[Evaluation of non-proliferative diabetic retinopathy with subgroups classified by orbital color Doppler imaging].

PURPOSE: To evaluate the clinical characteristics of 5 non-proliferative diabetic retinopathy (non-PDR) groups classified by blood flow patterns on color Doppler imaging(CDI). METHODS: Eighty-one diabetic patients with non-PDR and normal serum albumin were examined by standard ophthalmic examinations with CDI and evaluated. RESULTS: Fifteen cases (18.5%) showed a normal blood flow pattern, and 26 cases (32.1%) showed a lower velocity only in the central retinal artery (CRA) as seen in conventional diabetic retinopathy. Twenty-nine cases (35.8%) showed a higher velocity in the central retinal vein (CRV) than CRA. Nine cases (ll.l%) had a blood flow pattern as seen in coronary artery disease. The remaining 2 cases (2.5%) showed a blood flow pattern as seen in occlusive carotid artery disease. Patients with narrowed CRV had significantly more frequent cystoid macular edema. Patients with coronary artery disease were significantly older, had lower diastolic blood pressure, and poorer visual acuity. CONCLUSIONS: Half of the subjects with non-PDR belonged to subgroups with specific CDIs, related to diabetic maculopathy and ocular ischemy. It would be useful to predict the prognosis of non-PDR by CDI.

[Differences of ocular circulation in eyes with proliferative diabetic retinopathy after panretinal photocoagulation with and without rubeosis iridis].

PURPOSE: To evaluate the differences of ocular circulation in eyes with proliferative diabetic retinopathy (PDR) after panretinal photocoagulation (PRP) with or without rubeosis iridis. METHODS: Sixteen cases with PDR after PRP were studied. There were eight cases with rubeosis iridis and eight cases without rubeosis iridis. All eyes were given a standard ophthalmic examination and orbital color Doppler imaging tests. RESULTS: The eyes with rubeosis iridis were found in patients who were significantly older (p = 0.05), had significantly lower systemic diastolic blood pressure (p = 0.01), and had significantly higher intraocular pressures (p = 0.03). End diastolic velocity was significantly slower and resistive index was significantly higher in the short posterior ciliary artery (p < 0.01, p = 0.02) and the central retinal artery (p = 0.01, < 0.01) in eyes with rubeosis iridis. A blood flow wave was not detected during diastolic phase in the short posterior ciliary artery in 2 eyes with rubeosis iridis, in the central retinal artery in 7 eyes with rubeosis iridis, and in one eye without rubeosis iridis CONCLUSIONS: The marked decrease in end diastolic velocity in both the central retinal artery and the short posterior ciliary artery was associated with rubeosis iridis, which might be related to the decreasing ocular perfusion pressure.

Correlation between higher blood flow velocity in the central retinal vein than in the central retinal artery and severity of nonproliferative diabetic retinopathy.

PURPOSE: To assess the correlation between a higher blood flow velocity in the central retinal vein (CRV) than in the central retinal artery (CRA) and the severity of nonproliferative diabetic retinopathy (non-PDR). METHODS: We evaluated both eyes of 20 non-PDR patients with higher peak systolic velocity (PSV) in the CRV than in the CRA unilaterally as determined by color Doppler imaging (CDI). The eyes with higher PSV in the CRV were placed in group D2-H, and the fellow eyes were placed in group D2-L. The stage of non-PDR was determined by the guidelines of the Early Treatment Diabetic Retinopathy Study. Normal subjects and non-PDR patients without higher PSV in the CRV were evaluated as CDI controls. RESULTS: Advanced non-PDR (P=0.001) and cystoid macular edema (P=0.02) were statistically more frequent in group D2-H. The velocities in the ophthalmic artery and the short posterior ciliary artery were not statistically different among all groups. The velocities in the CRA were similar in all non-PDR groups and significantly lower than in the normal subjects (P<0.05). The velocities in the CRV were significantly higher only in group D2-H (P<0.001). CONCLUSION: Higher PSV in the CRV than in the CRA was significantly correlated with the severity of non-PDR, especially in the presence of cystoid macular edema.

Classification of ophthalmic artery flow in patients with occlusive carotid artery disease.

PURPOSE: To investigate and classify the ophthalmic artery (OA) flow patterns in patients with occlusive carotid artery disease (OCAD). METHODS: Forty-three patients (52 eyes) with documented OCAD of > or =70% underwent orbital color Doppler imaging. The eyes were first divided into four groups by peak systolic velocity in OA (PSV(OA)): group A, PSV(OA) < or = 0; group B, 0 < PSV(OA) < or = 10; group C, 10 < PSV(OA) < or = 40; and group D, PSV(OA) > 40 cm/s, then further classified by the shape of the OA flow wave. The groups were then compared with respect to the collateral pathway (Co-Path), severity of the OCAD, and systemic diseases. RESULTS: Eyes with unidirectional reverse flow (group A(1)) had a Co-Path from the ipsilateral external carotid artery and 70%-100% OCAD. Eyes with bidirectional reverse flow (group A(2)) had no Co-Path, 75% OCAD, and impending ischemic heart disease (IHD). Group B eyes had dome-shaped OA flow waves with no Co-Path and 99%-88% OCAD. Group C(1) eyes, with normal flow waves, had a Co-Path from the contralateral internal carotid artery and 100% OCAD. Group C(2) eyes, with triangular-shaped flow waves, had no Co-Path, 93%-70% OCAD, and IHD. Group D eyes had normal high flow waves with no Co-Path, 75% OCAD, and hypertension. CONCLUSIONS: The OA flow patterns were variously affected by collateral pathway, severity of OCAD, and systemic diseases.

Ocular circulation in diabetic patients with coronary artery disease.

PURPOSE: To evaluate the ocular circulation in diabetic patients with coronary artery disease (CAD). METHODS: Thirty diabetic patients with diabetic retinopathy of grade 20 or 35, as evaluated by the Early Treatment Diabetic Retinopathy Study, were studied. They were divided into those without CAD (15 cases) and those with CAD (over 75% stenosis of carotid artery; 15 cases). All underwent standard ophthalmic examinations and orbital color Doppler imaging. Fifteen healthy controls underwent the same examinations. RESULTS: The peak systolic velocity in the central retinal artery was significantly lower in the two diabetic groups. The end-diastolic velocity in the central retinal artery was significantly lower only in the diabetic patients with CAD. There were no significant intergroup differences in blood flow velocities in the ophthalmic artery, short posterior ciliary artery, and central retinal vein. The blood flow waves were flattened in the diastolic phase for all orbital arteries in significantly more eyes in the diabetic patients with CAD. Echocardiography, performed only in the diabetic patients with CAD, showed that 10 cases (67%) had reduced systolic functions and/or diastolic functions and/or asynergy of the left ventricle. CONCLUSIONS: A decrease in blood flow velocities in the diastolic phase was found in diabetic patients with CAD. The findings indicate that this is probably related to the decrease in cardiac output.

Case of infectious endocarditis predicted by orbital color Doppler imaging.

BACKGROUND: There are no specific ocular findings for infectious endocarditis. We report a case of infectious endocarditis detected by combining orbital color Doppler imaging (CDI) and ophthalmological findings. CASE: A 47-year-old man suffered from lumbar pain and low-grade fever. He had undergone heart surgery for a ventricular septal defect and received blood transfusions 20 years earlier, and he had started interferon therapy for chronic hepatitis C 8 months previously. Systemic examinations suggested either collagen disease, malignant lymphoma, or infectious disease. OBSERVATIONS: The patient underwent a complete ophthalmological examination, including CDI. Ophthalmoscopy showed multiple cotton-wool patches in both eyes and branch retinal artery occlusion in the left eye. Orbital CDI showed that bilateral ophthalmic arteries and central retinal arteries flowed synchronously with abnormal waves composed of three narrow, sharp peaks. These findings were suggestive of a cardiac valve disorder, which can lead to embolisms. Echocardiography established the diagnosis of infectious endocarditis. CONCLUSIONS: To the best of our knowledge, this is the first reported case of infectious endocarditis detected by orbital CDI.

Optic disk manifestation in diabetic eyes with low serum albumin: late fluorescein staining and high blood flow velocities in the optic disk.

PURPOSE: To evaluate ocular findings and blood flow characteristics in diabetes mellitus (DM) patients with low serum albumin (ALB). METHODS: We studied 106 eyes of 53 type II DM patients without proliferative diabetic retinopathy and panretinal photocoagulation. All underwent standard ophthalmic examinations, color Doppler imaging, and serum ALB measurements. The patients were divided into Group 1 (34 cases) with a serum ALB > or =3.8 g/dl and Group 2 (19 cases) with ALB<3.8 g/dl. RESULTS: All of the optic disks appeared normal by Ophthalmoscopy except one case with the lowest serum ALB. The number of optic disks showing late fluorescein staining was significantly higher in Group 2 than in Group 1. Peak systolic velocities in the central retinal artery (CRA, P=0.02) and central retinal vein (CRV, P<0.001) were significantly higher in Group 2, and significantly correlated with the serum ALB value (CRA; r=0.41, P=0.003 and CRV; r=0.60, P<0.001). CONCLUSIONS: We suggest that low serum ALB enhances the permeability of the vessels in or around the optic disk and induces subclinical optic disk edema, which is characterized by late fluorescein staining and high blood flow velocities in the CRA and CRV.