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1.
Invest Ophthalmol Vis Sci ; 63(13): 25, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36580309

RESUMO

Purpose: To assess the benefits of the cilioretinal artery on macular function in high myopia using the quantitative contrast sensitivity function (qCSF) method. Methods: This cross-sectional study was conducted at the Eye and Ear, Nose, and Throat Hospital of Fudan University. In total, 137 highly myopic patients (with axial length [AL] ≥ 26.00 mm) were enrolled and divided into cilioretinal artery absent and present groups based on their fundus photographs. One eye in each patient was randomly selected. Choroid thickness was measured using macular optical coherence tomography. The best-corrected visual acuity (BCVA) was evaluated by Early Treatment Diabetic Retinopathy Study charts, and the area under the log CSF (AULCSF), CSF acuity, and CS at six spatial frequencies were evaluated with the qCSF method. Results: Although no significant BCVA difference was found between the cilioretinal artery absent (97 patients) and present (40 patients) groups, choroid thickness, AULCSF, CSF acuity, and CSF at low and intermediate spatial frequencies (1-6 cycles per degree) were all significantly higher in the cilioretinal artery present group than in the absent group (all P < 0.05). In addition, eyes with temporal cilioretinal arteries exhibited significantly higher AULCSF, CSF acuity, and CSFs at 3 and 6 cycles per degree (all P < 0.05) than those with a nasal one (all P < 0.05). Multivariate analysis showed that better AULCSF was associated with the presence of cilioretinal artery and the interaction of AL and choroid thickness. Conclusions: The cilioretinal artery may associate with the larger choroid thickness in highly myopic eyes and may play a role in preserving qCSF outcomes, which are more sensitive than chart-based acuity tests.


Assuntos
Sensibilidades de Contraste , Miopia Degenerativa , Humanos , Acuidade Visual , Estudos Transversais , Artérias Ciliares , Tomografia de Coerência Óptica/métodos
2.
Medicine (Baltimore) ; 101(45): e31204, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36397396

RESUMO

RATIONALE: Central retinal artery occlusion (CRAO) sparing the cilioretinal artery (CLRA) with severe subretinal fluid and non-characteristic cherry-red spot is uncommon. In the present case, the patient received an intravitreal injection of anti- vascular endothelial growth factor, which is very rare. PATIENT CONCERNS: A 59-year-old man underwent vitrectomy of the left eye for diabetic retinopathy and vitreous hemorrhage. Six months after the operation, the patient presented with sudden painless visual-acuity decline in his left eye and was diagnosed with CRAO; his best corrected visual acuity was weak light perception. Whole retinal edema was seen on the fundus, and macular gray retinal opacification was present without a characteristic cherry-red spot. Optical coherence tomography revealed subretinal fluid (SRF) in the papillomacular bundle and inner retinal thickening. Fundus fluorescein angiography confirmed that the central retinal artery was not filled at 40 seconds and that the CLRA supplied a part of the macular area. Eight months after the second intravitreal injection of ranibizumab, Optical coherence tomography showed a significant reduction in inner retinal hyperreflectivity and the thickness of the nasal macular retina. The SRF was clearly absorbed, and the visual acuity improved to 1.1 logMAR units. DIAGNOSIS: Atypical CRAO. INTERVENTIONS: The patient was treated with intravitreal injection of anti-VEGF in his left eye. The thickness of the nasal macular retina decreased. OUTCOMES: The SRF was clearly absorbed, and the patient's visual acuity significantly improved. LESSONS: When CRAO occurs in patients with diabetic retinopathy sparing the CLRA, the non-characteristic cherry-red spot may be due to macular inner retinal edema, SRF and other factors. According to the patient's condition, anti-vascular endothelial growth factor can be administered as appropriate to inhibit choroidal neovascularization, reduce SRF in the macular retina, and save some vision.


Assuntos
Retinopatia Diabética , Edema Macular , Papiledema , Oclusão da Artéria Retiniana , Masculino , Humanos , Pessoa de Meia-Idade , Líquido Sub-Retiniano , Retinopatia Diabética/complicações , Retinopatia Diabética/tratamento farmacológico , Papiledema/complicações , Oclusão da Artéria Retiniana/etiologia , Artérias Ciliares , Inibidores da Angiogênese/uso terapêutico , Edema Macular/etiologia , Edema Macular/complicações , Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Anticorpos Monoclonais/uso terapêutico
3.
J Fr Ophtalmol ; 45(10): 1184-1191, 2022 Dec.
Artigo em Francês | MEDLINE | ID: mdl-36319527

RESUMO

PURPOSE: To characterize the magnitude and consequences for interpretation of macular elevations associated with short posterior ciliary arteries (SPCA) extending to the fovea. METHODS: Retrospective study of 96 eyes of 138 patients who underwent multimodal imaging (color photographs, SD-OCT with OCT-angiography analysis, fluorescein angiography [FA] and indocyanine green angiography [ICG]) over a two-year period. The authors selected patients with a focal choroidal elevation (FCE) associated with a SPCA extending to the fovea. FCEs were classified according to their magnitude as "Low" (<50µm), "Medium" (50µm to 100µm) and "High" (>100µm). RESULTS: Ten patients aged 80.10±11.82 years had a FCE associated with a macular SPCA. The patients were followed for advanced AMD with neovascularization (2 cases), advanced AMD with geographic atrophy (3 cases), intermediate AMD (1 case) ; one patient was followed for diabetes ; three patients had no identified retinal pathology. The FCE associated with the SPCAs was Low (3 cases), Medium (2 cases), High (3 cases). In 2 cases, the FCE was limited to an unmeasurable choroidal fold. The interpretation associated with these FCEs was not always related to the magnitude of the elevation. CONCLUSION: Our observations show the value of multimodal imaging in the identification of SPCA extending to the fovea, sometimes associated with a macular FCE. In some cases, the signs associated with FCE interfered with the monitoring of the condition for which the patient was being followed. Identifying these FCEs and grading their amplitude is relevant, as they should not be confused with pathological structures.


Assuntos
Neovascularização de Coroide , Humanos , Estudos Retrospectivos , Neovascularização de Coroide/diagnóstico por imagem , Artérias Ciliares/diagnóstico por imagem , Acuidade Visual , Angiofluoresceinografia/métodos , Imagem Multimodal
4.
Rom J Ophthalmol ; 66(2): 178-184, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35935085

RESUMO

We report a case of a 25-year-old woman with sudden and painless diminution in vision and central scotoma in her left eye (LE). She was a smoker and had been taking combined oral contraceptive (COC) pills for 1 year. On admission, the best-corrected visual acuity (BCVA) was 1,5/50 in the LE. Posterior segment examination revealed optic disc edema with flame-shaped retinal hemorrhages, mildly tortuous and dilated retinal veins. Moreover, retinal edema in the peripapillary and perimacular region, foci of hemorrhages and Roth's spots in the posterior pole, as well as pale superior papillomacular bundle were observed. Fundus fluorescein angiography (FFA) confirmed the delayed flow of contrast through the cilioretinal artery in the LE. The clinical picture suggested left central retinal vein (CRVO) with cilioretinal artery occlusion (CLRAO). All laboratory and imaging tests were normal except for homozygous methylenetetrahydrofolate reductase (MTHFR) gene mutation (A1298C genotypes). However, serum homocysteine (Hcy) level was normal. Low molecular weight heparin (LMWH) treatment was administered. Retinal lesions, as well as BCVA improved, but central scotoma remained. Abbreviations: aPTT = activated partial thromboplastin time, BCVA = best-corrected visual acuity, CBC = complete blood count, CLRAO = cilioretinal artery occlusion, COC = combined oral contraceptive, CRA = central retinal artery, CRP = serum C-reactive protein, CRVO = central retinal vein occlusion, CT = computed tomography, CTA = computed tomography angiography, ECG = electrocardiography, ESR = erythrocyte sedimentation rate, FERG = flash electroretinogram, FFA = fundus fluorescein angiography, GCA = ganglion cell analysis, GCL = ganglion cell layer, Hcy = homocysteine, ICGA = indocyanine green angiography, INR = international normalized ratio, IOP = intraocular pressure, IPL = inner plexiform layer, LE = left eye, LMWH = low molecular weight heparin, mfERG = multifocal electroretinogram, MTHFR = methylenetetrahydrofolate reductase, OCT = optical coherence tomography, RE = right eye, VF = visual field.


Assuntos
Oclusão da Artéria Retiniana , Veia Retiniana , Adulto , Artérias Ciliares , Anticoncepcionais Orais Combinados , Feminino , Heparina de Baixo Peso Molecular , Homocisteína , Humanos , Metilenotetra-Hidrofolato Redutase (NADPH2) , Oclusão da Artéria Retiniana/diagnóstico , Oclusão da Artéria Retiniana/patologia , Oclusão da Artéria Retiniana/terapia , Veia Retiniana/patologia , Escotoma
5.
Int Ophthalmol ; 42(10): 3109-3116, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35511318

RESUMO

PURPOSE: This study aimed to evaluate ocular blood flow and, retinal, choroidal and retinal nerve fiber layer thickness in children with familial Mediterranean fever (FMF) with patients who had at least five attacks. METHODS: Fifty-six patients with FMF and 56 healthy subjects were enrolled in the study. Each participant's choroidal thickness (CT) and retinal thickness (RT) measurements were performed in the foveola and at horizontal nasal and temporal quadrants within 500-µm intervals up to 1.500 µm from the foveola using spectral-domain optical coherence tomography as well as the retinal nerve fiber layer thickness (RNFLT). Disc boundaries were determined manually by identifying seven points on the inner edge of the scleral ring. Following complete ophthalmological evaluation, peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistivity index (RI) values in the central retinal artery (CRA), ophthalmic artery (OA), and nasal posterior ciliary artery (NPCA) were measured using color Doppler ultrasonography (CDU) in the left eyes of the patients diagnosed with FMF and the controls. The results were subsequently compared. RESULTS: No statistically significant differences were observed between the groups in terms of all RNFLT quadrant and RT measurements. All CT measurements were thinner in patients with FMF than in the controls (For Central and Temporal_1500 p = 0.01; For Temporal_500, Nasal 500 and Nasal_1000 p < 0.001; Temporal_1000 p = 0.002) except than the Nasal_1500 point. For nasal_1500 p = 0.121). The PSV and EDV values in the OA, CRA, and NPCA were significantly lower in patients with FMF compared to healthy controls (p < 0.001 for all). In contrast, the RI values of all arteries were significantly higher than in the control group (Regarding OA, CRA and NPCA RI, p = 0.003, p = 0.039, and p = 0.039, respectively). CONCLUSIONS: The results of this study support the idea that chronic inflammation and frequent attacks in FMF may have an effect on decreased ocular blood flow and choroidal thinning.


Assuntos
Febre Familiar do Mediterrâneo , Artéria Retiniana , Velocidade do Fluxo Sanguíneo/fisiologia , Criança , Corioide , Artérias Ciliares/diagnóstico por imagem , Febre Familiar do Mediterrâneo/complicações , Febre Familiar do Mediterrâneo/diagnóstico , Humanos , Fibras Nervosas , Artéria Oftálmica/diagnóstico por imagem , Artéria Retiniana/diagnóstico por imagem , Ultrassonografia Doppler em Cores/métodos
7.
Lupus ; 31(5): 582-587, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35343283

RESUMO

OBJECTIVE: To analyze the blood flow in retrobulbar vessels in systemic lupus erythematosus (SLE) by color Doppler imaging (CDI) and to investigate the associations between immunological markers, retinal abnormalities, disease activity, and vascular parameters. METHODS: We examined 30 patients with SLE who were aged 32.1 ± 11.6 years with a disease duration of 68.0 ± 55.6 months and 30 participants in a control group. The peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI), and resistive index (RI) of the ophthalmic artery (OA), central retinal artery (CRA), and posterior ciliary arteries (PCAs) were determined. Physical and ophthalmic examinations with assessments of immunological markers were performed. All parameters were compared between SLE patients and normal controls while the correlations among parameters were analyzed. RESULTS: In the SLE group, CDI confirmed blood flow abnormalities in the CRA and PCAs, with significantly lower blood flow velocities and increased RI and PI (p < 0.05). There was a significantly negative correlation between disease duration and EDV in the CRA, PCA, and OA (p = 0.0423, 0.0453, 0.0448). There was also a significant relationship between the SLE Disease Activity Index and the PI of the OA (p = 0.0367). The patients who had received biological agents (Rituximab) had lower EDV in the CRA and PCA (p = 0.0026, 0.028). SLE patients with kidney or CNS involvement had a significant increase in the PI in the OA (p = 0.0287). The PSV and EDV in the CRA were significantly related to creatinine (p = 0.0007 and 0.0418). We also noted a significant decreased EDV in the CRA and an increased RI in the OA among participants positive for anti-dsDNA antibodies (p = 0.0331 and 0.0228). CONCLUSIONS: Retrobulbar circulatory disturbances were detected in SLE patients by CDI. These findings seem likely to affect smaller vessels like the CRA and PCA. However, the presence of measurable changes in the OA is generally indicative of a coexistent nephropathy or central nervous system (CNS) vasculitis. Creatinine, the disease activity index, being positive for anti-dsDNA, and receiving biological agents were associated with measurable changes on the retrobulbar blood flow.


Assuntos
Artérias Ciliares , Lúpus Eritematoso Sistêmico , Adulto , Anticorpos Antinucleares , Velocidade do Fluxo Sanguíneo/fisiologia , Artérias Ciliares/diagnóstico por imagem , Artérias Ciliares/fisiologia , Humanos , Artéria Oftálmica/diagnóstico por imagem , Artéria Oftálmica/fisiologia , Fluxo Sanguíneo Regional/fisiologia , Adulto Jovem
8.
BMJ Case Rep ; 15(2)2022 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-35228223

RESUMO

A young boy in his 20s presented with sudden diminution of vision in right eye 2 days ago. Best-corrected visual acuity was hand movement in right eye and 20/20 in left eye. Funduscopy demonstrated diffuse retinal opacification and swelling at the posterior pole with a cherry red spot at the macula. There was sparing of the superonasal macula with a patent cilioretinal artery. OCT showed diffuse inner retinal thickening of the temporal macula. He was diagnosed as central retinal artery occlusion with cilioretinal sparing in right eye. He was a known case of Eisenmenger syndrome secondary to a large congenital ventricular septal defect. Medical history was notable for prominent pulmonary hypertension and shortness of breath on exertion. Physical examination revealed a harsh systolic murmur. Extremities showed digital erythema and severe clubbing. Chest X-ray demonstrated cardiomegaly. Laboratory examination revealed haemoglobin-220 g/L, haematocrit-60%, serum iron-20 µg/dL.


Assuntos
Complexo de Eisenmenger , Oclusão da Artéria Retiniana , Artérias Ciliares , Complexo de Eisenmenger/complicações , Complexo de Eisenmenger/diagnóstico , Angiofluoresceinografia , Humanos , Masculino , Oftalmoscopia , Oclusão da Artéria Retiniana/complicações , Oclusão da Artéria Retiniana/diagnóstico
9.
J Fr Ophtalmol ; 45(4): 398-404, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35123811

RESUMO

PURPOSE: To explore the retinal vascular morphology and blood flow characteristics of patients with varying degrees of intracranial internal carotid artery (IICA) stenosis. MATERIALS AND METHODS: A total of 280 eligible patients were divided into non-stenosis (n=39), mild stenosis (n=80), moderate stenosis (n=83) and severe stenosis groups (n=49). Hemodynamic indices of the posterior ophthalmic artery (OA), central retinal artery (CRA) and posterior ciliary artery (PCA) in the dark zone of optic nerve were detected using color Doppler ultrasonography. CRA equivalent (CRAE), central retinal vein equivalent (CRVE) and arteriole-to-venule ratio (AVR) within 0.5-1.0 PD from the optic disc rim to the center of the fundus image were measured using IVAN software. The diagnostic values of PCA peak systolic velocity (PSV) and end-diastolic velocity (EDV) for severe IICA stenosis were evaluated by receiver operating characteristic (ROC) curves. RESULTS: The blood flow parameters (PSV and EDV) of the OA, CRA and PCA in the severe stenosis group were the lowest (P<0.05). The PSV and EDV of the OA, CRA and PCA had significant negative correlations with severe IICA stenosis, and PCA PSV was more sensitive in the presence of the same index. The areas under the ROC curves for PCA PSV and EDV were 0.722 and 0.761, respectively, indicating that PCA PSV and EDV had high diagnostic values. CONCLUSIONS: There is no correlation between retinal vascular morphology and IICA stenosis. Severe IICA stenosis has significant negative correlations with ocular the blood flow parameters PSV and EDV, and PCA PSV is most sensitive with the same index, thus being a potential predictive index.


Assuntos
Estenose das Carótidas , Disco Óptico , Artéria Retiniana , Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Artérias Ciliares/diagnóstico por imagem , Constrição Patológica , Hemodinâmica , Humanos , Artéria Oftálmica/diagnóstico por imagem , Artéria Retiniana/diagnóstico por imagem
11.
Retina ; 42(3): 485-493, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-35188490

RESUMO

PURPOSE: To explore the condition of fellow eyes of patients with macular neovascularization Type 3 (MNV3) and to verify whether the retinal-choroidal anastomosis (RCA) develops equally in all MNV types. METHODS: The contralateral eyes of 94 patients with MNV3, 96 patients with MNV1, and 96 patients with MNV2 were included. Multimodal imaging was performed. The MNV3 stage including the development of fibrosis and RCA over 24 months was determined. RESULTS: In the contralateral eyes of patients of the solitary (one lesion) MNV3 group, 32 eyes (42.1%) showed early/intermediate age-related macular degeneration, 25 eyes (33%) showed MNV3, and 11 eyes (14.5%) experienced fibrosis, of which 4 eyes (5.2%) had a RCA, 7 eyes (9.2%) had atrophy after resolved MNV3, and 1 eye (1.3%) developed MNV1. In the multifocal (more than one lesion) MNV3 group, 2 eyes (11.1%) showed early/intermediate age-related macular degeneration, 9 eyes (50%) showed 15 MNV3 lesions, and 4 eyes (22.2%) showed fibrosis, of which 2 eyes (11.1%) manifested with a RCA and 3 eyes (16.7%) showed atrophy after resolved MNV3. The number of eyes with a RCA accounted for 40% of all eyes with fibrosis. The count of simultaneous bilateral multifocal MNV3 was 5 (55.6%). In the MNV1 and MNV2 groups, no eye developed a RCA. The incidence of RCAs in the scarred eyes in MNV3 was significantly higher (P < 0.0001). CONCLUSION: Retinal-choroidal anastomosis is an exclusive clinical feature of MNV3. The development of the multifocal MNV3 is usually bilateral and simultaneous. The occurrence of fibrosis in MNV3 has decreased dramatically after the introduction of the antiangiogenic therapy.


Assuntos
Fístula Artério-Arterial/diagnóstico por imagem , Corioide/irrigação sanguínea , Artérias Ciliares/patologia , Neovascularização Retiniana/diagnóstico por imagem , Vasos Retinianos/patologia , Idoso , Idoso de 80 Anos ou mais , Artérias Ciliares/diagnóstico por imagem , Corantes/administração & dosagem , Estudos Transversais , Feminino , Fibrose/diagnóstico , Angiofluoresceinografia , Seguimentos , Atrofia Geográfica/diagnóstico , Humanos , Verde de Indocianina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Retina/patologia , Vasos Retinianos/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Tempo , Tomografia de Coerência Óptica
12.
Retin Cases Brief Rep ; 16(2): 141-144, 2022 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31725598

RESUMO

PURPOSE: To describe clinical features including multimodal imaging in a rare case of presumed embolic cilioretinal artery occlusion with long-term follow-up examination. METHODS: A 61-year-old man presented after noticing an acute-onset central scotoma in the left eye during coronary arteriography. Fundus color photography, red-free imaging, near-infrared reflectance, spectral domain optical coherence tomography (OCT), fluorescein angiography, and swept-source OCT angiography were performed. RESULTS: Color and red-free fundus imaging both showed retinal whitening in the territory corresponding to a cilioretinal artery in the left eye. Consistent with an ischemic event, the near-infrared reflectance showed a hyporeflective area in the same location. Spectral domain OCT showed hyperreflectivity and generalized thickening of the inner nuclear layer, ganglion cell layer, and retinal nerve fiber layer. Seven years later, color, red-free, and near-infrared reflectance imaging appeared normal, but the spectral domain OCT showed thinning of all retinal layers in the affected area. Furthermore, swept-source OCT angiography demonstrated markedly reduced capillary flow signal in the superficial and deep capillary plexuses, corresponding to a persistent scotoma described by the patient. CONCLUSION: This case report illustrates hallmark features of a rare presumed embolic cilioretinal artery occlusion and its long-term manifestations with thorough historical and multimodal imaging data. When standard fundus imaging with color, red-free, and near-infrared reflectance appears normal years after a retinal vascular insult, OCT and OCT angiography can corroborate a patient's persistent visual deficit and provide clarity to the diagnosis.


Assuntos
Oclusão da Artéria Retiniana , Artérias Ciliares/diagnóstico por imagem , Angiofluoresceinografia , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Oclusão da Artéria Retiniana/diagnóstico por imagem , Vasos Retinianos/diagnóstico por imagem , Escotoma , Tomografia de Coerência Óptica
13.
J Neuroophthalmol ; 42(1): e437-e439, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-34238887

RESUMO

ABSTRACT: Paracentral acute middle maculopathy (PAMM) is a relatively new optical coherence tomography finding, defined by hyperreflectivity in the inner nuclear layer. In this article, we present a case of a 73-year-old woman who presented with transient vision loss followed by the sudden onset of complete vision loss to counting fingers at 1 foot for one day in the left eye. Dilated examination showed a right cotton wool spot, left pallid optic disc edema, and retinal edema in the distribution of the cilioretinal artery. OCT demonstrated hyperreflective band at the level of the inner nuclear layer, compatible with PAMM. Clinical and laboratory findings were consistent with GCA, for which she was prescribed high-dose oral prednisone, with confirmation of GCA on a subsequent temporal artery biopsy. PAMM may be seen in the context of GCA, and OCT of the macula serves as an important adjunct to define the retinal manifestations of this condition.


Assuntos
Arterite de Células Gigantes , Macula Lutea , Degeneração Macular , Neuropatia Óptica Isquêmica , Papiledema , Oclusão da Artéria Retiniana , Doenças Retinianas , Idoso , Cegueira/complicações , Artérias Ciliares , Feminino , Angiofluoresceinografia/métodos , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/diagnóstico , Humanos , Macula Lutea/patologia , Neuropatia Óptica Isquêmica/complicações , Neuropatia Óptica Isquêmica/etiologia , Papiledema/complicações , Oclusão da Artéria Retiniana/complicações , Oclusão da Artéria Retiniana/etiologia , Doenças Retinianas/diagnóstico , Tomografia de Coerência Óptica/métodos
14.
Eye (Lond) ; 36(6): 1261-1265, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-34140653

RESUMO

OBJECTIVES: To compare the visual outcome of patients treated for non-arthritic central retinal artery occlusion (CRAO) in a medical centre that uses hyperbaric oxygen therapy (HBOT) as part of the standard of care (SOC) to medical centres that does not. METHODS: The study included data from two tertiary medical centres. The medical records of all patients diagnosed with non-arthritic CRAO without a patent cilioretinal artery between January 2010 and December 2018 in two tertiary medical centres were reviewed. RESULTS: One hundred and twenty-one patients were treated by HBOT and 23 patients received only SOC. In the HBOT group, best-corrected visual acuity (BCVA) improved from 2.89 ± 0.98 logMAR at presentation to 2.15 ± 1.07 logMAR upon the end of HBOT (P < 0.001), while the SOC group had no significant improvement, from 3.04 ± 0.82 logMAR at presentation to 2.80 ± 1.50 logMAR (P = 0.24). With adjustment for age, gender, and the duration of symptoms, final BCVA in the HBOT group was significantly better compared to the control group (P = 0.023). Rates of patients achieving vision of 20/200 or better were similar between groups (17.4% vs. 19.8%, P = 0.523). CONCLUSION: Utilizing HBOT as part of the SOC for CRAO improves the final visual outcome. HBOT is safe and can be implemented, if available, as part of SOC in all tertiary medical centres.


Assuntos
Oxigenoterapia Hiperbárica , Oclusão da Artéria Retiniana , Artérias Ciliares , Humanos , Oxigênio , Oclusão da Artéria Retiniana/terapia , Estudos Retrospectivos
15.
Retina ; 42(2): 381-387, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-34561405

RESUMO

PURPOSE: To investigate the correlation between choroidal vascularity index and the enlargement of geographic atrophy (GA) lesion secondary to age-related macular degeneration during the 2-year follow-up. METHODS: In this longitudinal observational study, 26 eyes (26 patients, mean age 75.7 ± 8.8 years) affected by GA were included. Choroidal vascularity index was calculated in the subfoveal 3000-µm area. The main outcome measure included correlation analysis between baseline choroidal vascularity index and the rate of GA enlargement. RESULTS: During the 2-year follow-up, the mean GA area increased from 6.99 ± 5.28 mm2 to 10.69 ± 6.61 mm2(P < 0.001), accounting for a growth rate of 0.35 ± 0.20 and 0.31 ± 0.17 mm/year after the square root transformation in the first and second year of follow-up, respectively. Stromal choroidal area significantly decreased during the 2-year follow-up (P = 0.002). Interestingly, there was a significant correlation between the baseline choroidal vascularity index and the rate of GA enlargement (r=-0.432, P = 0.027) and between stromal choroidal area and the rate of GA enlargement (r = 0.422, P = 0.032). No other significant relationship was disclosed among choroidal parameters with the rate of GA enlargement. CONCLUSION: Choroidal vascularity index impairment is strictly related to the rate of GA enlargement during the 1-year and 2-year follow-up in patients affected by GA. For this reason, choroidal vascularity index could be considered a predictor of GA progression in the clinical setting, and it could be considered as a new potential biomarker in the efficacy evaluation of new GA interventions.


Assuntos
Corioide/irrigação sanguínea , Artérias Ciliares/fisiopatologia , Atrofia Geográfica/diagnóstico por imagem , Atrofia Geográfica/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Corioide/diagnóstico por imagem , Artérias Ciliares/diagnóstico por imagem , Corantes/administração & dosagem , Progressão da Doença , Feminino , Angiofluoresceinografia , Seguimentos , Atrofia Geográfica/etiologia , Humanos , Verde de Indocianina/administração & dosagem , Degeneração Macular/complicações , Degeneração Macular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fluxo Sanguíneo Regional/fisiologia , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia
16.
Surv Ophthalmol ; 67(2): 570-578, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34332961

RESUMO

There are various hypotheses for the anatomic origin of a choroidal macrovessel. We assess whether a choroidal macrovessel is a dilated posterior ciliary artery. A systematic review of published literature on choroidal macrovessels was performed with two additional cases from our institution. We compared the visible entry and vascular course of the macrovessel in the published literature. We performed a comparative analysis using indocyanine green angiography, swept source optical computed tomography, and 3D reconstruction of two choroidal macrovessels using 3D Slicer (Harvard, Boston, USA, https://www.slicer.org/). From the 14 studies found, 18 cases met inclusion criteria. The reported literature and our two cases showed a radiating course along a sectoral distribution pattern of either short or long posterior ciliary arteries. Our review of literature and 3D reconstruction analysis support the hypothesis that choroidal macrovessels are dilated posterior ciliary arteries.


Assuntos
Corioide , Tomografia de Coerência Óptica , Corioide/irrigação sanguínea , Artérias Ciliares/diagnóstico por imagem , Angiofluoresceinografia/métodos , Humanos , Tomografia de Coerência Óptica/métodos
17.
Int Ophthalmol ; 42(5): 1357-1368, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34822054

RESUMO

PURPOSE: 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. MATERIAL AND METHODS: 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. RESULTS: 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). CONCLUSION: 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.


Assuntos
Glaucoma , Hipertensão Ocular , Artéria Retiniana , Velocidade do Fluxo Sanguíneo/fisiologia , Artérias Ciliares/diagnóstico por imagem , Humanos , Pressão Intraocular , Hipertensão Ocular/diagnóstico , Artéria Oftálmica/diagnóstico por imagem , Artéria Retiniana/diagnóstico por imagem , Ultrassonografia Doppler em Cores
18.
Am J Ophthalmol ; 237: 204-210, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-34780795

RESUMO

PURPOSE: To investigate the association between the presence of a cilioretinal artery (CRA) and advanced age-related macular degeneration (AMD), including the prevalence of choroidal neovascularization (CNV) and geographic atrophy (GA). DESIGN: Retrospective cross-sectional study. METHODS: This was a single-center study. A total of 738 patients with AMD who underwent optical coherence tomography angiography (OCTA) were included in the study. Fundus photographs were reviewed to determine the presence of the CRA. In patients with a unilateral CRA, paired tests were performed between eyes with and without the CRA to compare AMD severity and prevalence of CNV and GA. The main outcomes of interest were AMD stage and prevalence of CNV and GA. Macular vasculature, including vessel density, perfusion density, and foveal avascular zone, were examined using OCTA. RESULTS: A total of 174 eyes from 87 patients with a unilateral CRA were examined. A total of 27.8% and 8.1% of patients had a CRA in 1 eye and both eyes, respectively. Eyes with a CRA showed lower AMD stage (4-step AREDS category; P = .037) and a lower prevalence of CNV (23.0% vs 41.4%; P = .024) than those without a CRA. The prevalence of GA and macular vessel density, perfusion density, and foveal avascular zone measured by OCTA were similar in both groups. CONCLUSIONS: In the eyes with a CRA, AMD stage and prevalence of CNV were lower than those in the eyes without a CRA. However, the effect of the CRA on the macular vascular system remains unclear.


Assuntos
Neovascularização de Coroide , Atrofia Geográfica , Macula Lutea , Degeneração Macular , Artérias Ciliares , Estudos Transversais , Angiofluoresceinografia/métodos , Humanos , Degeneração Macular/complicações , Degeneração Macular/diagnóstico , Degeneração Macular/epidemiologia , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos
19.
J Neuroophthalmol ; 42(2): e514-e516, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34860740

RESUMO

ABSTRACT: Giant cell arteritis (GCA) is a life-threatening vasculitis occurring in older adults that can cause blindness by ischemia of the choroid, retina, and optic nerve. We report a case of a patient who presented with "occult" GCA with severe anterior ischemic optic neuropathy affecting both optic nerves, delayed choroidal filling, and a concomitant cilioretinal artery occlusion in the left eye. The retinal territory supplied by the affected cilioretinal artery was hypoperfused, yet this retinal territory at least partially corresponded to the only preserved visual field in that eye. The sector of the optic disc corresponding to the emergence of the cilioretinal artery was the only sector spared by pallid edema. This pattern of sectoral sparing associated with a cilioretinal artery has been observed in other patients with GCA and in animal models of posterior ciliary artery occlusion. This case serves as a clear example of an incompletely understood phenomenon in posterior pole circulation in vascular occlusive disease that deserves further study.


Assuntos
Arterite de Células Gigantes , Neuropatia Óptica Isquêmica , Oclusão da Artéria Retiniana , Idoso , Animais , Artérias Ciliares , Arterite de Células Gigantes/complicações , Humanos , Neuropatia Óptica Isquêmica/complicações , Neuropatia Óptica Isquêmica/diagnóstico , Oclusão da Artéria Retiniana/complicações , Oclusão da Artéria Retiniana/diagnóstico , Vasos Retinianos
20.
Indian J Ophthalmol ; 70(1): 296-298, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34937260

RESUMO

We describe an effective surgical approach for the management of cilioretinal artery occlusion. A 23-G pars plana vitrectomy assisted with two soft tip cannulas was performed. One cannula pressed the cilioretinal artery branch directed toward the macula, distal to the location of the embolus, whereas the other cannula was used to gently swipe over the cilioretinal artery proximal to the occlusion. Anatomical and functional outcomes were evaluated by fundus examination, fluorescein angiography, Goldmann visual field, and best-corrected visual acuity (BCVA). It was possible to mobilize the embolus by mechanical displacement with 23-G soft-tip cannulas and disintegrate it, preventing the passage toward the branch directed to the macula. Restoration of retinal circulation was confirmed by fluorescein angiogram. The patient recovered his previous documented BCVA and visual field. The described technique can be considered as a new possibility for achieving a solution to cilioretinal artery occlusion or any other retinal artery occlusion.


Assuntos
Embolia , Oclusão da Artéria Retiniana , Oclusão da Veia Retiniana , Artérias Ciliares , Angiofluoresceinografia , Fundo de Olho , Humanos , Oclusão da Artéria Retiniana/diagnóstico
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