Lateral Posterior Ciliary Artery Research Articles

The state of ocular arterial blood flow in active retinopathy of prematurity

Purpose: to study the state of blood flow in the ocular arteries of patients with various forms, stages and course types of active retinopathy of prematurity (ROP). Material and methods. Colour duplex scanning was performed by colour Doppler mapping and pulsed Doppler sonography for 55 premature babies (55 eyes) with active ROP and 8 premature babies (8 eyes) without ROP signs. The children’s gestation age was 25 to 32 weeks, and the body weight at birth was 680 to1760 g. Blood flow was examined in the ophthalmic artery (OA), the central retinal artery (CRA) and the medial and lateral posterior short ciliary arteries (PSCA). Results. The ophthalmic artery revealed no significant differences between the children with ROP and without ROP, except for a significant increase in the peak systolic velocity (Vsyst) in an unfavorable course of stage III of ROP. The development of aggressive posterior ROP is accompanied by a statistically insignificant decrease in blood flow velocity of OA. Hemodynamic parameters of CRA indicate an increase in peripheral vascular resistance in children with an unfavorable course of ROP. A significant increase of Vsyst in the posterior short ciliary arteries was revealed in children with an unfavorable course of stages I–III of ROP and Vsyst, and Vdiast (diastolic blood flow velocity) in children with aggressive posterior ROP as compared with children without ROP. A pronounced impact of the ROP course (favorable or unfavorable) on the Vsyst, Vdiast, and PI indicators in the posterior short ciliary arteries was revealed. The most informative hemodynamic parameters in predicting the course of active ROP are Vsyst and Vdiast values in the ophthalmic artery and Vsyst in the posterior short ciliary arteries. The least informative were the hemodynamic parameters of the central retinal artery. Conclusion. The assessment of hemodynamic changes in eye arteries may be used as an additional diagnostic criterion in the early diagnosis of ROP.

Дифференциально-диагностический подход в оценке характера течения частичной атрофии зрительного нерва

Purpose. To determine the diagnostic criteria for the progressive nature of the course of non-glaucomatous etiology of ONA according to the data of electrophysiological and Doppler studies. Material and methods. In accordance with the purpose of the study, 3 groups were formed of 95 patients aged 37 to 72 years, (average age 56±9 years), 53 of them were men and 42 were women. Clinical data of three clinical groups were compared, of which the first group with stationary ONA, the second with progressive ONA, and the third control group, without pathology of the retina and optic nerve. Results. It was revealed that the progressive nature of the course of non-glaucomatous ONA is influenced by changes in indicators such as electrical lability of the optic nerve, maximum systolic and end diastolic blood flow velocity in the ophthalmic artery and in the lateral posterior short ciliary arteries. Conclusion. The results formed the basis for our development of a method for assessing the course of ONA. Key words: partial atrophy of the optic nerve, electrophysiological studies, Doppler studies.

Anatomical study of the eye arterial blood supply in adult river buffalo (Bubalus bubalis).

Obtaining information about the eye arterial supply in the buffalo can be a criterion for ocular diseases diagnosis and give a morphological basis for even more researches on the related clinical surgery of this animal. The aim of the present study was to describe the course and branches of the arteries supplying the eye in the adult river buffalo (Bubalus bubalis). In this study, the heads of eight buffaloes were prepared from the public slaughterhouse and dissected to study the eye arterial supply. This research results showed that the eye blood supply in the buffalo originates from the external ophthalmic, internal ophthalmic, superficial temporal and malar arteries. The external ophthalmic artery was given rise to branches to take part in the ophthalmic rete mirabile formation and also given off lacrimal, external ethmoidal, supraorbital and ciliary arteries as well as muscular branches to supply the eye ball and extra-ocular muscles. The internal ophthalmic artery was one of the sources of lateral posterior long ciliary artery. The superficial temporal artery was detached off some branches to supply the lateral angle of inferior and superior eyelids as well as lacrimal branch to supply lacrimal gland. The malar artery was originated from the infra-orbital artery and its branches were supplied the medial angle of inferior, superior and third eyelids. There were no obvious differences between buffalo and yak regarding arteries supplying the eyes. However, there were minor differences between buffalo and oxen, sheep and goat and there were obvious differences between buffalo and camel and giraffe.

Evaluating the Effect of Intravitreal Ranibizumab on Retrobulbar Hemodynamics by Color Doppler Ultrasonography in Neovascular AMD.

To evaluate changes in retrobulbar blood flow by using color Doppler ultrasonography (CDUS) after intravitreal ranibizumab injection in patients with neovascular age-related macular degeneration (AMD). Eighteen patients who had undergone intravitreal ranibizumab (0.05 mg/0.05 mL) injection due to choroidal neovascular membrane (CNVM) were included in the study. Contralateral eyes of the patients were also analyzed. Peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI), and resistivity index (RI) were measured from the ophthalmic artery (OA), central retinal artery (CRA), lateral posterior ciliary artery (LPCA), and medial posterior ciliary artery (MPCA) for all patients pre-injection, and at 1 day, 1 week, and 1 month after ranibizumab injection. The mean age of the 18 patients included in the study was 66.94 years (± 8.3 years). Of these 18 patients, eight were female and 10 were male. After Bonferroni's correction for multiple comparisons was carried out, there were significant differences only in some values of LPCA; these included the decrease in EDV and an increase in PI values of LPCA between the pre-injection and post-injection of the first month measurements in uninjected eyes (P = .002, P = .002), and a decrease in PI value of LPCA between post-injection first day and first week measurements in injected eyes (P = .004). There were no statistically significant differences in other parameters. Ocular blood flow velocities may change after intravitreal ranibizumab injection in patients with CNVM. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:437-443.].

Сolor Doppler Imaging in Eye Hemodynamics Evaluation in Syndrome of Thrombotic Microangiopathy

Purpose.To assess the state of blood flow in retrobulbar vessels using the method of color Doppler imaging in thrombotic microangiopathy (TMA) associated with atypical hemolytic uremic syndrome (aHUS), malignant hypertension (MH) and catastrophic antiphospholipid syndrome (CAPS).Methods. The study involved 16 patients aged from 18 to 43 years with TMA associated with aHUS (13 patients), MH (2 patients) and CAPS (1 patient). All patients underwent a study of the state of blood flow in the vessels of the retrobulbar space by color Doppler imaging using a multifunctional ultrasonic diagnostic device Voluson 730 Pro and Voluson E8. The spectrum of blood flow in the ophthalmic artery (OA), central retinal artery (CRA), central retinal vein (CRV), in the medial and lateral short posterior ciliary arteries (SPCA) was recorded and the following parameters were determined: maximum systolic velocity (Vsyst), final diastolic velocity (Vdiast), peripheral resistance index (RI), pulsation index (PI).Results. The analysis of the Doppler blood flow spectrum in all patients with TMA syndrome revealed a decrease in Vsyst in the vessels of the retrobulbar space, more pronounced in the CRA, with an increase in the venous component of the Doppler spectrum. In patients with TMA associated with aHUS and MH Vdiast in the studied vessels were in normal limits or increased, RI and PI were reduced. In aHUS a statistically significant correlation was found between Vdiast in OA and the level of haptoglobin in blood serum, which is a classic marker of intravascular hemolysis.Conclusion. Color Doppler imaging of retrobulbar vessels is an important method for the diagnosis of ocular hemodynamics disorders in the syndrome of TMA. All patients with TMA syndrome are characterized with a decrease in the systolic component of the Doppler spectrum of blood flow in the vessels of the retrobulbar space, especially in the CRA, with an increase in the venous component. With aHUS and MH diastolic blood flow in the retrobulbar vessels corresponds to the norm or increases, RI and PI decrease. In TMA associated with aHUS, the final diastolic velocity of blood flow in OA depends on the level of microvascular hemolysis.

Polycythemia causing posterior segment vascular occlusions

A 44-year-old male patient presented with features suggestive of transient central retinal artery occlusion (CRAO) followed by permanent CRAO and lateral posterior ciliary artery occlusion. He had diagnostic features of polycythemia vera (PV). When presented for the first time, the patient had features of ocular ischemia such as ocular pain, conjunctival congestion, and retinal opacification but with normal arm-to-retina time and normal arteriovenous transit time. During the second presentation, he had ocular pain, congested conjunctiva, retinal opacification, cherry red spot with box-carrying of retinal vessels, and choroidal infarct (Amalric's sign). He had lost light perception in that eye. Patients with polycythemia are prone to multifocal vascular occlusions and this can be the presenting feature in PV. A timely diagnosis and prompt management can prevent these repeated thromboembolic occlusive episodes.

Value of Structural and Hemodynamic Parameters for the Early Detection of Primary Open-Angle Glaucoma

ABSTRACTPurpose: To compare the diagnostic value of ocular blood flow parameters and choroidal thickness (CT) with standard structural parameters for early glaucoma detection.Methods: A total of 32 patients with pre-perimetric glaucoma were compared with 30 age-matched normal subjects. The thickness of the ganglion cell complex (GCC), retinal nerve fiber layer (RNFL), and the choroid and foveal loss volume (FLV) were measured by means of optical coherence tomography (OCT). Retrobulbar blood velocities (Color Doppler Imaging), corneal compensated intraocular pressure (IOPcc), and corneal hysteresis (CH) were also evaluated. Mean ocular perfusion pressure (MOPP) was calculated by measuring IOP and mean arterial blood pressure as MOPP = ([2/3 diastolic BP + 1/3 systolic BP] × 2/3-IOP). The value of each diagnostic indicator (z-value) was calculated using the Wilcoxon–Mann–Whitney test and the area under the receiver operating characteristic curve (AUC).Results: The following indicators had the largest AUC and diagnostic value (z-value): mean blood flow velocity in the vortex veins (AUC 1.0; z-value 5.35) and central retinal vein (0.85; 3.74), diastolic blood flow velocity in the central retinal artery (0.73; 2.74) and lateral short posterior ciliary arteries (0.71; 2.53), IOPcc (0.74; −2.9), CH (0.69; 2.24), CT (0.69; −2.28), GCC (0.67; 2.05), and FLV (0.66; −1.86) to discriminate pre-perimetric glaucoma from healthy subjects.Conclusions: Interestingly, ocular hemodynamic parameters performed better than structural parameters in detecting early glaucoma. This highlights the potential of techniques to measure ocular blood flow in glaucoma diagnostics independently of the question whether perfusion abnormalities are a cause or a consequence of the disease.

Doppler evaluation of ocular vessels in patients with primary open angle glaucoma.

To assess ocular blood flow in patients with primary open angle glaucoma (POAG) with or without progressive visual field loss in comparison with controls. Color Doppler imaging was performed on 78 eyes with established POAG (25 with progressive visual field loss and 53 with stable visual field) and 78 control eyes. Peak systolic velocity, end diastolic velocity (EDV), and resistance index (RI) were measured in the ophthalmic (OA), central-retinal, and medial and lateral posterior ciliary arteries. Peak systolic velocity and EDV were lower and RI was higher in the ocular vessels of eyes with POAG (p < .01). The OA and medial posterior ciliary arteries RI was higher, and the OA EDV was lower in glaucomatous eyes with progressive than with stable visual field loss. The receiver operating characteristic curve showed the optimal cutoff RI to be 0.847. Ocular blood flow appears compromised in eyes with POAG, particularly in those with progressive visual field loss.

Evaluation of retrobulbar blood flow by color doppler ultrasonography after intravitreal ranibizumab injection in patients with neovascular age‐related macular degeneration

This study aimed to evaluate the changes in retrobulbar blood flow by using color Doppler sonography in patients who had undergone intravitreal ranibizumab injection for neovascular age-related macular degeneration (AMD). The study comprised 37 AMD patients who had undergone intravitreal 0.5 mg ranibizumab injection. The ophthalmic artery, central retinal artery, and short lateral posterior ciliary artery of both eyes of patients were evaluated by color Doppler sonography. Peak systolic velocity, end-diastolic velocity, and resistance index were calculated before injection, and after injection on day 7 and day 30. The pre- and postinjection values were compared using Wilcoxon signed rank test. In a comparison with the preinjection values of peak systolic velocity, end-diastolic velocity, and resistance index, the postinjection values at both day 7 and day 30 showed no statistically significant difference in ophthalmic artery, lateral posterior ciliary artery, and central retinal artery (p > 0.05). Similarly, for the same parameters, pre- and postinjection values in the uninjected fellow eye showed no statistically significant difference (P > 0.05). Intravitreal ranibizumab injection for neovascular AMD does not cause a significant change in the retrobulbar blood flow in either the injected eye or the fellow eye.

Extraocular blood flow in multiple sclerosis (MS) patients

AbstractPurpose Buckground: Multiple sclerosis is autoimmune disease which is often associated with vascular dysregulation syndrome (VDS), mediated by endothelin‐1 (ET‐1). Vascular dysregulation syndrome can lead to diminished blood flow in eyeball arteries. The aim of this study is evaluation of retrobulbar hemodynamics in multiple sclerosis (MS) patients.Methods Material of this study consisted of 76 eyes of 38 MS patients (8 males and 30 females, mean age 39,38 years, range : 22‐56 years, SD: 10.02 ) which were recruited from Neurology and Epileptology Department. The healthy controls consisted of 52 eyes of 26 patients ( 3 males and 23 females, mean age: 36.26 years, range: 19‐55 years, SD: 10.88). No patients in the active stage of the disesses. The peak systolic (PSV) and‐ diastolic (EDV) blood flow velocities, indicators of peripheral vascular resistance such as Gosling Index (PI) and Pourcelot Index (RI) of the ophthalmic artery (OA), lateral short posterior ciliary arteries (LSPCA) and central retinal artery (CRA) were measured in each eye, using color Doppler imaging (CDI). In order to compare examined eyes between two groups we used analyze of variance (Unianowa). Additionaly, we analyzed the obtained values of blood flow in patients who received immunomodulation therapy and in patients who passed neuritis optica in history.Results Statistically significant disturbances in the examined eyeball arteries were found in CRA and OA. The affected parameters were: diminished PSV velocity in CRA and OA; EDV in CRA (border of statistical significance); PI, RI in OA and increased EDV in OA.Conclusion This study suggests that in MS eyes may exists of retrobulbar hemodynamics impairment.

The flicker ERG and retinal blood flow relationship in diabetic patients without retinopathy

AbstractPurpose To evaluate the association between functional and hemodynamic alterations of the retina in diabetes mellitus (DM) without retinopathy (NDR).Methods 15 patients (63±6.3 years) with DM type II (duration 6±3.5years) and NDR, and 40 age matched controls were examined. Color Doppler Imaging (CDI) was conducted to visualize blood flow in ophthalmic artery (OA), central retinal artery (CRA), medial and lateral posterior ciliary arteries brevis (PCAB). Photopic and scotopic flicker ERGs (p‐FERG and s‐FERG) were recorded at 8.3, 10, 12, 30 Hz flickering.Results In NDR, the increase of the blood flow peak systolic velocity (V syst) and end diastolic velocity (Vdiast) was noted in AO. The most significant changes in blood flow were observed in CRA and PCAB. A reliable correlations were shown between Vdiast, the resistance index RI in CRA and insulin levels (r=0.64), serum C‐peptide (r=0.60) and the index of insulin resistance IR (r=0.65); between Vdiast, RI in PCAB and insulin levels, the C‐peptide level and IR (r=0.59, 0.56, 0.59, respectively). The amplitude of light and dark adapted FERG at 8.3‐12 Hz declined in more than 60% eyes up to 69‐80%. The p‐FERGs at 24 and 30 Hz did not differ from the control; but we found a sharp increase in s‐FERG (155.5±15.3 ‐ 319.9±21.4% for 24 ‐ 30 Hz respectively). Significant correlation was shown between the 10Hz‐FERG amplitude (but not the 24Hz or 30Hz‐FERG) and Vdiast in CRA and PCAB (r=0.51; r=0.50).Conclusion There is a significant relationship between the retina hemodynamics and physiological effects of insulin, leading to metabolic disorders. Signs of blood flow deficiency in CRA and PCAB in NDR correlated with an early alteration in the photoreceptor function.

In Vivo Human Choroidal Vascular Pattern Visualization Using High-Speed Swept-Source Optical Coherence Tomography at 1060 nm

To investigate the retinal and choroidal vascular pattern, structure, and thickness using high-speed, high axial resolution, swept-source optical coherence tomography (SS-OCT) at 1060 nm, demonstrating enhanced penetration through all choroidal layers. An ophthalmic SS-OCT system was developed operating at 57,000 A-lines/s with 5.9 μm axial resolution and was used to collect 3D images with scanning angles up to ∼70° × 35°. The similar features were observed in the choroidal layers by imaging three healthy volunteers. En face images, extracted at different depths, capture features of the retinal and choroidal vasculature networks and substructure. Retinal and choroidal thicknesses were measured over scanning angles of ∼14° × 14°, yielding retinal and choroidal thickness maps. The retinal layers, choriocapillaris (CC), Sattler's layer (SL), Haller's layer (HL), and the lamina suprachoroid layer (LSL) were delineated in 2D sagittal tomograms. The sagittal tomograms and en face reflectance images over a 2-cm(2) field of view captured the paraoptic, lateral and medial distal short posterior ciliary artery (SPCA) branches as well as the two lateral and medial long posterior ciliary arteries (LPCAs). En face images in the HL revealed the superotemporal, inferotemporal, superonasal, and inferonasal major choroidal vessels. High-speed, high-resolution SS-OCT centered at 1060 nm enables retinal and choroidal vasculature networks visualization, including retina vessels, posterior ciliary artery (PCA) branches, and venous vascular patterns. This technology offers diagnostic opportunities by monitoring change in these networks, substructure, and retinal and choroidal thicknesses during disease initiation and progression.

Ischaemia in the Zinn–Haller circle and glaucomatous optic neuropathy in macaque monkeys

AimsTo elucidate the morphological features of optic neuropathy in an ischaemic model of glaucoma in macaque monkeys.MethodsThe regional degenerative process was investigated by experimentally occluding the paraoptic branches of the...

The island of ischaemia: submacular choroidal nonperfusion in giant cell arteritis

Sir, Olali et al1 presented a case of biopsy-proven giant cell arteritis (GCA) with atypical visual loss. The visual impairment had manifested as bilateral reduction of visual acuity but with sparing of peripheral field. Fluorescein angiography provided the denouement: there was focal perfusion defect localised to the submacular choroid. The angiographic curiosity was more pronounced in the right eye, with its central scotoma of greater eminence, as evidenced by a poorer acuity. The authors noted that this pattern—of isolated focal ischaemic choroidopathy in GCA patients—had been reported earlier.2 However, as the literature burgeons we become ever remiss of treasures from the past. Almost 40 years ago a monograph called ‘Segmental nature of the choroidal vasculature' appeared in the British Journal of Ophthalmology, a masterclass by SS Hayreh on the anatomy and haemodynamics of the choroidal vascular system, with allusion to the superimposition of diseases including arteritis.3 A homage to this contribution better explains the features observed by Olali et al1 in their patient. They wished specifically to report ‘pigmentary disturbance' at the maculae in a case of GCA in whom there appeared no other ophthalmoscopic features. A reference to the oeuvre of Hayreh affords insight: acute submacular choroidal ischaemia causes pallor of the overlying retinal pigment epithelium. Eventually, the pallid zone acquires depigmentation, the precise ophthalmoscopic anomaly visible in the patient under discussion. Indeed the description appended by Olali et al1 to their case report can be elevated to a formulation in dilgenter: in their presented arteritic case, the occurrence of submacular ischaemia (with sparing of the optic nerve head) denoted hypoperfusion in the lateral posterior ciliary artery (LPCA), the vascular stalk that serves the temporal posterior choroid. As perfusion pressure decreased inside the LPCA—in this situation as consequence of arteritis—the submacular choroid was the first casualty of ischaemia because it is a watershed vascular territory. This is the explanatory nub of the clinical constellation detected in this patient. Of further intrigue, the optic nerve head escaped infarction because it retained perfusion from the medial PCA and a meshwork of circumferential short PCAs. With unsuppressed disease progression, however, the inevitable course would have been arteritic anterior ischaemic optic neuropathy, as the operational nerve head feeders succumbed finally to arteritis. Through a marshalling of superb diagrams, the outstanding duo of McLeod and Hayreh,4 both now emeritus professors, have earlier expounded the behaviour of the choroidal tree as observed after piecemeal cauterisation of its various feeder PCAs. Also in this patient, the submacular choroidal ischaemia was cast into a sharp outline by the 19-s image from the angiogram. Later, at 52 s, the outermost fringe of the ischaemic zone had turned indistinct. Explanation for this observation again comes from the experiments of landmark stature, which hark back some 40 years. As ischaemic patches form within the choroid there is remedial response from neighbouring vascular systems, instanced among others by retrograde flux in the vortex veins. When such zones of choroidal ischaemia are captured over days and weeks via serial angiograms, the non-perfused zones are seen to contract in area. The speed of angiographic filling improves through brisk consolidation of collateral flow. Thus, late frames were found to show dye ingress into choroidal zones that showed stark ischaemia in the opening sequence. The broader message for ophthalmologists is that, in its incipient stealthy phase, GCA can produce localised ischaemic patches in the choroid while entirely sparing the optic nerve and retinal arterial system. Ophthalmologists must be cognizant of this possibility when faced with an older patient who has seemingly inexplicable visual loss and biomicroscopic signs of minimal intensity.

Hemi-central retinal artery occlusion in young adults

Dear Editor, We thank Chopdar[1] for the interest in our article,[2] and concur with the author about our finding of early branching of the central retinal artery (CRA) prior to its entry through the lamina cribrosa. We used the term ‘Hemi-central retinal artery occlusion’ to describe a clinical entity. This early branching pattern of CRA has been documented on Doppler imaging [Fig. 7] for the first time in our report.[2] This provides evidence for an embryological basis of the unusual branching pattern of CRA. The author states, “In Case 1, [Fig. 1] shows associated choroidal infarct of the upper half of the fundus.” We agree that choroidal infarction may be seen concomitantly along with central retinal artery occlusion (CRAO) but we did not encounter such lesions in our case, as is also evident from Fig. 3. Choroidal ischemic lesions as seen in malignant hypertension consist of retinal pigment epithelial lesions (secondary to choroidal infarction), serous retinal detachment and in some eyes, white lines due to choroidal sclerosis.[3] Our patients lacked any of these lesions. Fundus fluorescein angiography (FFA) findings of choroidal ischemia may range from delayed filling of choroidal circulation to near-total lack of choroidal perfusion in infarction. A spectrum of choroidal perfusion defects have been reported to exist with CRAO.[4] Amalric described it earlier[5] and similar findings (Amalric sign) have also been reported by others in cases with CRAO and lateral posterior ciliary artery occlusion. The author further states that, “Fig. 2 shows that the upper artery is a cilioretinal artery whereas the lower one is the true central retinal artery.” Figs 2, 9, 14 and 18 depict separate evolution of central retinal hemi-trunks from the optic disc cup and not at the margin of the optic disc.[2] This has been corroborated with Doppler imaging that shows branching from CRA and not from choroidal circulation. Cilioretinal arteries have been shown histologically to originate from short posterior ciliary arteries and, in rare instances, directly from choroidal vessels.[6] First described by Muller in 1856,[6] they appear ophthalmoscopically to emerge from the optic disc or disc margin separately from CRA or its branches.[7] They make a characteristic bend as they leave the disc margin and are recognizable on fundoscopy. It has also been recognized, however, that ophthalmoscopic examination is not a true guide to the presence or absence of a cilioretinal artery.[4] Hence, it is difficult to say just from Fig. 2 of Case 1 that the upper artery is a cilioretinal artery. The author further states that, “FFA in Fig. 3 shows that the upper artery is brighter than the lower indicating that this is an earlier branch”. FFA in our cases shows that the upper artery is brighter than the lower but this does not necessarily mean that it is a cilioretinal artery. However, carotid Doppler study in all cases showed bifurcation of CRA into two hemi-trunks just behind the lamina cribrosa, ruling out the possibility that the upper artery is an earlier branch. We rather postulate that the affected branch being possibly less tortuous in its course shows earlier filling than the other. Finally, the author states that, “Cases 2, 3, and 4 are identical to Case 1 and all of them are associated with choroidal and retinal ischemia”. This aspect has already been dealt with as above.

Letter to the Editor

Embryology of the ophthalmic artery (OA) is complex, as elegantly depicted by Padget in detailed embryonic diagrams about 60 years ago1. However, Lasjaunias et Al explained its processes differently with angiographic images 2 (Figure ​(Figure1).1). According to their explanation, two primitive OAs supply the orbit first, i.e., the ventral OA (VOA) and dorsal OA (DOA) (Figure ​(Figure1A).1A). The VOA is the ocular artery, which originates from the anterior cerebral artery and passes through the optic canal while DOA originates from the internal carotid artery (ICA) at the carotid siphon runs through the superior orbital fissure (SOF). Then, two anastomoses are formed: one near the optic nerve in the orbit between the VOA and DOA (Figure ​(Figure1B),1B), and the other near the intradural optic canal between the VOA and the ICA (Figure ​(Figure1C).1C). The proximal parts of the VOA and DOA regress, resulting in the formation of the adult OA (Figure ​(Figure1D).1D). The remnant of the proximal DOA is the inferolateral trunk (inferior cavernous sinus artery). In the meanwhile, supraorbital artery (branch of the stapedial artery formed from the second aortic arch) also passes through the SOF and contributes to give off branches to the orbit, including ethmoidnasal and lacrimal arteries (Figure ​(Figure1E).1E). This concept has been well accepted in the neuroradiological field for more than 40 years3. Figure 1 Embryology of the ophthalmic artery proposed by P. Lasjaunias. Abbreviation in figures: ACho a, anterior choroidal artery, Br, branch of the primitive internal carotid artery, DOA, dorsal ophthalmic artery, OA, ophthalmic artery, SOF, superior orbital fissure, VOA, ventral ophthalmic artery. According to Padget1 (Figure ​(Figure2),2), however, the DOA first appears at the opposite side of the bifurcation of the primitive ICA, i.e., in front of the branch (future posterior communicating artery), giving off the hyaloid artery (future central retinal artery) and lateral posterior ciliary artery, which supply the dorsolateral aspect of the developing optic vesicle (Figure ​(Figure2A).2A). The VOA appears at the primitive ICA near the origin of the anterior choroidal artery, and gives off the medial posterior ciliary artery, supplying the ventro-medial aspect of the optic vesicle. Subsequently, the origin of the DOA moves proximally after complex anastomotic processes called caudal migrationto the point of the adult OA (Figure ​(Figure2B).2B). It never goes down to the cavernous sinus. The proximal portion of the VOA regresses and the adult OA is formed finally. At the same time, the stapedial artery gives off two branches: supraorbital and maxillo-mandibular artery (Figure ​(Figure2C).2C). The supraorbital artery enters the orbit through the SOF and anastomoses with the VOA-DOA complex, making a small arterial ring around the optic nerve, at the future second intraorbital portion of the adult OA (Figure ​(Figure2D).2D). After regression of the ventral aspect of the arterial ring, the final adult configuration of the OA is established (Figure ​(Figure2E2E). Figure 2 Embryology of the ophthalmic artery observed by DH Padget. Abbreviation in figures: ACho a, anterior choroidal artery, Br, branch of the primitive internal carotid artery, DOA, dorsal ophthalmic artery, OA, ophthalmic artery, SOF, superior orbital fissure, VOA, ventral ophthalmic artery. As the arteries run together with the corresponding nerves in principle, the supraorbital artery accompanies the ophthalmic nerve (V1) and the maxillo-mandibular artery (future infraorbital artery and inferior alveolar artery) accompanies the maxillary (V2) and mandibular nerves (V3), respectively. Thus, each artery accompanies the division of the trigeminal nerves and passes through the corresponding fissure or foramina (SOF, foramina rotundum and ovale). Embryologically, maxillary and mandibular nerves are related to the first aortic arch, but the ophthalmic nerve is different and not related to the first aortic arch. There is a possibility that the ophthalmic nerve is related to the premandibular arch. In consideration of the branching order from the ICA of mandibular artery (vidian artery after exiting the skull base), maxillary artery (inferior hypophyseal artery), and the inferolateral trunk, and accompanying trigeminal nerves, the inferolateral trunk could be related to the dorsal remnant of the premandibular arch (Figure ​(Figure2E2E). In this communication, I would like to revise the widely accepted concept that only the VOA passes through the optic canal and contributes to vision, and the remnant of the DOA is inferolateral trunk. As Padget observed, I believe that the optic canal is for the ocular artery for vision consisting of both the VOA and DOA, and the SOF is for the orbital artery for lacrimal secretion and orbital muscles consisting of the supraorbital artery of the stapedial artery. The DOA is more important for vision than the VOA since the DOA branches off the central artery of the retina.

Amalric sign and central retinal artery with lateral posterior ciliary artery occlusion

Amalric sign and central retinal artery with lateral posterior ciliary artery occlusion

Anatomic Characteristics of the Ophthalmic and Posterior Ciliary Arteries

There is little documentation of the course and relations of the ophthalmic artery (OA) and posterior ciliary arteries (PCAs). The anatomic characteristics of the OA and PCAs were determined from a dissection of 19 neoprene-injected cadaver heads. The intraorbital OA had three segments, considering its relation to the optic nerve in the sagittal plane. The first segment extended from the point where the OA entered the orbit to its curving point. The second segment coursed superomedially from the inferolateral part of the optic nerve, crossing the optic nerve either superiorly or inferiorly. The third segment extended from the curving point of the superomedial distal portion of the second segment to the vessel's termination. The OA was deviated at the junction of its first and second segments, defined as its "angle"; and at the junction of the second and third segments, defined as its "bend." The PCAs arose from the first OA segment, the angle of the OA, the second OA segment and the OA bend. The patterns of branching of the PCAs were medial and lateral and medial, lateral, and superior. The superior PCA and the lateral PCA arose mainly from the angle of the OA, whereas the medial PCA arose from the curving point of the OA. The most frequently observed PCA pattern was a medial PCA and a lateral PCA. The average diameters of the medial PCA, the superior PCA, and the lateral PCA were 0.65, 0.48, and 0.68 mm, respectively. In all cases, pial arteries branching from the PCA and supplying the optic sheath were observed to form a vascular plexus on the optic sheath. The OA and PCAs were surrounded by a network of sympathetic nerves. Because the most common pattern of PCAs is a medial and lateral branch, a surgical approach to the orbit from those directions carries a higher risk of damage to those vessels than a superior or inferior approach.

Microvasculature of the mouse eye: Scanning electron microscopy of vascular corrosion casts

Purpose For drug safety assessment, ophthalmic fundus examination is of diagnostic importance in experimental animals. Interim blood samples are usually collected from the orbital venous sinus in the mouse. This report characterizes the angioarchitecture of the mouse eye. Methods In 10 mice, the microvasculature of the eyes of was investigated using scanning electron micrographs of corrosion casts. Results The mouse eye was characterized as having a rich vasculature with many thick retinal arteries and a well-developed orbital venous sinus. The eye receives its primary blood supply from the external ophthalmic artery, which is divided into three branches: the central retinal artery, as well as the medial and lateral long posterior ciliary arteries. The central retinal artery is divided into 8–9 radiating retinal arteries. The mouse has an orbital venous sinus around the orbit rather than a well-developed orbital venous plexus in the retrobulbar space as is in the rat. The orbital venous sinus is formed by the episcleral veins, the ophthalmic vein, the superior palpebral vein, inferior palpebral vein and numerous anastomotic veins among these veins. Conclusions The mouse ocular vasculature is quite similar to that of rats. It is recommended that the best location for insertion of a capillary tube for collecting blood is in the lateral canthus around the eye where the sinus is larger and is most readily accessible. Functional significance of the vascular patterns of the eye is discussed.

Color Doppler evaluation of the ocular arterial flow changes in chronic obstructive pulmonary disease

Purpose To evaluate the hemodynamic changes in the extraocular orbital vessels of the patients with chronic obstructive pulmonary disease (COPD), using color Doppler ultrasonography (CDU) technique, and to compare the results with those of healthy control subjects. Methods Forty-five patients with COPD and 17 healthy control subjects were included in this study. Patients with COPD were classified according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Fifteen patients of stage I COPD (mild airflow limitation), stage II COPD (worsening airflow limitation) or stage III COPD (severe airflow limitation) were enrolled into Group I, II and III, respectively. End tidal carbon dioxide (EtCO 2), peripheral oxygen saturation (SpO 2), pulse rate (PR) and respiratory rate (RR) were measured by using capnograph/pulse oximeter in all patients. Measurements were performed in only one randomly chosen eye of each participant. The peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI) were measured in the ophthalmic artery (OA), central retinal artery (CRA), lateral short posterior ciliary artery (LPCA) and medial short posterior ciliary artery (MPCA), using CDU technique. Results The PSV measurements of the OA were significantly higher in Groups II and III compared to control group ( p < 0.01, p < 0.001, respectively). The RI values from OA and CRA were significantly higher in Group II and III than the control group ( p < 0.05). The RI values of LPCA and MPCA were also significantly higher in Group II than the control subjects ( p < 0.05). When RI values were compared, mean values of LPCA and MPCA were significantly lower in Group III than in Group II ( p < 0.05). There were no significant differences between Group I and control patients about PSVs, EDVs and RI values of all arteries Statistically significant correlations were found for the EtCO 2 with PSV ( r = 0.53, p < 0.01) and EDV ( r = 0.51, p < 0.01) of the OA. Statistically significant correlations were also found for the SpO2 with RI ( r = −0.34, p < 0.05) in the OA. Conclusion We concluded that COPD is associated with impaired retrobulbar hemodynamics, especially in the ophthalmic artery. Moreover, central retinal and posterior ciliary arteries with increased resistance are also found to be affected when compared with healthy control eyes.