Ophthalmic Artery Research Articles

The Treatment of Indirect Carotid Cavernous Fistula in a Pediatric Patient With Deep Recurrent Ophthalmic Artery and Hemophilia

The Treatment of Indirect Carotid Cavernous Fistula in a Pediatric Patient With Deep Recurrent Ophthalmic Artery and Hemophilia

Ophthalmic artery originating from anterior inferior cerebellar artery: a rare variation.

The variations of origin of ophthalmic artery are extremely rare. Here, we aimed to present a patient had a rare variation of the ophthalmic artery. The patient had a history of Moyamoya disease. The imaging studies revealed ophthalmic artery origination from basillar artery. In addition, M1-segment fusiform aneurysm, vasculitis and, as a variation, middle meningeal artery originating from the ophthalmic artery were also detected. We presented this case report as it is the first case with ophthalmic artery originating from anterior inferior cerebellar artery. In our case we reported, M1 segment fusiform aneurysm, vasculitis, and as a variation, middle meningeal artery originating from the ophthalmic artery and anterior inferior cerebellar artery as ophthalmic artery origin and hereby present it for inclusion into the literature. Ophthalmic artery anatomical abnormalities occupies so little place in existing literature when nominating rare variations. Ophtalmic artery originating from anterior inferior cerebellar artery firstly defined as an ophthalmic artery variation including its way-out branch structures.

Association between Breast Arterial Calcification on Mammography and Impaired Ocular Perfusion: A Novel Study Using Color Doppler Ultrasonography.

To investigate the relationship between the mammography-detected breast arterial calcification (BAC) and orbital color Doppler ultrasonography (CDUS) results. Our single-center study, included female patients who applied to our hospital between January and May 2022 and underwent mammography and orbital CDUS examinations. Two radiologists evaluated the mammograms, grouped the patients as BAC (+) and BAC (-), and performed orbital CDUS. Continuous variables obtained from CDUS were compared according to the presence of BAC. Also, receiver operating characteristics (ROC) analysis was used to determine the orbital CDUS threshold values for the presence of BAC. A total of 119 women were included with a median age of 62 years, 57 (47.90%) had BAC. Orbital CDUS examination was performed on both eyes of 119 patients (238 eyes in total). Peak systolic velocity (PSV) and end-diastolic velocity (EDV) values of the ophthalmic artery (OA) (P < .001) and EDV of the central retinal artery (CRA) (P < .001) were significantly lower in patients with BAC. Pulsatile index (PI) and resistive index (RI) values of OA (P < .001) and CRA (P < .001) were higher in patients with BAC. In ROC analysis, the cut-off values for the presence of BAC were calculated as OA PI ≥1.415 and OA RI ≥0.755 (P < .001); CRA PI ≥1.135 and CRA RI ≥0.655 (P < .001). Orbital perfusion disorders may be observed in patients with vascular calcification detected on routine mammography. Therefore, a more detailed evaluation of patients with BAC detected on mammography with orbital CDUS may enable early detection and treatment of ocular vascular problems.

Transcriptional responses in a mouse model of silicone wire embolization induced acute retinal artery ischemia and reperfusion.

Acute retinal ischemia and ischemia-reperfusion injury are the primary causes of retinal neural cell death and vision loss in retinal artery occlusion (RAO). The absence of an accurate mouse model for simulating the retinal ischemic process has hindered progress in developing neuroprotective agents for RAO. We developed a unilateral pterygopalatine ophthalmic artery occlusion (UPOAO) mouse model using silicone wire embolization combined with carotid artery ligation. The survival of retinal ganglion cells and visual function were evaluated to determine the duration of ischemia. Immunofluorescence staining, optical coherence tomography, and haematoxylin and eosin staining were utilized to assess changes in major neural cell classes and retinal structure degeneration at two reperfusion durations. Transcriptomics was employed to investigate alterations in the pathological process of UPOAO following ischemia and reperfusion, highlighting transcriptomic differences between UPOAO and other retinal ischemia-reperfusion models. The UPOAO model successfully replicated the acute interruption of retinal blood supply observed in RAO. 60 min of Ischemia led to significant loss of major retinal neural cells and visual function impairment. Notable thinning of the inner retinal layer, especially the ganglion cell layer, was evident post-UPOAO. Temporal transcriptome analysis revealed various pathophysiological processes related to immune cell migration, oxidative stress, and immune inflammation during the non-reperfusion and reperfusion periods. A pronounced increase in microglia within the retina and peripheral leukocytes accessing the retina was observed during reperfusion periods. Comparison of differentially expressed genes (DEGs) between the UPOAO and high intraocular pressure models revealed specific enrichments in lipid and steroid metabolism-related genes in the UPOAO model. The UPOAO model emerges as a novel tool for screening pathogenic genes and promoting further therapeutic research in RAO.

Transcriptional responses in a mouse model of silicone wire embolization induced acute retinal artery ischemia and reperfusion

Acute retinal ischemia and ischemia-reperfusion injury are the primary causes of retinal neural cell death and vision loss in retinal artery occlusion (RAO). The absence of an accurate mouse model for simulating the retinal ischemic process has hindered progress in developing neuroprotective agents for RAO. We developed a unilateral pterygopalatine ophthalmic artery occlusion (UPOAO) mouse model using silicone wire embolization combined with carotid artery ligation. The survival of retinal ganglion cells and visual function were evaluated to determine the duration of ischemia. Immunofluorescence staining, optical coherence tomography, and haematoxylin and eosin staining were utilized to assess changes in major neural cell classes and retinal structure degeneration at two reperfusion durations. Transcriptomics was employed to investigate alterations in the pathological process of UPOAO following ischemia and reperfusion, highlighting transcriptomic differences between UPOAO and other retinal ischemia-reperfusion models. The UPOAO model successfully replicated the acute interruption of retinal blood supply observed in RAO. 60 min of Ischemia led to significant loss of major retinal neural cells and visual function impairment. Notable thinning of the inner retinal layer, especially the ganglion cell layer, was evident post-UPOAO. Temporal transcriptome analysis revealed various pathophysiological processes related to immune cell migration, oxidative stress, and immune inflammation during the non-reperfusion and reperfusion periods. A pronounced increase in microglia within the retina and peripheral leukocytes accessing the retina was observed during reperfusion periods. Comparison of differentially expressed genes (DEGs) between the UPOAO and high intraocular pressure models revealed specific enrichments in lipid and steroid metabolism-related genes in the UPOAO model. The UPOAO model emerges as a novel tool for screening pathogenic genes and promoting further therapeutic research in RAO.

Measurement of transcranial Doppler insonation angles from three-dimensional reconstructions of CT angiography scans.

Blood velocities measured by Transcranial Doppler (TCD) are dependent on the angle between the incident ultrasound beam and the direction of blood flow (known as the Doppler angle). However, when TCD examinations are performed without imaging the Doppler angle for each vessel segment is not known. We have measured Doppler angles in the basal cerebral arteries examined with TCD using three-dimensional (3D) vessel models generated from computed tomography angiography (CTA) scans. This approach produces angle statistics that are not accessible during non-imaging TCD studies. We created 3D models of the basal cerebral arteries for 24 vasospasm patients. Standard acoustic windows were mapped to the specific anatomy of each patient. Virtual ultrasound transmit beams were generated that originated from the acoustic window and intersected the centerline of each arterial segment. Doppler angle measurements were calculated and compiled for each vessel segment. Doppler angles were smallest for the middle cerebral artery M1 segment (median 24.6°) and ophthalmic artery (median 25.0°), and largest for the anterior cerebral artery A2 segment (median 76.4°) and posterior cerebral artery P2 segment (median 75.8°). The ophthalmic artery had the highest proportion of Doppler angles that were less than 60° (99%) while the anterior cerebral artery A2 segment had the lowest proportion of Doppler angles that were less than 60° (10%). These angle measurements indicate the expected deviation between measured and true velocities in the cerebral arteries, highlighting specific segments that may be prone to underestimation of velocity.

Distribution of the Middle Meningeal Artery Variants in Patients Undergoing Embolization for Chronic Subdural Hematoma

The middle meningeal artery (MMA) is a major dural vessel that plays a significant role in developing chronic subdural hematomas (cSDH). Understanding its variable anatomy is essential for the effective management of cSDH and the prevention of complications. Middle meningeal artery anatomy was retrospectively assessed in a population of 92 patients who underwent digital subtraction angiography of cerebral vessels before middle meningeal artery embolization for chronic subdural hematoma. We assessed 121 middle meningeal arteries in 92 patients who underwent digital subtraction angiography for chronic subdural hematoma treatment from October 2020 to July 2023. The most common type in the extended Adachi classification was IC (19.82%) and the rarest was IB (6.31%). The anterior branch of the MMA was the most frequently dominant, while the most common origin of the posterior branch was observed in the distal segment. We reported 4 cases (3.31%) of the MMA arising from the ophthalmic artery. The most common configuration of MMA was Adachi-type IC. The MMA most often originated from the maxillary artery. The anterior branch of the MMA was typically dominant, and the posterior branch most frequently originated from the distal segment. There was no significant impact of Adachi type on treatment results or fluoroscopy time.

Histamine H3 receptor antagonist/nitric oxide donors as novel promising therapeutic hybrid-tools for glaucoma and retinal neuroprotection

Glaucoma is a degenerative optic neuropathy in which the degeneration of optic nerve and blindness occur. The main cause is a malfunction of ciliary processes (protrusions of the ciliary bodies) resulting in increased intraocular pressure (IOP). Ocular hypertension (OHT) causes ischemic events leading to retinal ganglion cell (RGC) depletion and blindness.Histaminergic and nitrergic systems are involved in the regulation of IOP. Therefore, we developed novel hybrid compounds that target histamine H3 receptor (H3R) with nitric oxide (NO) releasing features (ST-1989 and ST-2130). After H3R binding was proven in vitro, we investigated their effects in two OHT models in New Zealand White rabbits. Compound ST-1989 showed the highest NO elevation, together with antioxidative and anti-inflammatory features partly superior to the co-administered H3R antagonist (ciproxifan) and NO donor (molsidomine). This hybrid compound demonstrated IOP reduction in both OHT models induced by intravitreal injection of hypertonic saline and carbomer into the anterior chamber of the eye, respectively. Ocular perfusion and photoreceptor neuroprotection were evaluated in a model of ischemia/reperfusion (I/R) of the ophthalmic artery induced by repeated sub-tenon injections of endothelin-1 (ET-1), twice a week for six weeks. Compound ST-1989 counteracts retinal degeneration reducing ophthalmic artery resistance index and increasing photoreceptor responses, thus rescuing RGCs.Our results indicate that compound ST-1989 is a promising molecule with long-lasting hypotensive effects and good effectiveness in reducing inflammation, oxidative stress, and RGCs apoptosis. In conclusion, these hybrid compounds could be a novel strategy to combat glaucomatous blindness and RGC depletion for ocular diseases involving retinal damage.

Treatment of Acute Iatrogenic Cerebrovascular Injury Using Flow Diverter Stents

BACKGROUND AND OBJECTIVES: Iatrogenic cerebrovascular injury can cause intracranial hemorrhage and pseudoaneurysm formation, putting patients at high risk for postoperative bleeding. No consensus for management exists. This study describes endovascular treatment of these acute injuries with flow diverter stents. METHODS: Electronic medical records were retrospectively reviewed for injury type and etiology, timing of diagnosis, and endovascular management, including antiplatelet regimens, embolization results, and clinical outcome. RESULTS: Six patients were included. Three suffered an injury to the internal carotid artery, 1 suffered an injury to the left anterior cerebral artery, 1 suffered an injury to the right posterior cerebral artery, and 1 suffered an injury to the basilar artery. Four of the 6 injuries occurred during attempted tumor resection, 1 occurred during cerebrospinal fluid leak repair, and 1 occurred during an ophthalmic artery aneurysm clipping. All injuries resulted in pseudoaneurysm formation. Four were immediately detected on angiography; 2 were initially negative on imaging. Five were treated with a pipeline embolization device, and 1 was treated with a Silk Vista Baby. Two were treated with 2 pipeline embolization devices telescopically overlapped across the pseudoaneurysm. All devices deployed successfully. No pseudoaneurysm recurrence or rebleeding occurred. No parent artery occlusion or stenosis was observed, and complete pseudoaneurysm occlusion was observed in 4 patients (in 2 patients, follow-up imaging could not be obtained). CONCLUSION: With proper antiplatelet regimens, flow diverter stents can be used safely to successfully treat complex acute iatrogenic injuries. Early repeat angiogram is needed when immediate postinjury imaging does not discover the point of vessel injury.

Giant Cell Arteritis: Can Simple Ultrasound Examination Prevent Complex Consequences?

Giant cell arteritis (GCA) is a rare disease of the arteries, occurring mainly in the elderly. Although the involvement of temporal arteries can be mostly symptomatic, the occlusion of ophthalmic arteries has severe consequences. GCA affecting temporal arteries is an emergency requiring quick commencement of treatment with glucocorticoids due to the serious consequences of neglect-blindness. According to the new guidelines released by EULAR, ultrasound is the tool of choice in support of the clinical diagnosis of giant cell arteritis, replacing temporal artery biopsy (TAB), as it is a sensitive and non-invasive method that is widely available. The main limitation is that the reliability of this imaging is based on the technical expertise of ultrasonographers. However, performing imaging should not delay commencing the treatment. In this work, we present ultrasound images from a case report of a 74-year-old female patient where difficulties in establishing a diagnosis led to vision loss in both eyes. In this example, we describe the ultrasound findings in giant cell arteritis, emphasizing its usefulness in supporting a diagnosis of GCA.

Incidence of Orbital Infarction Syndrome Following Anterior Circulation Endovascular Thrombectomy

Background Orbital infarction syndrome (OIS) is a rare entity defined as acute ischemia of intraorbital structures. Its occurrence requires interruption of the rich collateral supply to the orbit from both the ophthalmic artery (OA) and branches of the external carotid artery. Three case reports have recently been published of OIS occurring after endovascular thrombectomy (EVT). The goal of this study was to determine the true incidence of post‐EVT OIS and to identify associated imaging findings on computed tomography angiography and digital subtraction angiography (DSA). Methods A retrospective cohort study was performed at our comprehensive stroke center, including all patients who underwent EVT for anterior circulation strokes in 2019 and 2020. Patient charts were reviewed up to 24 hours after EVT for the presence of acute painful vision loss, ophthalmoplegia, chemosis, and proptosis. Patients with any combination of these symptoms in the absence of a carotid‐cavernous fistula were defined as having OIS. Pre‐EVT computed tomography angiography, pre‐EVT DSA, and post‐EVT DSA images were reviewed to determine the sensitivity and specificity of absent OA opacification, nonopacified external carotid artery, and absent choroid blush (CB) for post‐EVT OIS. Patients were excluded from sensitivity and specificity analysis for each finding that was objectively impossible to assess on their images, either because it was outside the field of view or not tested during the procedure. Findings were deemed indeterminate if motion artifact or contrast timing led to uncertainty about their presence. Sensitivity and specificity calculations were performed on a worst‐case‐scenario basis, with all indeterminate findings assumed to be false positives or false negatives. Results Of 217 patients with anterior circulation EVT (male:female, 107:110; median age, 73 [21–98] years), 4 cases of OIS were discovered (male:female, 1:3; median age, 71 [66–80] years; incidence, 1.7%). The number of patients excluded from sensitivity and specificity analysis for each imaging finding was as follows: 34 for pre‐EVT CB, 45 for post‐EVT CB, 7 for pre‐EVT OA, and 19 for post‐EVT OA. CB was deemed indeterminate in 47 patients on pre‐EVT DSA and 36 patients on post‐EVT DSA. All indeterminate cases occurred in non‐OIS patients and were counted as false negatives. Absent OA opacification was 50% sensitive and 91% specific for OIS on both pre‐EVT computed tomography angiography and pre‐EVT DSA, and 0% sensitive and 97% specific on post‐EVT DSA. Absent CB was 33% sensitive and 65% specific for OIS on pre‐EVT DSA, and 100% sensitive and 73% specific on post‐EVT DSA. Conclusion Post‐EVT OIS is rare, with an incidence of 1.7%. Absent OA opacification is 91% specific for OIS on pre‐EVT computed tomography angiography and 97% specific for OIS on post‐EVT DSA. Absent post‐EVT CB is 100% sensitive for OIS, with a worst‐case scenario specificity of 73%. These findings may help alert clinicians to potential OIS cases as well as determine the underlying cause of OIS.

Color Doppler Imaging, Endothelin-1, Corneal Biomechanics and Scleral Rigidity in Asymmetric Age-Related Macular Degeneration.

Age-related macular degeneration (AMD) presents a multifaceted etiopathogenesis involving ischemic, inflammatory, and genetic components. This study investigates the correlation between ocular hemodynamics, scleral rigidity (SR), and plasma endothelin-1 (ET1) levels in treatment-naive patients with asymmetrical AMD. This study included 20 treatment-naive patients (12 females and 8 males) with an average age of 76.4 ± 3.7 years, who presented with AMD with neovascular membrane formation (nAMD) in one eye, and intermediate grade 2 AMD (iAMD) in the other eye. The control group consisted of 20 healthy subjects (13 females and 7 males) with a mean age of 74.7 ± 3.9 years. All patients and healthy controls underwent color Doppler imaging (i) of the ophthalmic artery (OA), short posterior ciliary arteries (SPCAs), and central retinal artery (CRA); Plasma ET-1 levels were measured for all patients and healthy subjects. Corneal biomechanics were assessed using an Ocular Response Analyzer and two indices were obtained: corneal hysteresis (CH) and corneal resistance factor (CRF). Results showed reduced blood flow velocities and increased resistance indices in AMD eyes, particularly affecting the short posterior ciliary arteries. According to mechanical theory, ARMD eyes exhibited elevated scleral rigidity and corneal resistance factor compared to controls, with a notable rise in SR in neovascular AMD (nAMD) eyes. As per the chronic subacute inflammation theory, plasma ET-1 levels were significantly higher in AMD patients, correlating with abnormal SPCAs blood flow and increased resistance indices. Findings suggest a multifactorial etiology of AMD involving an increase of ET-1 plasma levels with biomechanic damages of corneal and scleral tissue in nAMD.

Detailed measurements of the four extraocular rectus muscles’ contribution to the perfusion of the anterior segment of the eye

Background/aimsAnterior segment ischaemia (ASI) is a rare but serious complication of strabismus surgery, which may be caused by damage to the anterior ciliary arteries that run along the rectus muscles....

Evaluation of Ophthalmic Artery Doppler Parameters in Preeclamptic and Normotensive Pregnant Women.

Preeclampsia, whose pathophysiology is still not fully elucidated today, is a pregnancy-specific disease that affects most organ systems in pregnant women, including the central nervous system. In this context, we aimed to investigate the effects of preeclampsia on blood flow in the ophthalmic artery of the eye, which is considered a part of the central nervous system. This prospective, non-interventional cohort study was conducted between February 2022 and June 2022 at Umraniye Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey. Forty-six normotensive healthy pregnant women constituted the control group and 46 preeclamptic pregnant women constituted the preeclampsia group. Prenatal follow-up and delivery of the participants were carried out in our clinic. First, an obstetric ultrasound was performed on all participants with the same ultrasound device and the same clinician. Then, Doppler measurements of the ophthalmic artery of both eyes were made by the same clinician using the linear probe of the same ultrasound. Both groups were compared in terms of the first peak of systolic velocity (PSV), second PSV, pulsatility index (PI), PSV ratio, end-diastolic velocity (EDV), resistance index (RI), and systolic/diastolic ratio (S/D) measurements of the ophthalmic artery. RESULTS : The first PSV, second PSV, PSV ratio, and EDV were significantly higher in the preeclampsia group than in the control group (p=0.001, p<0.001, p=0.019, p<0.001, respectively). According to the receiver operating characteristic analysis, the second PSV with a cut-off value of 43.75 cm/s was the most powerful ophthalmic artery Doppler parameter in detecting preeclampsia with 63% sensitivity and 63% specificity. No significant difference was found between the early and late onset or mild and severe preeclampsia groups in terms of ophthalmic artery Doppler parameters. Although the number of participants was too small to draw a definitive conclusion, the second PSV seems to be the most powerful parameter for the detection of preeclampsia. Studies with larger series are needed to determine the usability of ophthalmic artery Doppler parameters in the routine clinical diagnosis of preeclampsia and follow-up of the disease.

Investigation of the effects of single and two-muscle horizontal rectus surgeries on macular microvasculature.

To investigate the changes in posterior segment hemodynamics caused by horizontal rectus muscle surgeries using the optic coherence tomography angiography (OCTA). Patients who underwent at least one horizontal rectus recession, resection, or combination surgery were included. The patients were evaluated with an OCTA preoperatively and 30days postoperatively. Postoperative changes in superficial capillary plexus (SCP)-vessel density (VD), deep capillary plexus (DCP)-VD, foveal avascular zone (FAZ) area and choriocapillaris (CC)-flow area parameters were examined. The mean differences (Δ) for the parameters in which significant changes were detected in the whole operated eyes group were compared between the single- and two-muscle surgery groups. Twenty-five eyes of 24 patients with an average age of 16.40 ± 6.75years (5-29) were included. Of the eyes, 10 underwent single muscle recession surgery. Two-muscle surgeries were performed in 15 eyes. SCP-VD in the superior parafoveal region increased significantly postoperatively (53.23 ± 4.11% vs. 54.54 ± 3.67%, p = 0.032). For DCP-VD, there was a statistically significant increase in all zones, except the superior hemisphere and fovea regions (p < 0.05 for all). FAZ area did not change significantly (p = 0.207). There was a significant increase in the CC-flow area (2.171 ± 0.146 mm2 vs. 2.232 ± 0.115 mm2, p = 0.013). There was a significant difference between the two groups only for the Δ SCP-VD/parafovea superior value (-0.62 ± 0.98 vs. 1.57 ± 3.07, p = 0.019). Conventional horizontal rectus muscle surgeries may cause alterations in posterior segment hemodynamics. The number of muscles incised does not seem to greatly affect the magnitude of changes that occur. What is known • After conventional horizontal rectus muscle surgeries, the anterior ciliary arteries are not recanalized, instead, anterior segment blood flow is maintained by increasing the flow in the long posterior ciliary arteries. • Previous studies using Doppler ultrasonography have shown increased flow in the ophthalmic artery, central retinal artery and long posterior ciliary arteries. What is new • In this study, significant increases were observed in superficial and deep capillary plexus-vessel density and choriocapillaris-flow area parameters in the first postoperative month with optic coherence tomography angiography device. • Hemodynamic increases in both retinal and choroidal vasculature were detected in the early period after conventional horizontal rectus muscle surgeries. • The number of muscles incised does not seem to greatly affect the magnitude of changes that occur.

Contralateral approach to giant ruptured and unruptured ophthalmic artery aneurysms: patient series.

Giant ophthalmic artery (OphA) aneurysms remain surgically challenging despite the progress in endovascular treatments. This study describes the contralateral interoptic corridor in select patients based on imaging criteria suitable for clipping. The aim of this study was to show that despite the growing use of novel endovascular techniques, such as coil embolization and flow diversion, for the treatment of OphA aneurysms, microsurgical clipping may still be preferred for giant ones under certain conditions. The authors retrospectively reviewed the records of the microsurgical treatment of unruptured and ruptured giant OphA aneurysms at the University Hospital Center "Mother Teresa," Tirana, from 2007 to 2016. Four patients were selected for microsurgery and the contralateral approach using ophthalmic evaluations and coronal imaging on computed tomography, magnetic resonance imaging, and digital subtraction angiography that demonstrated aneurysms with a small neck and an orientation between 11 and 13 on the coronal clock face. A prefixed chiasm was a contraindication to this approach. Giant OphA aneurysms can be safely clipped through a contralateral interoptic corridor without creating new visual deficits or a residual aneurysm. https://thejns.org/doi/10.3171/CASE2473.

Long-term cardiovascular assessment of women with previous pregnancy complicated by hypertensive disorder.

Women with a hypertensive disorder of pregnancy (HDP) are at increased risk of developing hypertension and cardiovascular disease later in life. However, from previous studies, it is difficult to define whether this association reflects pre-existing maternal cardiovascular risk or a potentially causal relationship between HDP and later cardiovascular risk. In this study, we performed detailed cardiovascular assessment in women in midgestation, prior to development of HDP, and at 2 years postpartum, aiming to identify cardiovascular changes prior to development of HDP and to assess persistent cardiovascular alterations long after the HDP event. This was a prospective observational study in which we performed detailed cardiovascular assessment in midgestation and at a median of 2.3 (interquartile range, 2.1-2.4) years postpartum. We examined 112 women who developed HDP and 451 women whose pregnancy was not complicated by hypertension. We used conventional and more advanced (i.e. speckle tracking) echocardiographic techniques to determine accurately left ventricular systolic and diastolic function. We used M-mode measurements to determine left ventricular remodeling and estimate left ventricular mass. Maternal vascular status was assessed using ophthalmic artery Doppler and by calculating peak systolic velocity (PSV) ratio, as a marker of peripheral vascular resistance. In midgestation, women who subsequently developed HDP had increased ophthalmic artery PSV ratio. These women also had mild cardiac functional and morphological alterations, which were accounted for mostly by maternal cardiovascular risk factors. At 2 years postpartum, women who had experienced HDP, compared to those who did not, had cardiovascular abnormalities with reduction in left ventricular systolic and diastolic function, which remained after multivariable analysis. Longitudinal analysis demonstrated that the evolution of cardiovascular changes in the HDP and non-HDP groups was similar. Mild cardiac functional and morphological alterations precede the development of HDP and such changes persist for at least 2 years postpartum. The cardiac changes are likely to be the consequence of pre-existing maternal cardiovascular risk factors rather than an adverse consequence of HDP. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Preeclampsia - the leading cause of maternal and neonatal mortality in the world - review of literature

Background: This review analyzes current knowledge on the pathophysiology, prevention and art of treatment of preeclampsia. Preeclampsia (known as EPH-gestosis) is nowadays the leading cause of maternal and neonatal mortality in the world. According to statistics it affects up to 5% of pregnant women. The symptoms are high blood pressure, edema, proteinuria. The scientists all over the world are trying their best to know the pathogenesis to devise a cure for the disease. Aim of study: The goal of this article was to gather information about the pathophisiology and treatment of preeclempsia to prevent the risk of ilness’ development. Materials and methods: A review of the literature available in the “PubMed”, Google Scholar and Medline databases. The search was performed by using following keywords: “preeclampsia”, “ophthalmic artery doppler”, “PIGF”, “aspirin”, “placenta”. Results and conclusions: In spite of the progress of science the preeclampsia is still a serious threat for pregnant women all around the world. Thank to the advanced molecular and ultrasonographic techniques the doctors can estimate the risk of complications. The most important is screening, which helps the doctors to define the group of risk and then launch the treatment. That should decrease the amount of maternal and neonatal complications and deaths.

Cerebral Complications Following Facial Autologous Fat Graft Injection: A Systematic Review and Meta-analysis.

With the increasing use of autologous fat (AF) grafting in plastic surgery, the occurrence of complications has garnered the attention from plastic surgeons. This study aims to estimate the cerebral complications following facial AF graft injection objectively and systematically with newly published literature. A comprehensive literature search was conducted systematically on PubMed, Embase, Web of Science, Cochrane, and ClinicalTrials.gov for articles published between 2000 and 2023. A systematic review and meta-analysis were performed in accordance with PRISMA guidelines. A total of 11 articles comprising of 37 participants were included, all of which are case reports. For AF facial filling, the incidence rate of cerebral embolism among cases of cerebral and ocular embolism was found to be 60% (95% CI 0.41-0.79). The incidence of cerebral embolism presenting with initial symptoms of unconsciousness was 69% (95% CI 0.48-0.9), with limb movement disorders was 55% (95% CI 0.26-0.84), and with vision loss was 30% (95% CI 0.12-0.49). The incidence of cerebral embolism with ophthalmic artery occlusion was 36% (95% CI 0.20-0.53), compared to was 71% (95% CI 0.48-0.95) without ophthalmic artery occlusion. AF grafting is generally safe and minimally invasive. However, with its widespread use as facial injection filling for cosmetic enhancement, the incidence of cerebral complications, such as cerebral infarction, has also increased. It is imperative to properly manage high-risk factors for cerebral embolism during the perioperative period to prevent its occurrence. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Evidence that systemic vascular resistance is increased before the development of gestational diabetes mellitus

The ophthalmic artery, which is the first branch of the internal carotid artery, has a Doppler velocity waveform with two systolic peaks. The ratio of the peak systolic velocity (PSV) of the second wave divided by that of the first wave, reflects increased peripheral resistance. Previous studies in the first, second and third trimesters of pregnancy have reported that in pregnancies that subsequently develop preeclampsia (PE) the PSV ratio is increased. Both PE and gestational diabetes mellitus (GDM) are associated with endothelial dysfunction and an increased risk of cardiovascular diseases during the first decade following pregnancy. To compare the ophthalmic artery PSV ratio at 11-13 weeks' gestation in women who subsequently develop GDM to unaffected pregnancies and those who develop PE. This was a prospective observational study in women attending for a routine hospital visit at 11+0 - 13+6 weeks' gestation at King's College Hospital, London, UK. This visit included recording of maternal demographic characteristics and medical history, ultrasound examination for fetal anatomy and growth, assessment of flow velocity waveforms from the maternal ophthalmic arteries and calculation of the PSV ratio, and measurement of mean arterial pressure (MAP). Linear regression was performed for the prediction of ophthalmic artery PSV ratio, from maternal characteristics and MAP. The PSV ratio in the group with GDM was compared to that of PE and unaffected pregnancies. 3999 women were included in the study, including 375 (9.8%) who developed GDM and 101 (2.5%) who developed PE. In the GDM group, 161 (43.3%) were treated by diet alone, 130 (34,1%) were treated with metformin and 84 (22.6%) received insulin ± metformin. Significant prediction of PSV ratio was provided by development of PE, maternal age, body mass index, MAP, first degree family history of diabetes mellitus, family history of PE, Asian ethnicity, and smoking. There was no significant contribution from GDM. In women who developed GDM requiring insulin treatment, ophthalmic artery PSV ratio (0.67 ± 0.09) was higher (p <0.001) than in unaffected pregnancies (0.63 ± 0.10), but it was not significantly different from that in the PE group (0.69 ± 0.10; p=0.90). In women who develop severe GDM, requiring insulin treatment, there is evidence of increased peripheral resistance which is apparent from the first-trimester of pregnancy.