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Ocular hypertension (OHT) is a clinical entity characterized by elevated intraocular pressure (IOP) without optic nerve damage. In the presence of other risk factors, OHT may progress to glaucoma. This study aimed to evaluate ocular blood flow (OBF) and choroidal thickness (CT), which may be markers and/or risk factors that could assess the progression of OHT to glaucoma. Age and gender matched 60 eyes of 32 patients with OHT and 61 eyes of 31 control patients were included for this study. All participants underwent a detailed ophthalmological examination including best-corrected visual acuity, IOP measurement with Goldmann applanation tonometry, gonioscopy, optic nerve evaluation with 78 D lens, and visual field test with Humphrey visual field analyzer. Retinal nerve fiber layer, ganglion cell complex, and central corneal thickness measurements were performed by optical coherence tomography (OCT). CT was measured with OCT in the fovea, 1.5 mm, 2 mm, 2.5 mm nasal and temporal to the fovea and from nasal and temporal to the optic disk. OBF data including peak systolic velocity (PSV), end-diastolic velocity (EDV), resistivity index (RI) and pulsatility index (PI) were measured with color Doppler imaging (CDI) from the ophthalmic artery (OA), central retinal artery (CRA), medial and lateral branches of short posterior ciliary arteries (MPCA, LPCA). Systolic (SBP) and diastolic arterial blood pressure were also noted. CT measurement at each point in the OHT group compared to the control group were found to be significantly thinner (p = 0.001). There was a decrement in CT from the fovea to the nasal and temporal retina in both groups. In the OHT group, there was a significant decrease in PSV and EDV of OA, CRA, MPCA, and LPCA, and a significant increase in PI and RI of measured arteries. (EDV p = 0.036, PI p = 0.006, RI p = 0.006 for OA and p = 0.001 for other arteries and all OBF measurements). There was a negative correlation between CT and age, IOP and axial length (AL) in OHT group (r = − 0.529, p = 0.001; r = − 0.258, p = 0.047; r = − 0.345, p = 0.007, respectively, for fovea). But there was no statistically significant correlation between CT and other measurements in the control group, except age (r = − 0.860 p = 0.001 for fovea). We found that OBF decrement and choroidal thinning in OHT group compared with controls. Interpretation both of CT measurements with OCT and OBF parameters with CDI and new imaging technologies may help to prevent and reduce the possible optic nerve damage.

Összefoglaló. Az agy és a szem vascularis katasztrófái számos esetben egymáshoz társuló vagy egymást előre jelző kórképek. Az arteria centralis retinae occlusio az ér rekanalizációjának hiányában a retina szöveteinek irreverzibilis károsodását okozza. Sem a nemzetközi, sem a hazai stroke-irányelvek nem foglalkoznak az ocularis stroke problémakörével, annak ellenére, hogy az arteria centralis retinae occlusio okozta retinalis ischaemia minden tekintetben megfelel az akut ischaemiás stroke definíciójának. Az eddig rendelkezésre álló irodalmi adatok alapján arteria centralis retinae occlusio esetén az intravénás thrombolysis 4,5 órán belül alkalmazva növeli a szignifikáns mértékű visusjavulás esélyét. Az országban jelenleg 4 centrum (Pécsi Tudományegyetem, Szegedi Tudományegyetem, Debreceni Egyetem, Semmelweis Egyetem) tervezi az ocularis stroke kezelésében a thrombolysis bevezetését. A maradandó látásromlás és a szekunder cerebrovascularis események megelőzése érdekében elengedhetetlen az alapellátásban és a társszakmákban dolgozó kollégákkal való szoros együttműködés. Orv Hetil. 2021; 162(47): 1871–1875. Summary. Vascular events of the brain and the eye may occur concomitantly or sequentially. In the absence of recanalization, central retinal artery occlusion causes irreversible damage to the retinal tissues. Even though retinal ischemia secondary to central retinal artery occlusion meets the definition of acute ischemic stroke, neither the international nor the Hungarian stroke guidelines mention ocular stroke. Based on the available literature, intravenous thrombolysis of the central retinal artery within 4.5 hours of occlusion can increase the odds of significant vision improvement. Currently 4 centers (University of Pécs, Debrecen, Szeged, and Semmelweis University) are planning to introduce thrombolysis in the treatment of ocular stroke. To prevent permanent visual loss and secondary cerebrovascular events, timely intervention requires the collaboration between general practitioners and other specialties. Orv Hetil. 2021; 162(47): 1871–1875.

PURPOSE We aimed to investigate the correlation between the color Doppler imaging (CDI) results and parameters determined by spectral domain optical coherence tomography (SD-OCT) in cases with pseudoexfoliation syndrome (XFS). METHODS 99 participants were included in this prospective study. Retinal nerve fiber layer (RNFL), ganglion cell complex (GCC), optic nerve head (ONH) measurements were recorded. Perfusions of the ophthalmic artery (OA) and central retinal artery (CRA) were determined and resistivity indices (RI) were calculated. RESULTS No statistically significant differences were determined between the groups regarding the RNFL and ONH parameters. Only the minimum GCC thickness value was determined to be reduced in XFS group (n = 49) when compared to the controls (n = 50) (p = 0.018). The OA-RI and CRA-RI values of XFS group were significantly higher than the control group (p

Diabetic retinopathy is one of the most common causes of blindness in work-aging adults and develops in one third of diabetic patients. Calcium dobesilate (CaD) treatment have protective effects on blood retinal barrier (BRB) and anti-oxidant as well as anti-inflammatory properties. To assess effects of CaD administration on retrobulbar blood flow and choroidal thickness in patients with diabetic retinopathy. In this quasi-experimental study, diabetic patients with diabetic retinopathy (DR) were recruited from Shahid Motahari and Poostchi ophthalmology clinic affiliated to Shiraz University of Medical Sciences. Patients were treated with CaD, 1 gr per day for seven days. Before and after CaD administration, retrobulbar blood flow and subfoveal choroidal thickness were assessed. Retrobulbar blood flow were evaluated by measuring peak systolic velocity (PSV), end diastolic velocity (EDV) and resistive index (RI) of ophthalmic artery (OA), central retinal artery (CRA) and short ciliary artery (SCA). In this study, 26 DR patients with a mean age of 56.15 ± 8.93 years and mean diabetes mellitus duration of 15.04 ± 7.64 years were enrolled. Subfoveal choroidal thickness was significantly increased from 316.08 ± 61.69 to 327.81 ± 58.03 after CaD treatment (P value

Los problemas vasculares oculares constituyen una patología emergente dentro de la actividad del internista. La ecografía ocular es una técnica ampliamente utilizada para evaluar una variedad de afecciones oculares; en particular, el estudio por ecografía Doppler de los vasos oftálmicos se ha convertido en una herramienta muy útil en el diagnóstico de diversas enfermedades oculares. La ecografía Doppler permite examinar el flujo sanguíneo ocular, incluso en presencia de opacidades oculares que impidan una visión del segmento posterior del ojo. En esta revisión describimos los principios y técnicas para el examen ecográfico Doppler vascular ocular y proporcionamos una aproximación general a las características ecográficas de los trastornos vasculares oculares más importantes para la práctica clínica de los internistas, entre los que se incluyen la oclusión de la arteria y de la vena central de la retina, el síndrome isquémico crónico retiniano, la neuropatía óptica isquémica anterior y la retinopatía diabética. Ocular vascular problems represent an emerging pathology within the activity of the internist. Ocular ultrasound is a widely used technique to evaluate a variety of eye conditions. Specifically, Doppler ultrasound of the ophthalmic vessels has become a very useful tool in diagnosing various eye diseases. Doppler ultrasound allows for examining blood flow in the eye even in the presence of eye opacities that impede viewing the posterior segment of the eye. In this review, we describe the principles and techniques of an ocular vascular Doppler ultrasound examination in clinical practice and provide a general approach to the ultrasound characteristics of the most important vascular eye disorders for internists. These include central retinal artery and vein occlusions, chronic retinal ischemic syndrome, anterior optic ischemic neuropathy, and diabetic retinopathy. Sin financiación 3.064 JCR (2021) Q2, 82/172 Medicine, General & Internal 0.300 SJR (2021) Q3, 1734/2489 Medicine (miscellaneous) No data IDR 2021 UEM

Background This study aimed to find the correlation of Gensini score with retinal vessel diameter and arteriovenous ratio in elderly patients with coronary heart disease (CHD). Methods This study included 120 senile CHD patients as the CHD group and 100 healthy individuals as the normal group (NG). Gensini score was used to evaluate the severity of coronary artery lesions. Central retinal artery equivalents (CRAE), central retinal venular equivalents (CRVE), and arteriovenous ratio (AVR) were measured. Results CHD group has lower CRAE and AVR than NG, while higher CRVE was observed in NG. CRAE and AVR in UAP (unstable angina pectoris) and AMI (acute myocardial infarction) groups showed reduction (stable angina pectoris); however, enhanced CRVE and Gensini scores in UA and AMI groups were observed as compared to the SAP group. CRAE and AVR in moderate and severe groups were reduced to a greater extent compared to the mild groups, while enhanced CRVE and Gensini scores were observed more often in the severe group than the mild group. CRAE and AVR were negatively correlated with the Gensini score; however, CRVE was positively correlated with the Gensini score. Conclusion AVR is expected to be a noninvasive index to diagnose and predict senile CHD, which has a certain evaluation value. Diabetes, smoking history, and TC are independent risk factors of senile CHD.

Objective: Diabetes can lead to diabetic retinopathy, which damages the retina due to blood flow remodeling of occular vessels. Early stages of diabetic retinopathy may not present with patient symptoms. Doppler indices, of the ophthalmic arteries, could help in determining the effect of diabetic vascular remodeling. This research was designed to compare the Doppler indices, in the ophthalmic artery and central retinal artery, in both diabetic and nondiabetic patients. Materials and Methods: This was a cross-sectional observational study of 72 total patients. Sonography was performed on the ophthalmic arteries of 36 diabetics and 36 nondiabetics, to compare Doppler indices. All patients were voluntarily consented to this research that was approved by the university’s Institutional Review Board (IRB). Doppler parameters recorded were peak systolic velocity, end dystopic velocity, resistive index, and pulsatility index, which were taken in both patient groups and compared. Results: A significant difference was noted in the ophthalmic artery peak systolic velocity, end-diastolic velocity, pulsatility index, and resistive index for diabetic and nondiabetic individuals, with a statistically significant set at .01. Conclusions: There was a significant difference between diabetic and nondiabetic ophthalmic Doppler indices in this cohort of patients. This cohort demonstrated vascular remodeling of the ophthalmic arteries, caused by diabetes; therefore, blood flow resistance was increased due to diabetes.

OBJECTIVES: Affection of the central nervous system and the eyes is increasingly recognized as manifestations of a SARS-CoV-2 infection (COVID-19). This review aims at summarizing and discussing recent advances concerning causes and locations of impaired vision because of an infection with SARS-CoV-2. METHODS: On a literature search through PubMed and ScholarOne, all available publications about COVID-19 patients with impaired vision were retrieved. RESULTS: Visual impairment in SARS-CoV-2-infected patients may be due to infection of lacrimal glands (dacryoadenitis), conjunctivitis, tonic pupils, vitritis, central retinal artery/venous occlusion, retinitis, retinal bleeding, panuveitis, anterior ischemic optic neuropathy, optic nerve stroke, optic neuritis, optic perineuritis, or occipital ischemic stroke. Visual impairment may be the initial manifestation of SARS-CoV-2. CONCLUSIONS: This mini review shows that impaired vision may be the initial manifestation of COVID-19, that all sections of the visual tract may be affected and causative for visual impairment in COVID-19 patients, and that SARS-CoV-2 manifests along the visual tract with ischemia, focal infection, and immunological reactions.

The study included patients with a verified diagnosis of “Traction retinal detachment” (RD) in pediatric (50 patients, mean age 13.8 ± 1.1 years, age range from 11 to 18 years) and adults (50 patients, mean age 54, 6 ± 2.2 years, age range 19 to 72 years). The control groups included 25 children (mean age 13.1 ± 1.2 years) and 25 adults (mean age 52.8 ± 1.6 years) patients without pathology of the organ of vision. A comprehensive examination of the functional state of the visual analyzer was performed, including the assessment of clinical (maximum corrected distance visual acuity, BCVA), subjective (Quality of Life, QOL), hemodynamic (pulsation index in the central retinal artery, PI), electrophysiological (threshold of electrical sensitivity of the retina (PESR); threshold of electrical lability of the retina; critical frequency of fusion and flashing (presentation of a red object); photostress test) and biochemical (antioxidant activity in the lacrimal fluid, AOA; superoxide dismutase indicator, PS in the lacrimal fluid) indicators of the visual system. The data obtained indicate some differences in the studied parameters in patients with OS in pediatric and adult practice. In particular, a higher level of BCVA in adults was found (by 18.8 %, p < 0.001). Along with this, it was determined that RD in children is accompanied by more pronounced disorders of hemodynamic and antioxidant parameters, which is associated with a more pronounced degree of proliferative vitreoretinopathy and preservation of antioxidant defense mechanisms. The results of stepwise discriminant analysis of the statistical characteristic F, which determines the weighting coefficient of the relationship in the regression equation of the basic AOA parameter with each indicator in the general array, determined the following most informative indicators (F > 3.0) of the visual system of patients with OS associated with antioxidant protection: in an adult practice — BCVA, QOL, PI, PESR, PS; in pediatric practice — BCVA, PI, PESR, PS. The obtained similar results of statistical analysis for children and adults are actualized by research in pediatric practice aimed at increasing the clinical effectiveness of vitrectomy for RD based on antioxidant protection methods tested in adult practice.

Background: Cigarette smoking has been associated with low blood velocity of ophthalmic artery, while systolic blood pressure has been positively correlated with velocities in the ophthalmic artery and the central retinal artery. These effects are the result of interaction of nicotine-induced peripheral vasoconstriction and vasodilation caused by carbon monoxide in smokers. OCTA is a novel, noninvasive scanning technology which allow visualizing of the retinal and choroidal circulation. It permits assessing the retinal vasculature layer by layer and allows physicians to take images of the deep capillary plexus with no dye injection.Methods: retrospective case control study included 100 participants (50 smokers and 50 healthy nonsmokers) recruited from Ophthalmology Department in Beni -Suef University Hospital. Participants were equally divided into two groups: Group (1): Included 50 smokers otherwise healthy. Group (2): Included 50 normal subjects (nonsmokers) used as control. Both groups underwent OCTA study.Results: A highly significant statistical difference between both groups regarding smoking duration, while age and gender were of no significant. No statistical difference between both groups regarding perfusion within retinal layers between both groups as recorded in whole image. Age, IOP and neovascularization were positively, correlated with duration of smoking, perfusion and choroidal thicknesses in all areas were negatively correlated with duration of smoking. Conclusion: We did not find a significant difference in choroidal blood flow, vessel density, or choroidal thickness measurements between the study and control groups in a chronic period. We also noticed that OCTA is a good new noninvasive procedure for imaging choroidal circulation.

In the past few decades, minimally-invasive esthetic treatments and the use of injectable Hyaluronic Acid Gels and other filling agents to treat facial esthetics have increased dramatically. Although extremely rare, a filler can cause ocular and orbital ischemia by retrograde flow from the ophthalmic artery when injected in any of the anastomosis of the face. Once filler reaches the central retinal artery, blindness is inevitable, and no treatment is effective. While the risk of blindness happening with any filler injection is rare, the life-altering irreversible consequence of a procedure that was anticipated to be simple and beautifying is a reality that each injector must be prepared for with every injection. The parameters associated with an iatrogenic stroke of the eye are the site of injection, the injection technique, patient characteristics, and the material injected. Understanding the interplay of each of these variables might help us reduce the possibility of blindness during the injection of a soft-tissue cosmetic filler. Here, we explore the causes of Hyaluronic Acid Gels Filler embolic phenomena, review the natural course of the process, and discuss appropriate immediate interventions. We also (1) propose an education plan for injectors and describe how to carry out a focused ophthalmologic examination and procedural activities for a referral to an ophthalmologist, (2) outline steps to prevent emboli during filler injection, and (3) how to manage and support a patient with a sudden loss of vision during or immediately after a Hyaluronic Acid Gels filler treatment.

To characterize laser speckle flowgraphy (LSFG) pulse waveform parameters for ocular circulation evaluation, a multicenter, prospective, cross-sectional study was conducted in 111 eyes of 86 healthy Japanese individuals. Optic nerve head (ONH) tissue-area, vessel-area mean blur rate (MT and MV, respectively), and MT and MV pulse waveform parameters were obtained using LSFG and ONH structural parameters using planimetry. Multivariate linear mixed-effects modeled regression analysis identified factors contributing to MT- or MV-waveforms using age, gender, smoking history, body mass index, systolic and diastolic blood pressure, heart rate, intraocular pressure, axial length, disc, rim, and β-peripapillary atrophy areas, MT or MV, central retinal artery, and vein equivalents (CRAE and CRVE) as explanatory variables. MT- and MV-waveforms significantly correlated with one or more systemic factors, consistent with previous studies. Following confounding factor adjustment, MT-Skew significantly negatively correlated with β-PPA area (P = 0.026); MT- and MV-flow acceleration index positively correlated with CRAE, MT, and MV (P = 0.041–

The ophthalmic artery (OA) is a crucial artery. Centered at the OA, there are numerous extracranial-intracranial anastomoses. The OA and its collaterals can be involved in some intracranial vascular diseases. So, it is very important to understand its specific anatomy, variation, and role in different neurovascular diseases. The OA has various anomalies both in the origin and collateral circulation. When performing endovascular treatment (EVT), the OA may suffer unexpected embolization through the numerous dangerous anastomoses. In case of a dural arteriovenous fistula or brain arteriovenous malformation mainly fed by the OA, the OA can be the passage of EVT, during which the central retinal artery could be injured. During interventional recanalization of steno-occlusive diseases of the internal carotid artery, dissection at the cavernous segment could progress to the OA segment and occlude the origin of OA. Under the circumstance of moyamoya disease, the OA can provide collateral flow to the anterior cerebral artery. When performing EVT for OA aneurysm concurrent with moyamoya disease, the parent OA should be preserved. After placement of a flow-diverting device for ophthalmic ICA aneurysm, the covered OA could experience spontaneous occlusion, leading to visual disturbance. Hence, the OA is an extremely important artery in the EVT for intracranial vascular diseases. In this article, we would extensively review the related literature to increase our understanding of the role of OA in intracranial vascular diseases. In addition, some illustrative cases would also be provided.

The purpose of this study is to describe a surgical technique and report the functional outcome of treating nonarteritic central retinal artery occlusion (CRAO) in 2 eyes of two consecutive male patients. Two males (A) and (B) presented 6 days and few hours, respectively, after symptom onset with the clinical features typical of CRAO, including sudden severe deterioration of vision to counting fingers and a cherry-red spot in the left and right fovea, respectively. While A had been on recent treatment for hypertension and hyperlipidemia, B had no significant medical history. Both patients underwent surgery, A, 9 days, and B

The article analyzes the state of patients visual acuity after successful surgical treatment of retinal detachment. On the basis of gathered data, it was concluded that in case of detachment of the macula only in 50% of cases it is possible to increase visual acuity to 0.4 and higher. Restoration of visual functions continues for at least 6 months after the operation and is determined by the restoration of the structure of the outer segments of the photoreceptor cells. During this time, it is advisable to conduct drug therapy aimed at normalizing blood flow and functional activity of the retina. Visual functions recovery continues for at least 6 months after the operation and is connected with the restored structure of the outer segments of the photoreceptor cells. Important prognostic factors of central vision restoration in the postoperative period are visual acuity before surgery, duration of existence and height of macular detachment. Data on which of the methods of surgical treatment of retinal detachment allows to achieve higher visual acuity are contradictory. There is practically no data on the comparison of the effect on visual acuity of scleral buckling and vitrectomy in the long-term period, in patients with phakic eyes and with artiphakia. On visual acuity after fitting detachment of the macula may affect macular edema, epiretinal membrane formation and retinal folds, and edema of the peripapillary optic nerve head, progressive deterioration of blood flow in the basin of the central retinal artery, short posterior ciliary arteries and ophthalmic artery. It is believed that these factors are significantly more pronounced after scleral buckling than after vitrectomy. Some indicators of optical coherence tomography correlate with visual acuity after surgical treatment of retinal detachment: the state of the articulation line of the external and internal segments of the photoreceptors, as well as the state of the external limiting membrane.

Background In this case report, we present for the first time central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO) as a complication of persistent hyaloid artery (PHA). Case presentation In August 2019, a six-year-old male patient manifested right eye (RE) excessive tearing, conjunctival injection and pain. On examination, RE demonstrated light perception and intraocular pressure of 36 mmHg. The diagnoses of neovascular glaucoma, CRVO and CRAO were established as affirmed with fluorescein angiography (FA). PHA was not reported. Extensive work-up and family history were unremarkable. The child was born on term after uncomplicated twin pregnancy. In December 2019, he was referred to our Centre. Transillumination revealed fully dilated, non-reactive RE pupil, clear lens and tubular remnant of HA containing blood cells in its lumen freely rotating in the anterior vitreous. Conclusions PHA results from failure of apoptosis during gestation. It can easily be observed during the red reflex screening at neonatal wards. We hypothesized that PHA twisting led to torsion of the residual primordial common bulb, branching off to HA and CRA with CRAO occurring first. The consequential CRVO presumably advanced by venous stasis due to decrease in arterial inflow. Liquid vitreous appears as early as 4 years of age enabling PHA to whirl more freely. Thus, in case of PHA, we advocate FA to be performed and if connection with retinal artery is proven, parents should be informed on the possible devastating complications and prompt surgical treatment should be considered.

The use of anticancer chemotherapy (ACC) has resulted in longer patient survival but has also increased drug-related adverse effects. A 22-year-old female receiving cisplatin-based intravenous chemotherapy for high risk variant of gestational trophoblastic neoplasia (GTN) presented with complaints of sudden painless loss of vision in her right eye for a duration of 4 hours. Ocular findings were suggestive of central retinal artery occlusion (CRAO). After exclusion of other potential aetiological risk factors, the patient was diagnosed with CRAO associated with cisplatin. Cancer patients are prone to thromboembolic events (TEE) not only due to primary disease but also due to underlying comorbidities and treatment modalities. The high incidence of TEE in patients under cisplatin therapy mandates a high degree of suspicion among the treating physicians. This rare possibility of irreversible visual toxicity should also be considered among the patients under cisplatin chemotherapy.

OBJECTIVES The aim of this study was to identify changes in Doppler flow parameters in the central retinal artery (CRA) and ophthalmic artery (OA) that could be indicative of de novo development of thyroid-associated orbitopathy in the early period after radioiodine treatment. METHODS Eighty-two patients with hyperthyroidism were enrolled: 44 with Graves disease and 38 with toxic nodular goiter. In both groups, blood flow parameters in the CRA and OA were analyzed before and 2 and 4 weeks after radioiodine administration. The peak systolic velocity and end-diastolic velocity (EDV) were evaluated, and the resistive index (RI) was calculated. RESULTS There were no statistically significant differences in the peak systolic velocity, EDV or RI between groups at baseline and 4 weeks after radioiodine administration. Two weeks after radioiodine administration, the RI in the CRA (P = .034) and EDV in the OA (P = .026) were significantly lower, and the EDV in the CRA (P = .004) was higher in patients with Graves disease than in patients with toxic nodular goiter. There was an inverse correlation between baseline thyrotropin receptor autoantibody (TRAb) levels and the difference between the RI at weeks 4 and 2 (RI3-RI2) in the CRA (r = -0.458; P

To evaluate retrobulbar hemodynamics in patients with optic disc drusen (ODD) by color Doppler imaging. A prospective study included 52 patients with bilateral ODD and 50 age-matched controls. Blood flow in the central retinal artery (CRA) in both eyes was evaluated. Peak-systolic velocity (PSV), end-diastolic velocity (EDV), and the resistivity index (RI) were measured. Mean values of the blood flow Doppler parameters were compared between the patients with ODD and the controls. Both PSV and EDV in the CRA were significantly lower in patients with ODD than in the controls (p p p = 0.05 and p = 0.03, respectively). Arterial hypertension, cigarette smoking and location of ODD in the left or right eye did not exert a significant effect on the blood flow in the CRA. Blood flow in the CRA is considerably disturbed in patients with ODD. This disturbance might result from mechanical stenosis of the vascular wall caused by the drusen. Color Doppler ultrasound is a useful method in the assessment of retrobulbar hemodynamics in ODD.

Introduction The entry point of the central retinal artery (CRA) into the outer meningeal sheath of the optic nerve posterior to the globe has been studied and debated for more than one hundred years. The authors have supervised an orbital anatomy course for more than two decades. This article summarizes previous studies of the CRA and presents the results of dissections of 67 orbits. Materials and methods Heads were hemisected prior to dissection at the Vagelos College of Physicians and Surgeons of Columbia University. The authors measured the entry point of the CRA with a caliper and noted the meridional orientation of the CRA. Results The mean entry point was 10.65 mm posterior to the globe, with a range of 5 to 18 mm. Most commonly, the CRA entered the sheath in the inferior meridian, but some entered slightly inferomedially or inferolaterally. Conclusions The entry point of the CRA into the sheath of the optic nerve is variable, and without detailed angiography the clinician cannot know the course of the CRA prior to performing invasive intraorbital procedures. Knowledge of common variations in CRA entry into the outer meningeal sheath of the optic nerve should help to minimize injury during surgery.

Hypertensive retinopathy refers to the retinal vascular changes associated with systemic arterial hypertension. Hypertensive retinopathy can be divided into chronic and acute phases. A cross‐sectional study was performed to explore a method of measurement in the diameters of retinal vessels for diagnosis of chronic hypertensive retinopathy based on spectral domain optical coherence tomography (SD‐OCT). The central retinal artery diameter (CRAD), the central retinal vein diameter (CRVD), and the artery‐to‐vein ratio (AVR) were measured. A total of 119 subjects with 119 eyes were included in this study, in which 56 subjects with 56 eyes were included in hypertensive group and 63 subjects with 63 eyes were included in normotensive group. There were significant differences between the two groups in the CRAD (t = −2.14, P = .04) and the AVR (t = −2.59, P = .01). The cutoff point of 0.75 was determined by receiver operating characteristic (ROC) curve (area under the curve, AUC 0.786; 95% confidence interval, 95% CI 0.70‐0.87). Multivariate logistic regression analysis showed the probability of AVR below to 0.75 was more in patients with high systolic blood pressure (odds ratio OR 4.39; P = .048), more in male (OR 4.15; P = .004) and more in smokers (OR 5.80; P = .01). Bland‐Altman plots showed small mean bias between the measurements of the two technicians in the CRAD, the CRVD, and the AVR. In summary, application of SD‐OCT is an accurate, reproducible, convenient method for measuring the diameters of retinal vessels. It is valuable for the diagnosis of chronic stage of hypertensive retinopathy.

PURPOSE: We examined cross-sectional associations of sleep measures with central retinal artery equivalent (CRAE) and central retinal vein equivalent (CRVE) and investigated whether sex and race/ethnicity modified these associations. METHODS: Participants (N = 202; 78% white; 71% men) were enrolled in the Buffalo Cardio-metabolic Occupational Police Stress study (2011–2014). Wrist actigraphy was used to assess sleep measures including sleep duration, sleep efficiency, sleep onset latency, wake after sleep onset, number of awakenings, and longest wake episode. CRAE and CRVE were obtained from fundus photography of retina and were averaged from both eyes per officer. RESULTS: We observed significant associations between sleep efficiency and CRVE (β = −2.81 μm; P= .046), and between longest wake episode and CRVE (β = 3.24 μm; P= .021). Adjustments for demographics, lifestyles, and physical and psychological factors attenuated these associations. Sex modified the independent associations of sleep onset latency and longest wake episode with CRVE. One standard deviation (SD) increase in sleep onset latency was associated with 4.81 μm larger CRVE (P= .028) (P-interaction = 0.098), and one SD increase in longest wake episode was associated with 4.62 μm larger CRVE (P= .032) (P-interaction = 0.115) among men. Race/ethnicity also modified the association between longest wake episode and CRVE (P-interaction = 0.088). A significant association was observed only among white officers (β = 4.96 μm; P= .025). CONCLUSIONS: We found that poor sleep quality, measured by longest wake episode, was positively and independently associated with retinal venular diameter among white and male officers. Longitudinal studies are warranted to assess whether poor sleep quality is a risk factor for retinal diameter changes.

Masked hypertension is known to induce microvascular complications. However, it is unclear whether early microvascular changes are already occurring in young, otherwise healthy adults. We therefore investigated whether retinal microvascular calibers and acute responses to a flicker stimulus are related to masked hypertension. We used the baseline data of 889 participants aged 20-30 years who were taking part in the African Prospective study on the Early Detection and Identification of Cardiovascular Disease and Hypertension. Clinic and 24-h ambulatory blood pressure were measured. The central retinal artery equivalent (CRAE) and central retinal vein equivalent were calculated from fundus images, and retinal vessel dilation was determined in response to flicker light-induced provocation. A smaller CRAE was observed in those with masked hypertension vs. those with normotension (157.1 vs. 161.2 measuring units, P < 0.001). In forward multivariable-adjusted regression analysis, only CRAE was negatively related to masked hypertension [adjusted R2 = 0.267, β = -0.097 (95% CI = -0.165; -0.029), P = 0.005], but other retinal microvascular parameters were not associated with masked hypertension. In multivariable logistic regression analyses, masked hypertension [OR = 2.333, (95% CI = 1.316; 4.241), P = 0.004] was associated with a narrower CRAE. In young healthy adults, masked hypertension was associated with retinal arteriolar narrowing, thereby reflecting early microvascular alterations known to predict cardiovascular outcomes in later life.

The purpose of this research was to study the features of the comorbid course of ischemic diseases of the visual organ and chronic cerebral ischemia in atherosclerosis. The material for this study was the results of complex examinations of 37 patients (74 eyes) with ischemic diseases of the visual organ in combination with chronic cerebral ischemia and atherosclerotic vascular lesions. In addition to complex ophthalmologic examination, ultrasound examination with color Doppler mapping of extracranial and intracranial segments of the great vessels of the brain, Color-Doppler sonography and magnetic resonance imaging of the brain with tractography were used to study the peculiarities of the course of ischemic diseases of the visual organ in chronic cerebral ischemia. The quantitative characteristics of blood flow in the vessels of the eye and brain were the maximum systolic, final diastolic speeds, resistance index, carotid - ophthalmic ratio. Analysis of the results of the study revealed a change in visual function to varying degrees in all patients, depending on the ratio of the degree of damage to middle cerebral artery and anterior cerebral artery, ophthalmic artery, central retinal artery and posterior short ciliary artery as well as time when a patient requested medical assistance. The data obtained from Doppler studies of extracranial and intracranial segments of the great vessels and magnetic resonance tractography correlated with changes in Color-Doppler sonography, visual impairment and the detection of defects in the visual field. Pathological changes in the extracranial and intracranial segments of the great vessels negatively affect not only the parameters of the blood circulation of the cerebral vessels, but also exacerbate disturbances in the parameters of the blood circulation of the vessels of the eye, which leads to the progression of ischemic diseases of the visual organ. The degree of viability of collateral circulation is of great importance in the development of chronic cerebral ischemia and the progression of ischemic diseases of the organ of vision. All thus, the good consistency of collateral hemodynamics eliminates ischemia of brain and eye tissues, while visual functions are less affected.

Background To investigate the diagnostic power of radial peripapillary capillary (RPC) density, measured with optical coherence tomography angiography (OCT-A), in patients with superior segmental optic hypoplasia (SSOH). Methods Forty subjects with SSOH and 40 age- and axial length-matched control subjects were retrospectively registered for this study. SSOH was defined as intraocular pressure less than 21 mmHg with the presence of two of the following: superior rim thinning, superior entrance of the central retinal artery, scleral halo, and pale optic disc; as well as non-progressive visual field loss. RPC density was measured with swept-source OCT-A (Triton, Topcon) overall, in the quadrants, and in the 12 clock-wise sectors. Changes in RPC density were also compared in SSOH patients and age-matched patients with mild- or moderate-stage of glaucoma. RPC density was compared in pairs of groups with Welch’s t-test. Diagnostic power was assessed with the area under the receiver operating characteristics curve (AUC). Results Overall cpRNFLT was significantly different in the normal (106.7 ± 9.5 μm) and SSOH (77.2 ± 13.7 μm, p p p = 0.756) quadrant. The diagnostic power of RPC density was highest in the superior quadrant (AUC = 0.928) and the 1 o’clock sector (0.896). Comparing the SSOH and glaucoma patients showed that there were no significant differences in RPC density either overall (p = 0.391) or in the superior quadrant (p = 0.268), while RPC density was significantly higher in the inferior (p = 0.005) and temporal quadrants (p p = 0.029). Conclusions Low RPC density was found in the three non-temporal quadrants of the optic nerve head in SSOH patients, in comparison to normal subjects. Regionally, RPC density in SSOH was lower in the nasal quadrant and higher in the inferior and temporal quadrants in comparison to glaucoma patients. Measuring RPC density with OCT-A may help the diagnosis of SSOH and may improve the management of glaucoma.

The relationship between diabetic retinopathy and macro-vascular complications in diabetes suggests a pathogenic association between these conditions. Vascular endothelium has been identified as a main site of blood vessel injury in diabetes. Diabetic retinopathy is associated with systemic arterial stiffness and altered vascular endothelium function and structure. Retinal vasculature endothelium at the macula, arterio-venous crossings, and in the optic nerve at the lamina cribrosa region is reported to differ from the endothelium in the rest of the retinal blood vessels. The central retinal artery and vein are in close proximity in the optic nerve where they share a common adventitia; thus, increased arterial wall stiffness and thickness may affect blood flow in the neighboring central retinal vein in this region. Moreover, increased arterial stiffness in small arterial beds is associated with retinal venular widening; it suggests the possibility of central retinal artery compressing the central retinal vein at the lamina cribrosa, thereby compromising venular outflow in the retina of diabetic patients. Altered blood flow in the central retinal vein in the postlaminar region has been detected in patients who experience progression of diabetic retinopathy. Increased hydrostatic pressure in the central retinal vein may play a major role in the pathogenesis of diabetic retinopathy. The aim of this review article is to emphasize this pathogenetic mechanism that has often been overlooked.

Platelet-rich plasma has become one of the most widely used facial cosmetics fillers. We evaluated four patients treated by cosmetologists with platelet-rich plasma injections who developed irreversible blindness due to iatrogenic occlusion of the ophthalmic artery; immediately after the injection in the glabellar area in three cases and in the nasolabial fold in one case. Early after the injections the fundi of all patients demonstrated central retinal artery and choroidal occlusions. Later, two patients developed retinal pigment dispersion and one of them a pigmented optic disc. The scars on the skin showed similar characteristics in all patients, which could constitute an important marker in the presumptive diagnosis of platelet-rich plasma injection associated complications.

Aim. To evaluate the effect of preset elevated intraocular pressure (IOP) level during phacoemulsification on central retina artery and central retinal vein hemodynamics and to determine possible compensatory mechanisms of the ocular blood flow autoregulation in response to intraoperational IOP jump. Methods. This prospective study included 23 cataract patients without concomitant ocular vascular conditions (15 women and 8 men) aged from 62 to 83 years. The mean age was 72.5 5.7 years. In all patients, an intraoperational color duplex scanning in the regimens of color Doppler imaging and pulsed wave velocity imaging using ultrasound scanner Logiq S8 (GE). The blood flow was estimated in retrobulbar vessels: central retinal artery, central retinal vein with maximal systolic velocity, end-diastolic velocity of the blood flow, and resistance index (RI). The investigation was performed under IOP control, which was measured using Icare Pro tonometer, and under blood pressure control using patient monitoring system Draeger Vista 120. In the operating room, ocular blood flow was examined three times: immediately before surgery, straight after the surgical incision sealing at preset intraoperational IOP level, and after IOP normalization and repeated sealing of the corneal tunnel. Results. Under preset intraoperational IOP maintenance on 58.01 8.10 mm Hg level, there was a clinically significant (p 0.05) decrease of blood flow velocity in the central retinal artery. In 30.4% of cases, the blood flow velocity in the central retinal artery during diastolic phase was not registered. The flow velocity in central retinal vein did not change significantly, and did not depend on IOP level (p 0.05). Conclusions. At the 5560 mm Hg IOP level, in humans, compensatory blood flow autoregulation mechanisms in response to intraoperational IOP jumps are absent, up to complete blood flow stop in the central retinal artery at the diastolic phase, and this could be a risk factor for retinal ischemia.