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Purpose To analyze the spectrum of ischemia associated with paracentral acute middle maculopathy (PAMM) in eyes with acute retinal vascular occlusion and to describe an ischemic cascade. Design A retrospective observational case series. Methods Patients presenting with PAMM secondary to acute retinal vascular occlusion were identified. Analysis of multimodal imaging was performed at baseline and at follow-up visits to elucidate the patterns and progression of ischemia within the retinal layers. Results Multimodal retinal imaging from 16 eyes of 16 patients with acute retinal vascular occlusion associated with PAMM was studied. Analysis of en face optical coherence tomography (OCT) segmentation of the inner nuclear layer (INL) identified distinct patterns of PAMM correlating with the severity of ischemia and not the type of occlusion. A perivenular fern-like PAMM pattern was associated with better visual outcomes (average final visual acuity was 20/25). This pattern was noted to sequentially progress in 2 cases to a diffuse globular PAMM pattern in the INL, or to a pattern of ischemia involving both the middle and inner retinal layers with commensurate vision loss. Globular patterns of PAMM or ischemia involving both the middle and inner retina correlated with poorer visual outcomes (average final visual acuity was counting fingers at 5.5 ft). These various patterns of ischemia developed in eyes with retinal vascular occlusions in which blood flow through the retinal capillary plexuses was present but was significantly reduced and delayed. Conclusions This study describes OCT findings suggestive of an ischemic cascade in eyes with retinal vascular occlusion. The middle retina at the level of the deep capillary plexus, especially at the venular pole, may be more vulnerable to ischemic injury.

Despite clinical and epidemiological studies quantitative and qualitative abnormalities red blood cell (RBC) role in thrombosis has been ignored. Abnormal interaction of RBCs with vascular endothelium has been demonstrated in diabetes mellitus, Polycythemia vera (PV) and retinal vascular occlusion (RVO) after the first description in sickle cell anemia. The molecular basis has been identified. In diabetes mellitus, glycation of RBC band 3 caused the ligation to the receptor for advanced glycation end products (RAGE) present on endothelium. An abnormal Lu/BCAM (CD 239) expression in PV is responsible for the binding to endothelium annexin V. In RVO, RBC phosphatidylserine overexpression mediated the attachment to vascular laminin alpha-5 chain. Red blood cell binding altered the nonthrombotic properties of endothelium leading to thrombosis.

A 65-year-old male presented with complaints of blurred vision OS beginning 3 years ago. He had visited a local hospital where the visual acuity was reported as 6/6 in the right eye and 6/10 in the left. He was diagnosed with branch retinal artery occlusion OS. Two years later, he developed blurry vision in his right eye. He visited another hospital and his vision was 6/60 OD and CF/10 cm OS then. Ophthalmoscopic examination showed retinal vascular occlusion with retinal hemorrhage in the right eye (Fig. 57.1). Fluorescein angiography revealed peripheral retinal vasculitis in both eyes (Fig. 57.2). MR imaging of brain was normal. He was then referred to our hospital. OCT revealed thinning of the inner retinal layer in both eyes (Fig. 57.3). He received panretinal photocoagulation OD and focal laser photocoagulation OS. His visual acuity was CF/20 cm in both eyes 6 months later. A full-field electroretinogram showed decreased amplitudes in both rod and cone functions. The visual fields were severely constricted with a residual central island in both eyes (Fig. 57.4). OCT found severe thinning of the peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GC-IPL) in both eyes (Fig. 57.5). Peripheral blood examination found positive ANA (1:160), TPHA (1:640), elevated ESR (93 mm/h), elevated IgM (>3100 mg/dL), and prolonged aPTT (38.6 s). CRP, IgG/A/E, cardiolipin IgG, lupus anticoagulant, anti-B2-glycoprotein, RF, SSA/SSB, protein C/S, antithrombin III, homocysteine, and PT time were all normal. A tall monoclonal spike in the gamma-globulin region was found by electrophoresis. Immunoelectrophoresis showed an IgM (kappa) monoclonal gammopathy, which was compatible with Waldenstrom’s macroglobulinemia. The plasma viscosity was 2.42 (1.16–1.56). He received plasmapheresis with fresh frozen plasma five times. A bone marrow biopsy showed nodular and interstitial infiltration of small lymphoid cells, plasmacytoid lymphocytes, and some plasma cells. The plasma cells were predominantly Kappa- or IgM-positive but only scantly with lambda-, IgG-, or IgA-positive. The clinical picture was compatible with lymphoplasmacytic lymphoma, and therefore, the patient received target and chemotherapy for lymphoma. He also received cataract surgery for both eyes. His vision improved to 6/8.6 OD and 6/60 OS 3 years later.

Retinal vascular occlusions can lead to sudden and permanent visual impairment or blindness. Few epidemiological studies on retinal vascular occlusions have been conducted, especially on diverse populations.This is a retrospective case-control study of all incident retinal vascular occlusions occurring during a three and one-half year study period at Montefiore Medical Center, capturing all potential cases by diagnosis codes. Patients with retinal venous occlusions (RVO) and retinal arterial occlusions (RAO) were analyzed separately and compared to age-matched control groups.All potential charts (n = 700) were reviewed, confirming 214 RVO and 35 RAO incident cases. In multivariable analyses, RVO was associated with type 2 diabetes mellitus (OR 2.41, p 0.001), history of cerebrovascular accident (OR 2.14, p = 0.011), hypertension (OR 1.83, p = 0.004), glaucoma (OR 6.91, p 0.001), black race (OR 3.72, p 0.001), and male gender (OR 2.19 p 0.001). RAO was significantly associated with current and former smoking combined (OR 8.95, p = 0.021) and male gender (OR 2.56, p = 0.038).Cardiovascular risk factors and glaucoma are reaffirmed as significant predictors of retinal vascular occlusions in a diverse patient population. Retinal vascular occlusions are more common in certain races and ethnicities, and further study into this may help identify high-risk individuals based on demographics.

Experimental animal models have critical importance for the recognition and the management of various retinal and choroidal diseases To date they were described for the induction of melanoma and neovascularizationof choroid degenerations and detachment in the retina proliferative vitreoretinopathy diabetic and hypertensive retinopathy pre retinal neovascularization central serous chorioretinopathy retinopathy of prematurity ROP or O induced retinopathy OIR and retinoblastoma The aim of this review is to provide an overview of experimental animal models for retinal and choroidal diseases To know the most favorite models and animals for these diseases will provide many utilities to the researchers in their experimental studies and thesis nbsp

This report describes a novel, non-invasive and label-free optical imaging technique, speckle variance optical coherence tomography (svOCT), for visualising blood flow within human retinal capillary networks. This imaging system uses a custom-built swept source OCT system operating at a line rate of 100 kHz. Real-time processing and visualisation is implemented on a consumer grade graphics processing unit. To investigate the quality of microvascular detail acquired with this device we compared images of human capillary networks acquired with svOCT and fluorescein angiography. We found that the density of capillary microvasculature acquired with this svOCT device was visibly greater than fluorescein angiography. We also found that this svOCT device had the capacity to generate en face images of distinct capillary networks that are morphologically comparable with previously published histological studies. Finally, we found that this svOCT device has the ability to non-invasively illustrate the common manifestations of diabetic retinopathy and retinal vascular occlusion. The results of this study suggest that graphics processing unit accelerated svOCT has the potential to non-invasively provide useful quantitative information about human retinal capillary networks. Therefore svOCT may have clinical and research applications for the management of retinal microvascular diseases, which are a major cause of visual morbidity worldwide.

Background Retinal artery occlusion is extremely rare in the pediatric population and most patients have risk factors. We report a case of a healthy child with segmental optic atrophy, complicated by incidental branch retinal artery occlusion (BRAO). Case presentation A 10-year-old boy who had a history of his mother’s gestational diabetes presented with an inferonasal visual field defect in the left eye. His best-corrected visual acuities were 20/20 in both eyes (OU). Fundoscopic examination revealed segmental pallor of the left optic disc, thinning of the superotemporal rim, a relative superior entrance of the central retinal artery and superior peripapillary scleral halo. Fluorescein angiography showed patchy filling delays in the corresponding disc area without retinal vascular abnormalities. Spectral domain optical coherence tomography (SD OCT) via automated segmentation analysis demonstrated sectoral absence of the ganglion cell layer and retinal nerve fiber layer with thinning of the inner plexiform layer, inner nuclear layer and outer plexiform layer in the corresponding retina. OCT angiography (OCTA) showed focal attenuation of superficial and intermediate/deep capillary plexuses in the corresponding areas. Systemic evaluation was unremarkable. The patient was diagnosed with segmental optic atrophy caused by incidental BRAO. Conclusions Retinal vascular occlusions are rare in childhood, and may present as segmental optic atrophy mimicking congenital anomalies. OCTA allows the detection of previous microvascular abnormalities in the chronic phase. To the best of our knowledge, this is the first report of a child with segmental optic atrophy presumably caused by BRAO, which was documented by SD OCT and OCTA in detail.

Introduction: Non-invasive measurement of blood oxygen saturation via spectroscopic imaging has provided insights into ocular physiology and the development of a variety of ocular conditions, including retinal vascular occlusion, diabetic retinopathy and glaucoma. Major developments since the late 90s have been enabled by advancements in imaging technology, computational image analysis, and innovative experimental methods.\ud \ud Areas covered: We review the theory of spectroscopic oximetry, the ocular blood vessels targeted for oximetry, the imaging systems utilised, and methods to validate oximetry measures. We detail the main physiological and clinical insights provided by ocular oximetry.\ud \ud Expert commentary: Oximetry has revealed physiological norms and auto-regulatory effects in the retina, choroid, episcleral, and bulbar conjunctival blood vessels. Retinal oximetry has provided insights into the development of diabetic retinopathy and glaucoma, and may enhance the evaluation and treatment of retinal vessel occlusion. Commercially available retinal oximetry systems have enabled oximetry in the clinical setting. The development of more sophisticated phantoms that resemble in vivo environments has helped validate oximetry applications. New insights into ocular physiology and disease are likely to be gleaned from future studies.

Retinal ischemia is a common pathomechanism in many ocular disorders such as age-related macular degeneration (AMD), diabetic retinopathy, glaucoma or retinal vascular occlusion. Several studies demonstrated that ischemia/reperfusion (I/R) leads to morphological and functional changes of different retinal cell types. However, little is known about the ischemic effects on the optic nerve. The goal of this study was to evaluate these effects. Ischemia was induced by raising the intraocular pressure (IOP) in one eye of rats to 140 mmHg for 1 h followed by natural reperfusion. After 21 days, histological as well as quantitative real-time PCR (qRT-PCR) analyses of optic nerves were performed. Ischemic optic nerves showed an infiltration of cells and also degeneration with signs of demyelination. Furthermore, a migration and an activation of microglia could be observed histologically as well as on mRNA level. In regard to macroglia, a trend toward gliosis could be noted after ischemia induction by vimentin staining. Additionally, an up-regulation of \(\textit {glial fibrillary acidic protein}\) (GFAP) mRNA was found in ischemic optic nerves. Counting of oligodendrocyte transcription factor 2 positive \((Olig2^{+})\) cells revealed a decrease of oligodendrocytes in the ischemic group. Also, \(\textit {myelin basic protein}\) (MBP) and \(\textit {myelin oligodendrocyte glycoprotein}\) (MOG) mRNA expression was down-regulated after induction of I/R. On immunohistological level, a decrease of MOG was detectable in ischemic optic nerves as well. In addition, SMI-32 stained neurofilaments of longitudinal optic nerve sections showed a strong structural damage of the ischemic optic nerves in comparison to controls. Consequently, retinal ischemia impacts optic nerve degeneration. These findings could help to better understand the course of destruction in the optic nerve after an ischemic insult. Especially for therapeutic studies, the optic nerve is important because of its susceptibility to be damaged as a result to retinal ischemic injury and also its connecting function between the eye and the brain. So, future drug screenings should target not only the retina, but also the functionality and structure of the optic nerve. In the future, these results could lead to the development of new therapeutic strategies for treatment of ischemic injury.

In this editorial it was aimed to call attention to the importance of the screening and the evaluation of the segmentations of vitreoretinal interface and avascular outer retina in optical coherence tomography angiography for subclinical or early pre retinal and choroidal neovascularization In optical coherence tomography angiography of a healthy subject both segmentations of vitreoretinal interface and avascular outer retina do not show obvious vascular structure Thus these two segmentations can be used for the screening of preretinal and choroidal neovascularization in various ischemic vascular diseases

Background. Ocular vascular occlusions following intraocular procedures are a rare complication. We report a case series of patients with retinal vascular occlusions or anterior ischemic optic neuropathy (AION) after anterior and posterior segment surgery and demonstrate possible risk factors.Methods. Observational case series.Results. In ten patients, vascular occlusions were observed within ten weeks after intraocular surgery: branch retinal arterial occlusion (BRAO) (n=2), central retinal artery occlusion (CRAO) (n=2), central retinal vein occlusion (CRVO) (n=1), branch retinal vein occlusion (BRVO) (n=1), anterior ischemic optic neuropathy (AION) (n=3), and combined central artery and vein occlusion (n=1). AION occurred later (27–69 d) than arterial occlusions (14–60 d) or venous occlusions (1-2 d). In all cases, either specific surgical manipulations or general vascular disorders were identified as risk factors. In addition to general cardiovascular risk factors (arterial hypertensionn=6, diabetes mellitusn=4), internal workup disclosed bilateral stenosis of the carotid arteries (n=1) and myeloproliferative syndrome (n=1).Conclusion. Vascular occlusions after surgical ocular procedures seem to be more frequent when cardiovascular diseases coexist. Surgical maneuvers and intra- or postoperative pressure changes may act as a triggering mechanism in patients with underlying systemic cardiovascular disorders. Affected patients should undergo thorough internal examination to identify possible underlying diseases.

1.1.Purpose: To measure and quantify choroidal neovascularization (CNV) lesion size in classic lesions visualized on Spectral Domain-Optical Coherence Tomography (SD-OCT) using automated segmentation analysis and confirm whether further refinement improves the accuracy of disease regression after loading dose Anti-VEGF injections. 1.2.Methodology: A retrospective study of 10 macular degeneration patients diagnosed with CNV. Blinded observers, trained to detect changes on OCT, delineated boundaries of CNV lesions using SD-OCT (Topcon 2000) with automated software and then modified segmentation manually before and after loading dose Ranbizumab injections. Automated measurements were then compared to manual segmentation values. Statistical analysis was performed, taking into account inter-observer variability. 1.3.Results: Automatic and manual segmentation measurements are similar in 1) retinal area and fovea center values both pre-and post-injection; and 2) retinal volume post-injection. Retinal volume pre-injection is 1) similar between the two blinded observers; 2) varies between automatic measurements and observers in some patients; and 3) underestimated for all patients in the automatic measurements. Overall, automatic segmentation detects a general reduction in CNV lesion size following loading dose injections. 1.4.Conclusion: SD-OCT automated segmentation software detects CNV lesions and reports size reduction after the third anti-VEGF injection. SD-OCT automatic segmentation using Topcon segmentation analysis in this small cohort is an accurate diagnostic tool to measure CNV surface area and volume as a biomarker of CNV regression.

Combined cilioretinal artery and retinal vein occlusions are infrequently documented retinal vascular disorders. The role of genetic polymorphisms has been investigated. A 45-year-old woman presented with decreased visual acuity in her right eye. Fluorescein angiography demonstrated a cilioretinal artery occlusion associated with central retinal vein obstruction. Results of testing for the factor V Leiden were negative. However, the patient was heterozygous for the prothrombin G20210A mutation and the two polymorphisms (C667T and A1298C) of the methylenetetrahydrofolate reductase (MTHFR) gene. Specific genetic factors can be associated with retinal vascular occlusions.

Background: Oxidized low-density lipoprotein (OX-LDL) is believed to be a key trigger factor in the genesis of atherosclerosis. It has been postulated that it can activate inflammatory mediators such as high sensitive C-reactive protein (hs-CRP), interleukin 6 (IL6), and tumour necrosis factor (TNF). These mediators have been demonstrated to have an atherogenic effect. Aims: This pilot study examined levels of OX-LDL and hs-CRP in patients with retinal vascular occlusive disorders. Methods: We enroled 7 patients with retinal vascular occlusions during a two-month period. A high sensitive CRP of greater than 3mg/l was considered significantly elevated and a median oxidised LDL value greater than 59 U/L was considered significantly elevated. Results: There were 4 cases of retinal vein occlusion, 1 case of amaurosis fugax, 1 case of cilioretinal artery occlusion and a case of cholesterol embolus in the retinal vasculature. Mean OX-LDL (55.6±21.1 U/L) was borderline, but within the normal range (

The retinal ischemia-reperfusion injury (RIR) is a common pathological process that leads to progressive visual loss and blindness in many retinal diseases such as retinal vascular occlusion disease, diabetic retinopathy, and acute glaucoma. Currently, there has been no effective therapy. The purpose of this study was to investigate the effects of transplantation of retinal progenitor cells (RPCs) into the subretinal space (SRS) and the superior colliculus (SC) in a rat model of RIR injury. We used cultured postnatal day 1 rat RPCs transfected with adeno-associated virus containing the cDNA encoding enhanced green fluorescence protein (EGFP) for transplantation. RIR injury was induced by increases in the intraocular pressure to 110 mmHg for 60 min. The effects of transplantation were evaluated by immunohistochemistry, electroretinography (ERG), and visual evoked potentials (VEP). We found that in rats with RIR injury, RPCs transplanted into the SRS and the SC survived for at least 8 weeks, migrated into surrounding tissues, and improved the ERG and VEP responses. Cells transplanted into the SC improved the VEP response more than those transplanted into the SRS. Our data suggest that transplantation of RPCs into the SRS and the SC may be a possible method for cell replacement therapy for retinal diseases.

Visual loss after nonocular surgery is rare but devastating. Peak rates of perioperative visual loss are with heart and spine surgery. The two possible main causes of visual loss after cardiac surgery are ischemic optic neuropathy and retinal ischemia due to embolism and / or low perfusion secondary to hemodynamic changes through cardiopulmonary bypass within the retinal, optic nerve and choroidal circulation. Stable preservation of some hemodynamic factors during cardiac surgery seems to be the key to stop visual loss. The purpose of this article is to briefly review perioperative visual loss after cardiac surgery.

Purpose To assess the spectrum of perivenular ischemia in eyes with retinal vascular obstruction (typically central or hemicentral retinal vein obstruction) using en face optical coherence tomography (OCT). Design Retrospective observational case series. Methods Eyes with recent retinal vascular occlusion illustrating paracentral acute middle maculopathy (PAMM) in a perivenular fern-like pattern with en face OCT were evaluated in this study. Multimodal retinal imaging including en face OCT segmentation of the inner nuclear layer was performed in all patients. Color fundus photography and fluorescein angiography (FA) images were used to create a vascular overlay of the retinal veins vs the retinal arteries to map the distribution of PAMM with en face OCT analysis. Results Multimodal retinal imaging was performed in 11 eyes with acute retinal vascular obstruction. While 7 eyes demonstrated obvious findings of retinal vein obstruction (5 with central and 2 with hemicentral retinal vein occlusion), 4 eyes were unremarkable at presentation. En face OCT analysis demonstrated a spectrum of perivenular PAMM illustrating a fern-like pattern with sparing of the periarteriolar area in all cases. Conclusion En face OCT may illustrate a remarkable perivenular pattern of PAMM in eyes with retinal vascular obstruction even in the absence of significant funduscopic findings. Perivenular PAMM with en face OCT demonstrates a wide spectrum of variation with narrow fern-like perivenular lesions at the mildest end and more diffuse lesions with only periarterial sparing at the most severe end of the spectrum. Arterial hypoperfusion secondary to outflow obstruction from a central retinal vein obstruction appears to be the most common cause of this presentation, although primary arterial hypoperfusion may also be an etiology.

Early detection of cystoid macula edema (CME) is critical for diagnosis and management. Traditional methods of accessing macular edema include contact and noncontact slit lamp biomicroscopy, indirect ophthalmoscopy, fluorescein angiography (FA), and fundus stereo photography. However the interpretation of their results can be subjective, and subtle changes in retinal thickness in early CME may not be evident.

Biomedical Image Processing is one of the significant DSP applications which need accurate mathematical platform to produce best results in understanding and to diagnose the various diseases. Eye is one of the sensitive organs in human body which have disorders like Glaucoma, Diabetic and Hypertensive Retinopathy, Retinal Vascular Occlusion etc., are not visible to naked eye; hence images of eye's back part are captured using fundus photography are processed. Various applications like Image Negative, Image Enhancement, Image Segmentation and Image Contrast Stretching are modeled in MATLAB using Simulink and Xilinx blocksets and the code is generated using Xilinx System Generator (XSG) Token. Power calculations, Timing and Delay calculations, Look Up Table (LUT) calculations are performed to implement design on FPGA. The results obtained from Power calculations and Delay calculations shows that techniques developed here consumes relatively low power and combinational path delay is less.

A 57-year-old woman underwent treatment of a left internal carotid artery aneurysm with a Pipeline embolization device. She subsequently experienced multiple branch retinal artery occlusions in her left eye. Although rare, ophthalmic complications may follow this new technique in the treatment of intracranial aneurysms.

RATIONALE Behcet disease is an autoimmune vasculitis, involving multiple systems and organs. It is often chronic and recurrent, and involves all levels of arteries and veins. PATIENT CONCERNS A 40-year-old Chinese male with sudden vision loss in his right eye for 3 days was reported. DIAGNOSES The patient was diagnosed as bilateral uveitis (obstructive retinal vasculitis in the right eye) and Behcet disease. INTERVENTIONS The patient was given topical corticosteroids and compound tropicamide eye drops in our department. In addition, he was also hospitalized in the Rheumatology Department, and received systemic infusion of methylprednisolone and cyclophosphamide. OUTCOMES Best corrected visual acuity vision acuity of the left eye was 20/20 and that of the right eye was no light perception after 2 weeks. During the telephonic follow-up after 1 year, the patient reported 2 recurrent episodes of uveitis in the left eye, which improved after treatment at the local hospital. LESSONS It cautions ophthalmologists of the high possibility of vasculitis in young and middle-aged patients with retinal vascular occlusion. It also reminds the ophthalmologists investigate systemic diseases, and obtain detailed medical history, not just depending on specific laboratory findings. This case further suggests that Behcet disease has diverse manifestations, complex diagnosis, and severe lesions, and the recurrence rate must be controlled to minimize irreversible consequences such as sudden vision loss during recurrence.

Intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents is increasingly used for the treatment of a wide variety of retinal diseases, including age-related macular degeneration, diabetic retinopathy and retinal vascular occlusions, and retinopathy of prematurity. Despite encouraging results in halting the disease and improving the vision, intravitreal injection of anti-VEGF agents may be associated with systemic adverse events and devastating ocular complications. In this review, we provide an overview of safety data for intravitreal injection of common anti-VEGF agents.

Sudden loss of vision, which causes consternation for both the patient and clinician, is a clinical problem that is encountered fairly regularly in most primary healthcare settings. Sudden visual loss or obscuration which is transient may simply be a symptom of a dry eye or a migraine, but it may also be the onset of irreversible visual loss or a stroke. Most cases of sudden loss of vision are serious, require referral and have an associated underlying systemic disease. Visual loss is usually unilateral, but may be bilateral. This clinical problem may present a diagnostic challenge. No cause may be found in some instances. However, it is important to remember that the more sinister causes of sudden visual loss, such as temporal arteritis, carotid or cardiac emboli that cause retinal vascular occlusion, retinal detachment, vitreous haemorrhage and orbital masses, need to be identified early. Using the duration of the visual loss as the primary differentiating factor, with associated symptoms and signs as supplementary factors, the causes can be narrowed down. A thorough history, goal-directed examination, proper investigation and appropriate referral should enable early diagnosis and adequate management. This will prevent further ocular morbidity, and even patient mortality.

The development and approval of anti-VEGF drugs for intravitreal injection has transformed the treatment and prognosis of several ocular conditions, including age-related macular degeneration and retinal vascular occlusion (the subject of this article). Their role in the treatment of ocular conditions is likely to continue to expand owing to the common pathway that VEGF plays in multiple retinal disorders. While important strides have been made, an important treatment challenge is the dosing frequency and the burden that this places on the patient and healthcare providers.

Purpose: Retinal ischemia has been traditionally assessed by fluorescein angiography, visualizing perfused vessels. However, this method does not provide any information about nonperfused vessels, and although it is often assumed that vessels in ischemic areas regress, we know little about how nonperfused retinal vessels change over time. Here, we aim to learn more about the long-term fate of nonperfused vessels in the retinal vasculature.\ud \ud Methods: Optical coherence tomography (OCT) was used to visualize perfusion as well as structural properties of the retinal vasculature in patients suffering from retinal vascular occlusions. In addition, postmortem tissue from a patient with long standing (6 years) central retinal vein occlusion (CRVO) was investigated, using immunohistochemistry on whole-mount retina and paraffin sections to visualize blood vessel components.\ud \ud Results: Comparing OCT angiography with enface OCT images revealed that in ischemic areas of the retina, nonperfused, larger vessels could be detected as hyperreflective structures in enface OCT images. Furthermore, analysis of a postmortem tissue sample from a CRVO patient with a large nonperfused region in the macula, revealed preservation of the basement membrane from all retinal vessels, including nonperfused, acellular vessels of all calibers.\ud \ud Conclusions: Our data suggests long-term preservation of vascular basement membrane in ischemic retina. This has implications for therapeutic approaches aiming to alleviate retinal ischemia via the regeneration of damaged vessels.

Background Retinal ischemia is a retinal disorder related to retinal vascular occlusion, glaucoma, diabetic retinopathy and age-related macular degeneration. The study aimed to evaluate the protective effects and underlying mechanisms of Chi-Ju-Di-Huang-Wan (CJDHW) against retinal ischemia in rats. Methods High intraocular pressure (HIOP)-induced retinal ischemia was established in Wistar rats by raising their intraocular pressure to 120 mmHg for 60 min with in an eye whose anterior chamber was cannulated with a 30-guage needle adapted to a normal saline bottle through an intravenous line. This ischemic insult was followed by 1 or 7 days of reperfusion. The effects of CJDHW were studied by (i) electroretinogram (ERG); (ii) real-time polymerase chain reaction to determine the retinal mRNA levels of Thy-1 and matrix metalloproteinase-9 (MMP-9); (iii) Western blot analysis to determine the retinal protein levels of B cell lymphoma 2 (Bcl-2), heme oxygenase-1 (HO-1), phosphorylated-p38 mitogen-activated protein kinase (P-p38 MAPK) and MMP-9; (iv) hematoxylin and eosin (HE) staining; (v) fluorogold retrograde labeling; and (vi) terminal deoxynucleotidyl-transferase (TdT)-mediated dUTP nick end-labeling (TUNEL) apoptosis assay. Moreover, after fixation with 4 % paraformaldehyde and 30 % sucrose, the isolated retinas were sectioned and immunolabeled with goat anti-choline acetyltransferase (ChAT) polyclonal antibody, mouse anti-vimentin monoclonal antibody and rabbit anti-glial fibrillary acidic protein (GFAP) polyclonal antibody. The retinal sections were then incubated with rhodamine-conjugated rabbit anti-goat antibody, fluorescein isothiocyanate (FITC)-conjugated goat anti-mouse IgG or FITC-conjugated goat anti-rabbit IgG. A daily oral intake of 3 mL of water (vehicle; Group 2) or CJDHW (2.8 or 4.2 g/kg/day; CJDHW2.8 or CJDHW4.2; Group 3 or 4) was given for 7 consecutive days either before (preischemic drug administration) or after HIOP-induced retinal ischemic injury (postischemic drug administration). In Group 5, an intravitreal injection of 4 μL of 0.5 mM SB203580 (p38 MAPK inhibitor) was performed on the ischemic eye 15 min before retinal ischemia. The control rats received a sham procedure (Group 1) where the saline reservoir was not raised. Results The ischemia-induced changes (Group 2) were significantly modulated by pretreating the rats with 4.2 g/kg/day of CJDHW (Group 4; ERG: P

Stephan G Dixon,1 Carl T Bruce,1 Charles J Glueck,1 Robert A Sisk,2,3 Robert K Hutchins,2,3 Vybhav Jetty,1 Ping Wang1 1Cholesterol, Metabolism, and Thrombosis Center, Jewish Hospital of Cincinnati, 2Cincinnati Eye Institute, 3Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, OH, USA Aim: Our specific aim was to document the pathoetiologic importance of thrombophilia among females presenting with severe ischemic retinal vein (RVO) or retinal artery (RAO) occlusion, without typical risk factors, and to emphasize that the ophthalmologists’ diagnosis of thrombophilia has important diagnostic and therapeutic downstream ramifications for nonocular thrombosis, including reproductive outcomes. Methods: We evaluated familial and acquired thrombophilia in 60 females with RVO (central RVO, n=52; branch RVO, n=8) and 16 with RAO (central RAO, n=11; branch RAO, n=5). They were referred by retinologists, without typical risk factors for RVO/RAO and/or severe ocular ischemic presentation. We focused on extraocular thrombotic events, particularly pregnancy complications, including unexplained spontaneous abortion, pre-eclampsia–eclampsia. Thrombophilia measurements in the 76 females were compared with 62 healthy normal females without ocular vascular occlusions (OVOs). Results: The 76 females with OVO were more likely than 62 normal female controls to have high homocysteine (24% vs 0%, P150%) factor VIII (42% vs 11%, P150%) factor XI (22% vs 4%, P=0.004). Of the 76 females, 26 (34%) had ≥1 spontaneousabortion; 17(22%) had ≥2 spontaneous abortions and/or pre-eclampsia–eclampsia. Compared to 62 healthy female controls, these 17 females with pregnancy complications had high homocysteine (29% vs 0%, P=0.0003), high anticardiolipin antibody immunoglobulin M (24% vs 3%, P=0.02), high factor VIII (38% vs 11%, P=0.02), and were marginally more likely to be heterozygous for the factor V Leiden mutation (19% vs 3%, P=0.058). Conclusion: In females lacking typical risk factors for retinal vascular occlusion or severely ischemic presentation, by diagnosing thrombophilia as an etiology for OVO, the ophthalmologist opens a window to family screening and preventive therapy, with particular relevance to pregnancy outcomes and venous thromboembolism. Keywords: thrombophilia, retinal vascular occlusion, retinal vein occlusion, retinal artery occlusion

PURPOSE To describe an adult with chickenpox resulting in systemic vasculitis and bilateral retinal vascular occlusions. METHODS Single case report. RESULTS A 58-year-old man with chickenpox complicated by disseminated varicella-zoster systemic and retinal vasculitis resulting in a combined arterial and venous occlusion in one eye with multiple branch retinal vein occlusions in the other eye. There was no evidence of retinitis. The patient systemically improved after treatment with acyclovir and steroids; however, his vision remained poor. CONCLUSION Chickenpox can be associated with systemic vasculopathy and may rarely result in multiple systemic and ocular infarcts, including severe retinal vascular occlusions.

We report a rare clinical case of a 66-year-old Caucasian male with slightly decreased vision in his left eye. After comprehensive ophthalmic examination and multimodal imaging with fundus photography, spectral domain optical coherence tomography (OCT), fluorescein angiography (FA), and a 30-2 visual field tests, he was diagnosed with congenital retinal macrovessel crossing the fovea avascular zone in his left eye. His right eye is unremarkable on ophthalmic exams. Congenital retinal macrovessel refers to an aberrant vessel, usually a vein, which transverse the macula and supplies both sides of the horizontal raphe. Various retinal abnormalities or clinical complications have been reported in association with congenital retinal macrovessel, such as cystoid macular edema, fovea cysts, macular exudates, hemorrhage, serous retinal detachment and branch vein occlusion. In our patient, there were not significant clinical complications. The reduction in the vision of the left eye could be explained by irregularity and slight enlargement of the foveal avascular zone (FAZ). In addition, patient's congenital macrovessel may have caused a relative angioscotoma, which could also affect the visual acuity (VA).