Ocular Circulation Research Articles

Improving effects of topical administration of iganidipine, a new calcium channel blocker, on the impaired visual evoked potential after endothelin-1 injection into the vitreous body of rabbits

To investigate the effect of topical iganidipine, a new dihydropyridine derivative calcium channel blocker, on impairment of the ocular circulation caused by endothelin-1 (ET-1), we examined modification of the effect of ET-1 on visual-evoked potential (VEP) in albino rabbits. To clarify whether VEP could be used to indicate the extent of ocular circulatory impairment, we evaluated the dose dependency of changes in VEP over 2 hours after intravitreal injection of 3 ET-1 doses (1.0, 3.3, or 10 pmol) and the vehicle. Then modification of the effect of ET-1 on the VEP by iganidipine was examined. One hour after the topical instillation of 0.1% iganidipine (20 microl) or its vehicle, 10 pmol of ET-1 was injected into the vitreous in rabbits. The VEP was measured for 2 hours after ET-1 application, and the response was compared between the eyes with iganidipine and vehicle pretreatment. Intravitreal injection of ET-1 dose-dependently reduced the VEP amplitude. Topical administration of 0.1% iganidipine significantly suppressed the reduction of VEP amplitude for the entire 2-hour monitoring period after intravitreal injection of 10 pmol ET-1. There was no significant change of the systemic blood pressure as well as intraocular pressure after topical administration of iganidipine. Iganidipine eyedrops may be useful for the treatment of ischemic retinal and optic nerve disorders related to abnormal ET-1 production for the maintenance of visual function.

Improving effects of topical administration of iganidipine, a new calcium channel blocker, on the impaired visual evoked potential after endothelin-1 injection into the vitreous body of rabbits

Purpose. To investigate the effect of topical iganidipine, a new dihydropyridine derivative calcium channel blocker, on impairment of the ocular circulation caused by endothelin-1 (ET-1), we examined modification of the effect of ET-1 on visual-evoked potential (VEP) in albino rabbits. Methods. To clarify whether VEP could be used to indicate the extent of ocular circulatory impairment, we evaluated the dose dependency of changes in VEP over 2 hours after intravitreal injection of 3 ET-1 doses (1.0, 3.3, or 10 pmol) and the vehicle. Then modification of the effect of ET-1 on the VEP by iganidipine was examined. One hour after the topical instillation of 0.1% iganidipine (20 µl) or its vehicle, 10 pmol of ET-1 was injected into the vitreous in rabbits. The VEP was measured for 2 hours after ET-1 application, and the response was compared between the eyes with iganidipine and vehicle pretreatment. Results. Intravitreal injection of ET-1 dose-dependently reduced the VEP amplitude. Topical administration of 0.1% iganidipine significantly suppressed the reduction of VEP amplitude for the entire 2-hour monitoring period after intravitreal injection of 10 pmol ET-1. There was no significant change of the systemic blood pressure as well as intraocular pressure after topical administration of iganidipine. Conclusions. Iganidipine eyedrops may be useful for the treatment of ischemic retinal and optic nerve disorders related to abnormal ET-1 production for the maintenance of visual function.

Is vascular regulation in the central retinal artery altered in persons with vasospasm?

To assess the relation between ocular perfusion pressure and blood flow velocity in the central retinal artery in patients with acral vasospasm. Eighteen otherwise healthy subjects with acral vascular dysregulation, as demonstrated by nail-fold capillaroscopy, and 18 age- and sex-matched healthy volunteers without vasospasm were recruited. After subjects had rested for 20 minutes in a supine position, intraocular pressure and blood flow velocity in the central retinal artery were determined by applanation tonometry and color Doppler imaging, respectively. The peak systolic velocity, end-diastolic velocity, and resistivity index were assessed. Correlations between the mean ocular perfusion pressure (2/3 x [2/3 x diastolic blood pressure + 1/3 x systolic blood pressure] - intraocular pressure) and blood flow velocities in the central retinal artery were determined by the Pearson linear correlation factor. The Student t test was used to evaluate differences between controls and subjects with vasospasm. The mean +/- SD ocular perfusion pressure was 42.0 +/- 7.4 mm Hg in the group with vasospasm and 47.1 +/- 6.5 mm Hg in the control group (P= .04). In the subjects with vasospasm, the peak systolic and end-diastolic velocities and the resistivity index of the central retinal artery correlated significantly with the mean ocular perfusion pressure (R = 0.49, P = .04 P = .01; and R = -0.67, P = .002, respectively). Such correlations were not found in the control group. An altered blood flow regulation is suggested in the ocular circulation of patients with acral vasospasm.

Pressure measurements during injection of corticosteroids: in vivo studies.

Intralesional injection of corticosteroids is an effective treatment for capillary hemangiomas. Complications include embolisation of corticosteroid particles into the ocular circulation resulting in permanent loss of vision. This research is aimed at developing an injection cannula and monitoring system to prevent such inadvertent embolisation. A cannula has been designed to simultaneously estimate the pressure at its tip and the flow rate during injection. The estimation technique has previously been validated using an in vitro model. In this study, the cannula was tested in vivo with canine liver at injection flow rates of 2.5 to 21 ml min-1. The pressure generated in the tissue during injection was calculated using the technique developed. This was compared with direct in situ pressure measurements made with a coaxial outer cannula. The mean calculated pressure was seen to be linearly related to the mean measured pressure with a slope of 0.97, correlation coefficient of 0.99 and standard error of 2.74 mmHg. Similar trends were observed between the maximum calculated and maximum measured injection pressure: slope = 1.0, r = 0.99 and standard error = 5.54 mmHg. The estimation of the mean and maximum pressure from the cannula and monitoring system was accurate in canine liver. High pressures close to 250 mmHg were generated in tissues during injection.

Effects of peribulbar anesthesia on ocular blood flow in patients undergoing cataract surgery

PURPOSE: The effects of extraconal, peribulbar anesthesia on ocular blood flow may be caused by concomitant elevations in intraocular pressure or direct pharmacologic alteration of vascular tone. We quantified the effect on ocular circulation with a new technique for assessment of ocular hemodynamics. METHODS: In a prospective study, ocular hemodynamics were measured before and 1 and 5 minutes after peribulbar anesthesia in 22 eyes with age-related cataract. Measurements included fundus pulsation amplitude with a laser interferometric method assessing the pulsatile choroidal blood flow and mean blood flow velocity as well as resistive index in the ophthalmic and central retinal artery with Doppler sonography. Systemic blood pressure and pulse were monitored throughout the period of ocular hemodynamic measurements. RESULTS: Fundus pulsation amplitude decreased significantly after peribulbar anesthesia (after 1 minute and 5 minutes: −13% and −8%; P< .001). In the central retinal artery, mean blood flow velocity dropped (−15%; P < .001) and resistive index increased (+3%; P = .02) 1 minute after peribulbar anesthesia compared with baseline. There were no changes in ophthalmic artery hemodynamics. Intraocular pressure was elevated 1 minute after peribulbar anesthesia (+29%; P = .003) but reached baseline values after 5 minutes. CONCLUSION: Pulsatile choroidal blood flow and retinal blood flow velocities were reduced after peribulbar anesthesia. These reductions were still present 5 minutes after peribulbar anesthesia, when intraocular pressure had returned to baseline values. This supports the theory of drug-induced vasoconstriction after peribulbar anesthesia. A loss of vision may be a risk of peribulbar anesthesia in patients who have compromised ocular blood flow before surgery.

Systemic and Ocular Vascular Roles of the Antiglaucoma Agents b-Adrenergic Antagonists and Ca 2+ Entry Blockers

This review addresses whether the antiglaucoma agents β-adrenergic antagonists and Ca 2+ entry blockers cause vasoactive effects in the retinal and other ocular vasculatures, as they do in other tissues. The potent vasodilating effects of Ca 2+ entry blockers on ocular vessels have recently been demonstrated in in vivo and in vitro studies, implying that the maintenance of ocular vascular tone relies almost exclusively on extracellular Ca 2+. Ca 2+ entry blockers may potentially play a role in relaxing the retinal, long posterior ciliary, and ophthalmociliary arteries to improve the ocular circulation in vascular diseases in which there is considerable vascular tone present. The β-adrenergic antagonists are discussed with reference to their antihypertensive role, their effect on other vascular beds, and finally what is known of their effect in the ocular vasculature. The emerging evidence that particular selective β-adrenergic antagonists, such as betaxolol, are also potent Ca 2+ channel entry blockers in other vascular beds is presented. Betaxolol has been shown to induce vasodilatation in the retinal and other ocular vascular beds, although studies have shown that β 1-adrenergic receptors are sparse in these vascular beds. This implies that an alternative mechanism must be responsible for betaxolol-induced vasodilatation. Evidence is presented that betaxolol vasodilates via its potent Ca 2+ channel entry blocking properties, and its potency and ability to vasodilate are compared with those of nimodipine and timolol, as well as with those of other Ca 2+ channel entry blockers. Important areas for future research in this area are discussed.

Progress in measurement of ocular blood flow and relevance to our understanding of glaucoma and age-related macular degeneration.

New technologies have facilitated the study of the ocular circulation. These modalities and analysis techniques facilitate very precise and comprehensive study of retinal, choroidal, and retrobulbar circulations. These techniques include: 1. Vessel caliber assessment; 2. Scanning laser ophthalmoscopic fluorescein angiography and indocyanine green angiography to image and evaluate the retinal circulation and choroidal circulation respectively; 3. Laser Doppler flowmetry and confocal scanning laser Doppler flowmetry to measure blood flow in the optic nerve head and retinal capillary beds; 4. Ocular pulse measurement; and 5. color Doppler imaging to measure blood flow velocities in the central retinal artery, the ciliary arteries and the ophthalmic artery. These technique have greatly enhanced the ability to quantify ocular perfusion defects in many disorders, including glaucoma and age-related macular degeneration, two of the most prevalent causes of blindness in the industrialized world. Recently it has become clear, in animal models of glaucoma, that retinal ganglion cells die via apoptosis. The factors that initiate apoptosis in these cells remain obscure, but ischemia may play a central role. Patients with either primary open-angle glaucoma or normal-tension glaucoma experience various ocular blood flow deficits. With regard to age-related macular degeneration, the etiology remains unknown although some theories include primary retinal pigment epithelial senescence, genetic defects such as those found in the ABCR gene which is also defective in Stargardt's disease and ocular perfusion abnormalities. As the choriocapillaris supplies the metabolic needs of the retinal pigment epithelium and the outer retina, perfusion defect in the choriocapillaris could account for some of the physiologic and pathologic changes in AMD. Vascular defects have been identified in both nonexudative and exudative AMD patients using new technologies. This paper is a comprehensive update describing modalities available for the measurement of all new ocular blood flow in human and the clinical use.

Effects of Long-Term Hypotensive Therapy with Nonselective Beta-Blockers on Ocular Hemodynamics in Primary Open-Angle Glaucoma

Vascular factors have been implicated in the progression of glaucoma, but the impact of long-term beta blocker therapy on ocular circulation remains largely undefined. The purpose of this study was to prospectively evaluate the level of retrobulbar blood flow in patients with primary open-angle glaucoma (POAG) before and during long-term treatment with a nonselective topical beta blocker, and to compare these measures with those in untreated control subjects. Twelve control subjects and 12 patients with POAG were tested for intraocular pressure (IOP), heart rate, blood pressure, contrast sensitivity, visual field sensitivity, and retrobulbar flow velocity as measured by color Doppler imaging (CDI). Patients were evaluated after 4 weeks of drug washout and again after 3 and 6 months of treatment with a nonselective beta blocking agent. Control subjects were tested once. At baseline, patients with POAG had significantly higher IOP than normal controls; CDI measures of the central retinal artery (CRA) and short posterior ciliary artery (SPCA) in the patients were significantly different from those in control subjects. In the patients, treatment resulted in a significant reduction in IOP and in CRA and SPCA resistance index. Untreated patients with POAG have altered circulation in the CRA and SPCA compared with subjects of similar age and gender. These measures recover significantly during topical beta blocker therapy. The relationship of the pretreatment deficit and posttreatment recovery of CDI blood flow measures to the progression and therapeutic impediment of glaucomatous optic nerve deterioration remains to be determined.

Effect of Brimonidine Tartrate on Ocular Hemodynamic Measurements

To study the effect of a selective alpha 2-adrenoreceptor agonist, brimonidine tartrate, on ocular hemodynamics. Eighteen patients with ocular hypertension were enrolled in a prospective, randomized, double-masked study in which 0.2% brimonidine tartrate, administered twice daily, was compared with its vehicle in a crossover fashion. The effect on the ocular circulation was assessed by color Doppler ultrasound, which measured blood flow velocities (peak systolic and end diastolic velocities) in the central retinal, ophthalmic, nasal, and temporal ciliary arteries. The following tests were performed at 2 weekly intervals on both treatments, 0.2% brimonidine tartrate and the placebo: intraocular pressure, heart rate, blood pressure, and color Doppler ultrasound. Velocities and resistivity indices measured by color Doppler ultrasound in the ophthalmic artery, central retinal artery, nasal artery, and temporal ciliary arteries showed no statistically significant differences between the placebo and 0.2% brimonidine tartrate when compared with baseline values and between the groups. Intraocular pressure was decreased by 17.7% +/- 9.5% with 0.2% brimonidine tartrate (vs 9% +/- 8% with placebo). The hemodynamics of the posterior segment of the eye as measured by color Doppler ultrasound do not appear to be altered by 2% brimonidine tartrate.

Pressure measurements during injection of corticosteroids.

Corticosteroid injection into the orbit, eyelid and larynx is a common treatment for inflammation and neoplasm. Complications include embolisation into the ocular circulation resulting in permanent loss of vision. The overall aim of the reported research is to develop an injection cannula and monitoring system which can prevent inadvertent embolisation into the ocular circulation during injection of corticosteroids. To that end, a special cannula was designed that allows simultaneous estimation of pressure at the tip of the cannula and flow rate during injection. The cannula was tested with backpressures corresponding to physiological ranges of 0 to 125 mmHg and injection flow rates of 3 to 11 cm3 min-1. The estimated pressure at the tip of the cannula during injection of corticosteroids was compared with direct pressure measurements. The results show that the mean estimated pressure is linearly related to the mean measured pressure with a slope of 0.99 and correlation coefficient of 0.99. Statistical analyses show that with standard error of estimate (SEE) of 2.14 mmHg, the estimated pressure is well within the 95% prediction interval limits of the measured values. The estimation of pressure from the cannula and monitoring system was accurate and warrants further testing in animal models.

Ontogeny of cerebral and ocular prostanoids and prostanoid receptors: biological and clinical significance in the perinatal period

There exists abundant evidence that prostanoids are important messengers involved in a vast array of biological processes. Recent data suggest those prostanoids exert different roles in the regulation of cerebral and ocular circulation of the newborn compared to the adult. Not only are there ontogenic differences in the cerebral and ocular concentrations of prostanoids, which are higher in the newborn than in the adult, but also their receptor-mediated actions differ with age. Understanding of developmental changes in the characterization and regulation of prostanoid receptors on the cerebral and ocular vasculature sheds significant light on mechanisms that control brain and retinal circulation. In this paper, the results of investigation on ontogeny and developmental regulation of prostanoid receptors and their impact on nitric oxide synthase activity on cerebral and ocular vasculature are reviewed.

The effects of carotid endarterectomy on ocular haemodynamics.

To determine the profile of blood flow velocities and resistive indices in the ocular vessels of patients with atherosclerotic carotid disease and characterise the effect of endarterectomy on these parameters. Following a preliminary study on healthy volunteers, ophthalmic colour Doppler ultrasound examinations were performed on 27 male and 11 female patients with carotid disease. These measurements were compared with central retinal artery perfusion pressures and intraoperative internal carotid artery stump pressures. Significant changes were seen on the endarterectomised side. The peak systolic velocity in the ophthalmic artery, and resistive indices in the ophthalmic artery, central retinal artery and nasal posterior ciliary artery, rose from pre-operative values. No correlation between colour Doppler ultrasound measurements and intraoperative internal carotid artery stump pressures was present. When compared with ophthalmodynamometry readings, a relationship was noted with maximum velocities in the central retinal vein. Carotid endarterectomy alters the haemodynamics in selected vessels of the ocular circulation as measured by colour Doppler ultrasound, but more work is required to determine the clinical utility of this investigative modality.

Latanoprost--a new prostaglandin F2 alpha analog in therapy of glaucoma--an overview

An ideal glaucoma drug reduces intraocular pressure profoundly and long-lastingly without known major side effects. Latanoprost, a new prostaglandin F2 alpha-analogue, indeed has these properties. However, we need long-term experience to exclude major, clinically relevant side effects. The influence of latanoprost on ocular circulation also needs further evaluation. Nevertheless, the clinician does have a new and very potent drug to reduce intraocular pressure. Literature search by Medline.

Role of NO in the O2 and CO2 responsiveness of cerebral and ocular circulation in humans.

It is well known that changes in PCO2 or PO2 strongly influence cerebral and ocular blood flow. However, the mediators of these changes have not yet been completely identified. There is evidence from animal studies that NO may play a role in hypercapnia-induced vasodilation and that NO synthase inhibition modulates the response to hyperoxia in the choroid. Hence we have studied the effect of NO synthase inhibition by NG-monomethyl-L-arginine (L-NMMA, 3 mg/kg over 5 min as a bolus followed by a continuous infusion of 30 micrograms.kg-1.min-1) on the changes of cerebral and ocular hemodynamic parameters elicited by hypercapnia and hyperoxia in healthy young subjects. Mean flow velocities in the middle cerebral artery and the ophthalmic artery were measured with Doppler ultrasound, and ocular fundus pulsation amplitude, which estimates pulsatile choroidal blood flow, was measured with laser interferometry Administration of L-NMMA reduced ocular fundus pulsation. (-19%, P < 0.005) but only slightly reduced mean flow velocities in the larger arteries. Hypercapnia (PCO2 = 48 mmHg) significantly increased mean flow velocities in the middle cerebral artery (+26%, P < 0.01) and fundus pulsation amplitude (+16%, P < 0.005) but did not change mean flow velocity in the ophthalmic artery. The response to hypercapnia in the middle cerebral artery (P < 0.05) and in the choroid (P < 0.05) was significantly blunted by L-NMMA. On the contrary, L-NMMA did not affect hyperoxia-induced (PO2 = 530 mmHg) hemodynamic changes. The hemodynamic effects of L-NMMA (at baseline and during hypercapnia) were reversed by coadministration of L-arginine. The present study supports the concept that NO has a role in hypercapnia induced vasodilation in humans.

Retrobulbar haemodynamic changes studied by colour Doppler imaging in glaucoma.

To determine the effect of spontaneously elevated intraocular pressure (IOP) on the ocular circulation, and evaluate the result of IOP-lowering procedures in terms of haemodynamics. Colour Doppler imaging (CDI) was employed to determine the peak systolic velocity (PSV), end-diastolic velocity (EDV) and time average maximal velocity (TAMV), as well as the Pourcelot ratio (PR) and pulsatility index (PI), of the central retinal artery (CRA), posterior ciliary arteries (PCA) and ophthalmic artery. Various CDI parameters of the eyes with elevated IOP were compared with those of the clinically healthy fellow eyes and the control eyes, separately. Also, data from CDI of glaucoma eyes obtained during the period of elevated IOP and then following IOP-lowering procedures were compared, deliberately avoiding the influence of glaucoma medications. Eyes (n = 12) with elevated IOP showed significantly decreased flow velocities of the CRA and significantly increased PR and PI of the nasal and temporal PCA, compared with the fellow and control eyes, respectively. Following IOP-lowering procedures, the PR and PI of the nasal PCA decreased significantly. Spontaneously elevated IOP may induce haemodynamic changes in the CRA and PCA, but no significant change is identified in the ophthalmic artery. Flow velocities tend to decrease while the resistance indices tend to increase with elevated IOP. Such haemodynamic changes may reverse following normalisation of IOP.

Effect of Chronic Nitrate Treatment on Retinal Vessel Caliber in Open-angle Glaucoma

A recent report has suggested that nitrate therapy may delay the progression of glaucomatous damage. To investigate the mechanism that may mediate this effect, we sought to determine whether nitrate therapy is associated with retinal vasodilatation in patients with glaucoma. Retinal venous and arterial diameters were determined from color fundus photographs of the optic nerve head obtained during a retrospective study designed to investigate any potential effects of chronic nitrate treatment on the progression of glaucomatous pathology. Fourteen eyes of 14 patients who were receiving chronic nitrate therapy for systemic diseases unrelated to glaucoma were randomly selected. Vascular measurements were compared with those of 15 eyes of 15 control patients with glaucoma who did not receive any nitrate therapy. In comparison with control patients, nitrate-treated patients showed significant average vasodilatation of 17% (P = .008) and 13% (P = .01) in the superior and inferior temporal retinal veins, respectively. A 5% increase in average retinal arterial diameter was also detected, but this was not statistically significant. Chronic nitrate treatment is associated with retinal venous dilatation in patients with glaucoma. Although not assessed in this study, it is possible that a protective effect of nitrates may be mediated by a vasoactive effect leading to improved perfusion of the retina and perhaps the optic nerve head, in a similar fashion to what has been observed in the circulation of the heart. Additional studies of the effect of nitrates on the ocular circulation are needed, however, to support this speculation.

Effect of chronic inhibition of nitric oxide synthase on ocular blood flow and glucose metabolism in the rat

AIMSTo investigate the effects of chronic administration of nitric oxide synthase inhibition on ocular blood flow and metabolic demand in the rat and to compare these effects with changes in...

Effects of endothelin-1 (ET-1) on ocular hemodynamics

PURPOSE. There is evidence from in vitro and animal data that endothelin-1 (ET-1) plays an important role in ocular blood flow. The aim of the present study was to investigate the effect of systemic ET-1 administration on ocular circulation in healthy subjects. METHODS. In a double blind, placebo-controlled, randomized, 2-way cross over study in 10 healthy male subjects, we administered stepwise, increasing doses of ET-1 (0 (saline), 1.25, 2.5 and 5.0 ng/kg/minutes; 20 minutes per dose level) or placebo. Blood flow velocity in the ophthalmic artery as well as ocular fundus pulsations in the macula and the optic disc, and systemic hemodynamic parameters were measured. RESULTS. ET-1 dose-dependently reduced fundus pulsations in the macula (maximum effect – 12 ± 2% versus baseline; p < 0.001 versus baseline and placebo) and the optic disc (maximum effect: – 19 ± 5% versus baseline; p < 0.001 versus baseline and placebo), but did not affect blood flow velocity in the ophthalmic artery or systemic hemodynamics. CONCLUSIONS. Endothelin-1 reduces pulsatile blood flow in the choroid and the optic disc at doses which do not affect systemic hemodynamics or flow velocity in the ophthalmic artery. These results indicate that ocular circulation is particularly sensitive to changes in local ET-1 concentration and confirms the hypothesis that ET-1 may play a role in ocular vascular diseases.

Effect of panretinal photocoagulation on the ocular pulse curve

Most studies on the effects of panretinal photocoagulation (PRPC) on ocular circulation are concerned with retinal circulation. In the present study, we examined the ocular pulse curve after PRPC and determined pulsatile ocular blood flow (an indicator of choroidal circulation) and ocular perfusion pressure. In 10 patients with diabetes mellitus (8 with type II and 2 with type I; mean age 64 yrs) and severe, hitherto untreated, bilateral proliferative diabetic retinopathy, an intensive unilateral PRPC with 1500 argon laser burns (spot size: 500 mu) was performed in 2 sessions (interval: 3 wks). Before and-in 3-wk intervals-up to 9 wks after onset of treatment, an ocular pulse curve was recorded using oculo-oscillo-dynamography, and the following variables were determined: ocular pulsation amplitude (OPA), pulsatile ocular blood flow (POBF), systolic ophthalmic artery pressure (SOAP), and systolic ocular perfusion pressure (SOPP). PRPC led to a reduction of OPA and POBF in relation to the untreated contralateral eyes. 3 wks after the 1st coagulation, the reduction averaged 20% (OPA) and 19.1% (POBF). The maximum reduction was found 9 wks after onset of treatment (6 wks after the 2nd coagulation) and amounted to 29.9% and 29.2%, respectively. The differences between photocoagulated and untreated eyes were highly significant on average (P < 0.01; ANOVA) as well as for the time course (P < 0.001). SOAP and SOPP were not changed significantly during PRPC. OPA and POBF are determined by the cardiac cycle-related intraocular volume changes depending predominantly on choroidal blood flow. Thus, the reduction of POBF after PRPC is indicative of a lowered pulsatile choroidal blood flow. The morphological substrate is probably the choriocapillaries closure after photocoagulation described in the literature.

Diagnosis and Treatment of an Ophthalmic Artery Occlusion During an Intralesional Injection of Corticosteroid Into an Eyelid Capillary Hemangioma

To demonstrate the usefulness of simultaneous indirect ophthalmoscopy in the diagnosis and treatment of embolization of the ocular circulation during intralesional injection of corticosteroids into capillary hemangiomas. A 4-month-old infant had an ophthalmic artery occlusion during an intralesional injection of corticosteroids into a right upper eyelid capillary hemangioma. The injection was discontinued immediately and a paracentesis was performed. Fluorescein angiography was performed 20 minutes and three weeks after the ophthalmic artery occlusion. Fluorescein angiography after the paracentesis showed delayed retinal and choroidal filling and large areas of retinal and choroidal ischemia. Three weeks after treatment, the angiographic abnormalities had resolved, and the retinal and choroidal circulations were normal. Twenty-eight months after treatment, the visual acuity was 20/20 in each eye. Ophthalmic artery occlusion can occur during intralesional injection of corticosteroids into capillary hemangiomas. Simultaneous indirect ophthalmoscopy allows the surgeon to discontinue the injection and provide treatment to allow for the best possible visual outcome after this complication.