinal vein occlusion. An anterior chamber tap was performed immediately to lower intraocular pressure and improve perfusion. The next day, he reported that his vision was clearer (visual acuity 6/20) and the scotoma was smaller in size. Given his young age, we performed a full systemic young‐stroke workup to evaluate his vascular risk factors and rule out thrombophilia. He was found to have newly diagnosed diabetes and hyperlipidemia. His coagulopathy screen was negative. A primary care referral was made for management of his chronic diseases and for smoking cessation support. Conclusions: Combined retinal and venous occlusions are rare and are often associated with significant systemic comorbidities. In a young, healthy patient, it is particularly important to perform detailed investigations to work up its cause, as this could be a harbinger of future ischaemic events. [ABSTRACT FROM AUTHOR]

Purpose: A semi‐automated method of measuring the Central Retinal Artery Equivalent (CRAE) and Central Retinal Vein Equivalent (CRVE) has been developed. The method was used to calculate parametric probability distribution for CRAE and CRVE in healthy retinas in order to quantify possible vascular pathology degree. Methods: Using the ARIA software (MATLAB), the diameters of the retinal vessels located in a ring with radii 0.5 and 1 diameter of the optic disc were quantified. A measurement of CRAE and CRVE was obtained for two data base of healthy retinas (15 and 52 patients) measured with different retinal cameras. Subsequently, the probability distribution of CRAE and CRVE was calculated, as well as the bootstrap estimators of the mean, standard deviation, skewness, and kurtosis. MATLAB functions were used to select the parametric distribution that best fits the data. The Mahalanobis distance of each retina to healthy distribution was obtained. This classification distance was applied to healthy and glaucoma retinas. Results: The fits to theoretical distributions were good for a Generalized Extreme Value Distribution (gev) characterized by three parameters (scale, mean and standard deviation). They appear to be consistent across different databases. In retinas with glaucoma, the Mahalanobis distance allows the degree of pathology to be quantified. Moreover, the method can be used to classify the healthy retinas. Conclusions: The possible existence of parametric probability distributions for values of vascular calibres opens the possibility of quantifying the degree of vascular pathology. [ABSTRACT FROM AUTHOR]

Purpose To examine whether the incidence of retinal vein occlusions (RVOs) is associated with estimated cerebrospinal fluid pressure (CSFP). Methods The population-based Beijing Eye Study, which included 4439 subjects (age: 40 + years) in 2001, was repeated in 2011 with 2695 subjects participating (66.4% of the survivors). Fundus photographs were examined for the new development of RVOs, differentiated into central RVOs (CRVOs) and branch RVOs (BRVOs). CSFP was calculated as CSFP [mmHg] = 0.44 × Body Mass Index [kg/m2] + 0.16 × Diastolic Blood Pressure [mmHg]−0.18 × Age[Years]. Results Incident BRVOs were detected in 50 eyes and incident CRVOs in 8 eyes. BRVOs were located at arterio-venous crossings in 39 eyes. In multivariate analysis, a higher estimated CSFP was associated with a higher incidence of CRVOs (p = 0.004; standardized coefficient beta: 0.06; regression coefficient B: 5.35; 95% confidence interval (CI):1.73, 8.96) after adjusting for urban region (p < 0.001; beta: −0.52; B: −3.93; 95% CI: −4.29, −3.57), higher educational level (p = 0.001; beta: 0.13; B: 0.44; 95% CI: 0.28, 0.60), higher blood concentrations of triglycerides (p < 0.001; beta: 0.08; B: 0.11; 95% CI: 0.05, 0.16) and higher intraocular pressure (p < 0.001; beta: 0.16; B:0.21; 95% CI: 0.16, 0.27). As a corollary, a higher incidence of RVOs as a whole, as well as a higher incidence of CRVOs combined with a higher incidence of BRVOs originating at the optic nerve head, both were significantly associated with higher estimated CSFP (p = 0.002; odds ratio (OR): 1.15; 95% CI: 1.05, 1.25; and p = 0.037; OR: 1.17; 95% CI: 1.01, 1.35, respectively) after adjusting for older age. Conclusions A higher estimated CSFP was associated with a higher incidence of RVOs originating at the optic nerve head (i.e. CRVOs, hemi-central RVOs and BRVOs originating at the optic nerve head), and vice versa, a higher incidence of RVOs was associated with a higher estimated CSFP. It suggested an influence of higher estimated CSFP on higher central retinal vein pressure. [ABSTRACT FROM AUTHOR]

Purpose: To compare the amplitudes and implicit times of the flicker electroretinograms before and after an intravitreal injection of ranibizumab (IVR) in eyes with a central retinal vein occlusion (CRVO). Methods: We reviewed the medical records of 15 consecutive patients who had macular oedema secondary to CRVO and had received an IVR at the Nagoya University Hospital from November 2013 to July 2014. Flicker ERGs were recorded with both the RETeval™ system and a conventional ERG system before the IVR. One month after the IVR, recordings were repeated with only the RETeval™ system. Results: The mean implicit times of the flicker ERGs of the affected eyes recorded with the RETeval™ system were significantly longer than that of the fellow eyes (32.2 ± 2.6 msec versus 28.1 ± 1.2 msec, p < 0.001). One month after the IVR, the implicit times of the flicker ERGs of affected eyes were significantly shortened from 32.2 ± 2.6 to 30.6 ± 2.2 msec (p < 0.001). Conclusions: The shortening of the implicit times of the flicker ERGs after the IVR indicates an improvement of retinal function after anti-VEGF therapy for CRVO eyes. [ABSTRACT FROM AUTHOR]

Purpose To investigate retinal trunk vessel diameters in subjects with autosomal dominant optic atrophy ( ADOA) and mutation-free healthy relatives. Methods This cross-sectional study included 52 ADOA patients with the optic atrophy 1 ( OPA1) exon 28 (c.2826_2836delins GGATGCTCCA) mutation (age 8.6-83.5 years) (best-corrected visual acuity ( BCVA) 8-94 Early Treatment Diabetic Retinopathy Study ( ETDRS) letters) and 55 mutation-free first-degree healthy relatives (age 8.9-68.7 years, BCVA 80-99). Analysis of fundus photographs provided integrated magnification-corrected measures of retinal vessel diameters (central retinal artery equivalent, CRAE, and central retinal vein equivalent, CRVE). Statistical analysis was corrected for age, gender, spherical equivalent refraction, axial length and mean arterial blood pressure ( MABP) in a mixed model analysis. Results Retinal arteries and veins were thinner in ADOA than in healthy controls ( CRAE (mean ± 2 standard deviations ( SD)) 153.9 ± 41.0 μm and CRVE 236.1 ± 42.0 μm in ADOA, CRAE 172.5 ± 25.0 μm (p = 0.0004) and CRVE 254.2 ± 37.6 μm (p = 0.0019) in healthy controls). MABP was comparable in the two groups (p = 0.18), and in both groups, CRAE decreased with increasing MABP (p = 0.01 and p < 0.0001, respectively). In ADOA, CRAE and CRVE decreased with age (p = 0.011 and p = 0.020, respectively) and CRAE decreased with decreasing BCVA (p = 0.011). In patients with ADOA and in healthy controls, CRAE decreased with decreasing average macular ganglion cell-inner plexiform layer ( GC- IPL) thickness (p = 0.0017 and p = 0.0057, respectively). Conclusion Narrow retinal arteries and veins were associated not only with the severity of ADOA but with ganglion cell volume in patients with ADOA and in healthy subjects. This suggests that narrow vessels are a consequence rather than the cause of inner retinal hypoplasia or atrophy, although longitudinal studies are needed to confirm this hypothesis. [ABSTRACT FROM AUTHOR]

. Purpose: To investigate whether retinal vessel calibre measurements on optical retinal photography are affected by light and dark exposure prior to photography and whether the vessel calibre changes during an imaging sequence of several images. Methods: Digital optical retinal photographs were obtained from 32 healthy adults in two separate image sequences of six images during 1 min; one sequence with 10 min of dark exposure and one with 10 min of light exposure prior to imaging. Retinal arteriolar and venular calibres were measured computer-assisted and summarized as central retinal artery and vein equivalents (CRAE and CRVE). Outcome measures were difference in calibres after prior light versus prior dark exposure and difference in calibre during each of the two imaging sequences. Results: CRVE was wider with prior light exposure (2.7%, p = 0.0001), comparing the first image in each image sequence. Within each sequence, there was a venular dilatation from first to last image, both with prior light exposure (1.7%, p = 0.0003) and prior dark exposure (3.1%, p < 0.0001), with the change less pronounced with prior light exposure (p = 0.0164). CRAE showed no significant change in either outcome. Conclusions: Retinal venular calibre was wider with light exposure prior to imaging and increased slightly during the imaging sequences, less pronounced after prior light than dark exposure. Measurement error due to these effects will probably be reduced by avoiding dark prior to imaging, and a possible bias effect of endothelial dysfunction may possibly be reduced by measuring calibre on an image taken early in the image sequence. [ABSTRACT FROM AUTHOR]

Purpose To investigate the effect of flavonoid-rich dark chocolate and non-flavonoid-rich white chocolate on retinal vessel diameter in glaucoma patients and age-matched controls. Methods Thirty glaucoma patients and 30 age-matched subjects were assigned to dark or white chocolate by randomization with forced equal distribution. The number in each of the four groups was 15. Measured parameters included systemic blood pressure ( BP), blood glucose levels, static retinal vessel analysis, as measured by central retinal artery equivalent ( CRAE) (which relates to the diameter of the central retinal artery), central retinal vein equivalent ( CRVE) (which relates to the diameter of central retinal vein) and the arterio-venous ratio ( AVR), which represents the CRAE/ CRVE ratio, dynamic retinal vessel analysis as measured by the change in vessel diameter in response to flicker light stimulation. Three recording cycles from each were averaged. Results Blood pressure parameters (systolic BP, diastolic BP and pulse), IOP and blood glucose levels did not differ significantly between both groups before and after consumption of white or dark chocolate. Static vessel analysis did not show any significant changes in CRAE, CRVE or AVR before and after dark or white chocolate in both groups (p > 0.05). Mean dilatation of the venules in the control group was 3.2 ± 0.9 % before dark chocolate and 4.2 ± 1.4 % after dark chocolate intake, which was statistically significantly different (p = 0.01). Mean dilatation of the arterioles in the control group was 2.8 ± 1.8 % before dark chocolate and 3.5 ± 1.8 % after dark chocolate intake with a trend to statistical significance (p = 0.14), but not reaching the significance level. Mean diameter changes in the glaucoma group did not show any significant differences after dark chocolate consumption. Conclusion The present study showed a significant improvement of venous vasodilatation 2 hr after dark chocolate intake in the control group, but not in the glaucoma group. This effect might be indicative of an increased bioavailability of nitric oxide ( NO) after dark chocolate consumption. The lack of finding a significant venous response after dark chocolate in the glaucoma group might be related to the already impaired endothelial function in these patients. [ABSTRACT FROM AUTHOR]

. Purpose: To study intravascular characteristics of flowing blood in retinal vessels using spectral-domain optical coherence tomography (SD-OCT). Methods: Examination of selected arterial bifurcations and venous sites of confluence in 25 healthy 11-year-old children recruited as an ad hoc subsample from the population-based, observational Copenhagen Child Cohort 2000 study. Results: The blood stream in retinal arteries maintains a figure-of-8 SD-OCT profile consistent with a laminar flow in concentric sheets and a parabolic velocity distribution up to the point of divergence at arterial bifurcations. In contrast, the blood stream at the site of confluence of two retinal veins remains divided into two parallel sets of sheets with separate velocity distribution for a downstream distance of at least four trunk vessel diameters. Consequently, retinal trunk vessels near bifurcations/confluences have distinctly different internal SD-OCT profiles, a figure-of-8 pattern in arteries and a figure figure-of-88 in veins that can be used to distinguish between the two vessel types. Conclusion: This study verified the hypothesis that directions of blood flow at dichotomous vascular branchings can be determined using SD-OCT. This feature may assist the identification of flow reversal near sites of vascular occlusion, the analysis of blood flow near vascular malformations and the segmentation of retinal SD-OCT images. [ABSTRACT FROM AUTHOR]

. Purpose: To investigate the changes in the aqueous levels of various cytokines after intravitreal triamcinolone or bevacizumab for branch retinal vein occlusion (BRVO). Methods: Twenty-four eyes with macular oedema associated with BRVO and six eyes of six patients undergoing cataract surgery participated in this study. Each patient with BRVO randomly received an intravitreal injection of either 4 mg triamcinolone or 1.25 mg bevacizumab. Aqueous samples were obtained before and 4 weeks after the intravitreal injection in the BRVO group and before surgery in the control group. Aqueous concentrations of 16 cytokines were measured via multiplex bead assay. Results: Prior to the administration of the drugs, aqueous levels of interleukin (IL)-6, IL-8, IL-17 and vascular endothelial growth factor (VEGF) were significantly higher in the BRVO group than in the control group (p = 0.044, p = 0.013, p < 0.001, and p = 0.008, respectively). Between the control group and the BRVO group, no significant differences were noted between pre- and postinjection best-corrected visual acuity (p = 0.60, p = 0.54) and central foveal thickness (p = 0.47, p = 0.82). In the triamcinolone group, levels of IL-6, IL-17, IP-10, platelet-derived growth factor (PDGF)-AA and VEGF were reduced significantly (p = 0.012, p < 0.001, p < 0.001, p = 0.015, and p < 0.001, respectively). But in bevacizumab group, only VEGF was significantly reduced (p < 0.001). Between the IVTA group and the IVBe group, no significant differences in the changes in VEGF levels were noted (p = 0.06). Conclusion: Triamcinolone injection reduces plural inflammatory cytokines in BRVO, while bevacizumab has no influence on other cytokines as selective anti-VEGF therapy. No differences in the therapeutic effect were noted between an inhibition of plural inflammatory cytokines and an inhibition of VEGF only. [ABSTRACT FROM AUTHOR]

. Purpose: To describe the association between retinal vascular calibres and cardiovascular risk factors. Methods: Population-based cross-sectional study including 6353 participants of the Tromsø Eye Study in Norway aged 38-87 years. Retinal arteriolar calibre (central retinal artery equivalent) and retinal venular calibre (central retinal vein equivalent) were measured computer-assisted on retinal photographs. Data on blood pressure, body mass index (BMI), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, glycosylated haemoglobin (HbA1c) and smoking were collected. Association between retinal vessel calibre and the cardiovascular risk factors was assessed by multivariable linear and logistic regression analyses. Results: Retinal arteriolar calibre was independently associated with age, blood pressure, HbA1c and smoking in women and men, and with HDL cholesterol in men only. Blood pressure had the strongest effect on arteriolar calibre, with a decrease in calibre of 3.6 μm (women)/4.1 μm (men) per standard deviation increase in mean arterial blood pressure. Retinal venular calibre was independently associated with age, blood pressure, BMI, HDL and LDL cholesterol and smoking in men and women. The effect of BMI and HDL cholesterol on venular calibre was significantly stronger in men than in women. Current smoking was the most important factor for venular calibre, where smokers had 13.2 μm (women)/15.2 μm (men) wider calibre than nonsmokers. Conclusion: All the explored cardiovascular risk factors were independently associated with retinal vascular calibre, with stronger effect of HDL cholesterol and BMI in men than in women. Blood pressure and smoking contributed most to the explained variance. [ABSTRACT FROM AUTHOR]

. Purpose: To determine the reliability and reproducibility of the Vesselmap Oximetry Module for arteriolar and venular oxygen saturation (SO2) of the same retinal area, specified by a peripapillary annulus, in healthy subjects. Methods: Fundus oximetry images were obtained, using a standardized protocol by a single observer, from the right eye of 20 healthy individuals. Age range was 19-45 years old, and images were analysed using the oximetry module of the Vesselmap System (Imedos, UG, Germany). Intra-observer reliability (assessment of two measurements of SO2 values performed 5 days apart); interobserver reliability (assessment of SO2 performed by two different trained observers); and intrasubject reproducibility (comparison of SO2 measurements of two different images of the same subject and retinal area, taken 10 min apart) were assessed. The standard deviations between the repeated measurements (SDr), together with the intraclass correlation coefficient (ICC), of these three parameters were calculated. Results: The SDr for intra-observer reliability was 0.56% and 0.55% for arteriolar and venular SO2, respectively. The results were similar for intrasubject reproducibility (0.69% and 0.79% for arteriolar and venular SO2, respectively); interobserver reliability, however, was higher (SDr 1.22% and 1.01% for arteriolar and venular SO2, respectively). The ICC values for intra-observer reliability were 0.99 for both arteriolar and venular SO2. The results were similar for both interobserver reliability (0.94 for arteriolar SO2 and 0.96 for venular SO2) and intrasubject reproducibility (0.98 for both arteriolar and venular SO2). Conclusion: Retinal oxygen saturation values taken using the oximetry module of the Vesselmap System are highly reliable and reproducible, provided the image quality is standardized, the same measurement area is analysed in each image, and the number of observers analysing the images is kept to a minimum. [ABSTRACT FROM AUTHOR]

. Purpose: To assess the relation between retinal vascular caliber and renal function. Patients and methods: Eighty apparently healthy subjects screened for cardiovascular risk factors (mean age 47 years, 51% female, 36% hypertensive, without diabetes or renal dysfunction) were recruited. Retinal vascular calibers were measured from fundus photographs and expressed as central retinal artery and venular equivalent. Renal function was assessed by measurement of glomerular filtration rate (urinary clearance of 99mTc-DTPA) and urinary albumin/creatinine ratio. Results: Mean glomerular filtration rate was 117 ml/min/1.73m2. Overall, central retinal artery and venular equivalent were positively correlated with glomerular filtration rate ( r = +0.31, p = 0.005 and r = +0.30, p = 0.006, respectively). In addition, central retinal artery equivalent was negatively correlated with urinary albumin/creatinine ratio ( r = −0.34, p = 0.002). No significant relationship was found between central retinal venular equivalent and urinary albumin/creatinine ratio ( r = +0.12, p = 0.32). The observed relations between retinal vascular calibers and renal function parameters remained significant after adjusting for potential confounding factors. Conclusion: In apparently healthy subjects with normal renal function, retinal arteriolar and venular calibers were negatively correlated with kidney function, suggesting common determinants of these preclinical target organ damages. [ABSTRACT FROM AUTHOR]

. Purpose: To compare the efficacy of intravitreal injections of triamcinolone acetonide (TA) and that of bevacizumab for macular oedema because of branch retinal vein occlusion (BRVO). Design: Prospective, comparative, randomized, interventional clinical trial. Methods: Forty-three eyes of 43 patients with macular oedema because of BRVO were randomly assigned to 4-mg intravitreal injections of TA (IVTA)(21 patients, IVTA group) or 1.25-mg intravitreal injections of bevacizumab (IVB) (22 patients, IVB group) and followed for 12 months. No additional treatments were administered for 3 months after the initial injection; additional injections were administered when macular oedema recurred between 3 and 12 months after the initial injection. The best-corrected visual acuity (BCVA) and the central retinal thickness (CRT) were measured at baseline and monthly. The main outcome measures were changes in the logarithm of the minimal angle of resolution BCVA and CRT from baseline to 12 months. Results: Eighteen eyes of 18 patients in the IVTA group and 18 eyes of 18 patients in the IVB group completed follow-up at 12 months. The mean improvements in BCVA from baseline to 12 months were 0.12 in the IVTA group and 0.33 in the IVB group, which was significantly (p = 0.032) higher than in the IVTA group. There was no significant difference between the two groups in the mean reduction in CRT from baseline to 12 months after the initial injection. Two eyes in the IVTA group required intraocular pressure-lowering medications. Conclusion: Intravitreal injection of bevacizumab may be of greater benefit than that of TA for macular oedema because of BRVO. [ABSTRACT FROM AUTHOR]

. Purpose: We have previously shown that photopic cone b-wave implicit time ≥35.0 ms in 30 Hz flicker electroretinography (ERG) predicts ocular neovascularization (NV) in central retinal vein occlusion (CRVO). Here, we evaluate the effects of early panretinal photocoagulation (PRP) in patients with ERG-verified ischaemic CRVO. Methods: Patients with CRVO, admitted to our department between 2000 and 2008, were classified as having ischaemic or non-ischaemic CRVO based on the ERG-results. In a first group of 71 patients, 18 patients had ischaemic CRVO and were assigned to standard treatment that is regular examinations and PRP as soon as NV was found. In a consecutive group of 65 patients, 18 patients with ischaemic CRVO received early PRP. In this group, ERG was performed on average 6 weeks after the first symptoms of CRVO. The patients underwent PRP as soon as possible after the ERG-examination, and the treatment was completed within one to three sessions. Results: Twelve patients in the standard treatment group developed neovascular glaucoma during a mean period of 5 months after the CRVO. In the early treatment group, one patient developed subtle iris rubeosis 7 months after PRP. Otherwise, none of the patients showed any signs of ocular NV, and the intraocular pressure remained within normal range, without the necessity of supplementary medication, during a mean follow-up of 41 months. Conclusions: This study indicates that ocular NV in patients with CRVO can be predicted by photopic 30 Hz flicker ERG and that early PRP in ERG-verified ischaemic CRVO could be suggested as standard treatment. [ABSTRACT FROM AUTHOR]

. Purpose: The aim of this study was to test whether oxygen saturation in retinal blood vessels is affected by branch retinal vein occlusion (BRVO). Methods: The spectrophotometric retinal oximeter is based on a fundus camera. It simultaneously captures images of the retina at 586 and 605 nm and calculates optical density (absorbance) of retinal vessels at both wavelengths. The ratio of the two optical densities is approximately linearly related to haemoglobin oxygen saturation. Relative oxygen saturation was measured in retinal blood vessels in 24 patients with BRVO. Friedman's test and Dunn's post test were used for statistical analyses. Results: Oxygen saturation in occluded venules ranged from 12% to 93%. The median oxygen saturation was 59% (range 12-93%, n = 22) in affected retinal venules, 63% (23-80%) in unaffected venules in the BRVO eye and 55% (39-80%) in venules in the fellow eye (p = 0.66). Corresponding values for arterioles were 101% (89-115%, n = 18), 95% (85-104%) (p < 0.05) and 98% (84-109%). Conclusions: Venular saturation in BRVO is highly variable between patients. Hypoxia is seen in some eyes but not in others. This may reflect variable severity of disease, degree of occlusion, recanalization, collateral circulation, tissue atrophy, arteriovenous diffusion or vitreal transport of oxygen. [ABSTRACT FROM AUTHOR]

. Purpose: To evaluate the efficacy and the safety of intravitreal ranibizumab injection (Lucentis) in eyes with macular oedema secondary to central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO). Methods: The files of consecutive patients (34 eyes, 15 CRVO, 19 BRVO) were retrospectively analysed. Intravitreal injections of 0.5 mg ranibizumab were administered; retreatment was based on acuity visual changes and optical coherence tomography findings. Patients received 2-4 injections (mean, 2.1). Mean follow-up was 7 months. Results: After the first injection, mean best-corrected visual acuity (BCVA) improved from 20/160 to 20/80 and mean central retinal thickness (CRT) decreased significantly from 549 to 301 μm (p < 0.01). For each injection, BCVA improvement was on average nine letters (p < 0.01) and macular oedema reduction was 195 μm CRT (p < 0.01). The decrease in CRT was similar in CRVO and BRVO, but the improvement in BCVA was larger in BRVO. No local or systemic adverse effect was detected. Final visual acuity was correlated to initial visual acuity and to visual acuity measured after the first injection. The change in CRT was correlated to the number of injections and to initial CRT. Conclusion: Intravitreal injections of ranibizumab appeared to be a safe and effective option in the treatment of macular oedema secondary to retinal vein occlusion. Nevertheless, because the natural course has demonstrated a possible improvement in vision in almost one quarter of affected eyes at 3 years, further controlled and prospective studies are necessary to compare this treatment to the natural course with a longer follow-up. [ABSTRACT FROM AUTHOR]

. Purpose: To determine the aqueous humour levels of chemokines before and after an intravitreal injection of triamcinolone acetonide (IVTA) in eyes with macular oedema associated with a branch retinal vein occlusion (ME-BRVO). Design: Single-centre, prospective, consecutive interventional case series. Participants: Seventeen eyes of 17 consecutive patients with ME-BRVO who underwent IVTA were studied. Seven eyes without retinal vascular disease served as control. Intervention: All patients with ME-BRVO underwent IVTA. Main outcome measures: The optical coherence tomographically determined foveal thickness (FT) and the aqueous humour levels of inflammatory chemokines of the C-C subfamily, including eotaxin, monocyte chemotactic protein-1 (MCP-1), macrophage inflammatory protein-1α (MIP-1α), β (MIP-1β), and RANTES was determined before the IVTA (baseline) and at 1 week after the IVTA. Results: At the baseline, only MCP-1 and MIP-1β were detected in the aqueous, and MIP-1β was significantly higher in eyes with a ME-BRVO than in controls (p = 0.004). The level of both of these chemokines was not correlated with the FT (p = 0.654 and p = 0.608, respectively). One week after IVTA, the FT was significantly decreased (p < 0.001), and the levels of MCP-1 and MIP-1β were also significantly reduced (p < 0.001 and p = 0.044, respectively). The decrease in the FT was correlated with the decrease in only MIP-1β ( r = 0.58, p = 0.020). Conclusions: Alterations of the aqueous level of MIP-1β reflect the improvement of the macular oedema after IVTA in eyes with ME-BRVO. This indicates that the steroid-dependent ME-BRVO was closely related with the level of MIP-1β. [ABSTRACT FROM AUTHOR]

. Purpose: To compare cytokines in undiluted vitreous of treatment-naïve patients with macular oedema without vitreomacular traction secondary to branch (BRVO), central (CRVO) and hemi-central (H-CRVO) retinal vein occlusion. Methods: Ninety-four patients (median age 72 years, 42 men) underwent an intravitreal combination therapy, including a single-site 23-gauge core vitrectomy and the application of bevacizumab and dexamethasone due to vision-decreasing macular oedema. Among these were 43 patients with BRVO, 35 with CRVO and 16 patients with hemi-CRVO, which were distributed in a fresh or old retinal vein occlusion type (seven or more months after onset). Undiluted vitreous samples were analysed for interleukin 6 (IL-6), monocyte chemoattractant protein-1 (MCP-1) and vascular endothelial growth factor (VEGF-A) with cytometric BEAD assay. Vitreous samples from patients with idiopathic epiretinal membrane served as controls ( n = 14). Results: The mean cytokine values were highest in the CRVO group with IL-6 = 64.7 pg/ml (SD ± 115.8), MCP-1 = 1015.8 pg/ml (±970.1) and VEGF-A = 278.4 pg/ml (±512.8), followed by the H-CRVO group with IL-6 = 59.9 pg/ml (SD ± 97.5), MCP-1 = 938.8 pg/ml (±561.1) and VEGF-A = 211.5 pg/ml (±232.4). The BRVO group had IL-6 = 23.2 pg/ml (SD ± 48.8), MCP-1 = 602.6 pg/ml (±490.3) and VEGF-A = 161.8 pg/ml (±314.4). The values of MCP-1 and VEGF-A were significantly different for CRVO or H-CRVO versus BRVO. All values were significantly higher than in the control samples, which had 6.2 ± 3.4 pg/ml (IL-6), 253 ± 74 pg/ml (MCP-1) and 7 ± 4.9 pg/ml (VEGF-A). Within the old RVO type, only MCP-1 was significantly different for CRVO or H-CRVO versus BRVO. Conclusions: Both inflammatory markers and VEGF-A were higher in CRVO and H-CRVO than in BRVO undiluted vitreous samples. It seems that monocyte recruitment to the vessel wall, which might underlie the importance of eosinophils in tissue remodelling after RVO, is of special interest owing to the significant difference in MCP-1 in the older RVO types. [ABSTRACT FROM AUTHOR]

. Purpose: To establish safe laser parameter standards for 10-30 ms Pascal® laser in clinical practice and to evaluate clinical and visual outcomes using this 532-nm multi-spot photocoagulation system. Methods: Retrospective observational case series of 313 patients treated between 2006 and 2008. Evaluation of eight groups: A - panretinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR); B - focal laser treatment for clinically significant diabetic macular oedema; C - grid laser for diffuse diabetic macular oedema; D - sector PRP for ischaemic branch retinal vein occlusions (I-BRVO); E - full PRP for ischaemic central retinal vein occlusions (I-CRVO); F - macular laser treatment for macular oedema secondary to non-ischaemic BRVO; G - full PRP for rubeosis iridis and/or neovascular glaucoma (NVG) secondary to I-BRVO, I - CRVO or PDR; H - laser retinopexy for retinal breaks/degenerations. Results: Mean LogMAR visual acuity for all procedures improved postlaser (p = 0.065), and laser prevented visual loss in 85% eyes. Topical anaesthesia was only required. At mean follow-up of 5 months, 72% procedures had a successful clinical outcome. Significantly higher powers were required for PRP using Pascal® compared to conventional laser (p = 0.001) in PDR, I-BRVO, I-CRVO and NVG. Sixty-seven per cent of patients (15/20) were successfully treated with single-session 20-ms PRP using a mean 1952 burns. There were no laser-associated adverse effects or ocular complications associated with multi-spot PRP or macular Pascal® arrays. Conclusions: The clinical efficacy using 10- to 30-ms pulse duration Pascal® laser is comparable to conventional standard protocols used for the treatment of vascular retinal disorders. Higher power, 10- to 30-ms pulse duration laser may be safely and effectively used in clinical practice. [ABSTRACT FROM AUTHOR]

We report four patients with age-related macular degeneration (AMD) in whom multiple retinal vein thromboses developed after IAIs. The arrows indicate venous stenosis. gl Multiple retinal vein thromboses resolved spontaneously within 5-10 weeks in three patients (cases 2-4) who discontinued IAIs, but persisted with variations in the numbers for more than 1 year in one patient (case 1) who continued IAIs following diagnosis. The exact pathogenesis of multiple retinal vein thromboses remains unclear, and a definite causal relationship between multiple retinal vein thromboses and IAIs has not been established. [Extracted from the article]

A letter to the editor is presented in response to the article "Pre- and Intraretinal Haemorrhages in a 22-Weed-Old Fetus of a Mother Suffering from HELLP Syndrome and Factor V Leiden Mutation with Deep Vein Thrombosis" by Martina Christina Herwig, Klaus Kuchelmeister et al.

The article presents miscellaneous topics related to the December 1, 2015 issue of the journal "Acta Ophthalmologica." Topics discussed include cover page of the journal showing surgical technique for retinal vein cannulation, review of an article on efficacy of corneal collagen cross-linking in infectious keratitis, and a letter to the editor on risk of fishing accidents and need for eye protection.

A letter to the editor is presented in response to the article on implants based on dexamethasone towards retinal vein occlusion (ROV) treatment.

A letter to the editor is presented in response to spontaneous venous pulsations (SVPs) of the central retinal vein in children.

A letter to the editor is presented which discusses a study on the intravitreal concentrations of Angiopoietin (Ang)-2 and vascular endothelial growth factor (VEGF) in retinal vein occlusion RVO patients.

The article presents a study on the management of the macular edema (ME) with the Ozurdex after retinal vein occlusion in clinical practice. The study aims to evaluate the safety and the efficacy of the dexamethasone drug delivery system in eyes with ME secondary to retinal vein occlusion (RVO). It concludes that Ozurdex provides an efficient treatment option with an acceptable risk benefit ratio for treating RVO patients with ME.

A letter to the editor is presented in response to the article "Prevalence and associations of retinal vein occlusion in Australia" by P. Mitchell in the 1996 issue.

A letter to the editor is presented which discusses the study on the use of neovascular glaucoma and dexamethasone implants in central retinal vein occlusion.

The article presents a case study of a 79-year-old woman with severe visual impairment in the left eye (LE). She had type 2 diabetes for 25 years with good metabolic control abd hypertension controlled by systemic medications. The article discusses complication associated with the intravitreal dexamethasone implant which has not been previously reported. It highlights the need to carefully evaluate optical coherence tomography (OCT) findings particularly the vitreoretinal interface.