Ophthalmic Artery Doppler Velocimetry Research Articles

Changes in opthalmic artery doppler velocimetry in women with preeclampsia in Kano, Nigeria.

Hypertensive disorders in pregnancy are among the most serious complications of pregnancy and represent important contributors to maternal and neonatal morbidity and mortality worldwide. Preeclampsia (PE)-eclampsia syndrome is the most important hypertensive gestational condition. Maternal ophthalmic artery Doppler velocimetry enables the identification of pregnant women with increased cerebral blood flow who are at risk of developing severe PE and eclampsia. Hence the need to determine the changes in ophthalmic artery Doppler velocimetric indices in PE in Kano,Nigeria becomes paramount. Ninety-six patients with the clinical diagnosis of PE and 96 normotensive pregnant controls between 20 and 40 weeks' gestational age were recruited for this study. Ophthalmic artery Doppler velocimetric indices of the two groups were measured and documented. The mean velocimetric measurements in the control group were as follows: peak systolic velocity (PSV) = 38.04 ± 13.68 cm/s, End-diastolic volume (EDV) =9.14 ± 3.65 cm/s, resistivity index (RI) = 0.75 ± 0.091, pulsatility index (PI) =1.62 ± 0.55, peak mesodiastolic velocity (PMDV) = 21.02 ± 8.83 cm/s, peak ratio (PR) = 0.56 ± 0.14. The mean velocimetric indices in the PE group were PSV = 44.59 ± 11.54 cm/s, EDV = 12.23 ± 2.66 cm/s, RI = 0.71 ± 0.069, PI = 1.67 ± 0.42, PMDV = 32.27 ± 9.12 and PR = 0.72 ± 0.10. There is a significant difference in the ophthalmic artery Doppler velocimetric indices between women with PE and normal pregnant women. Ophthalmic artery Doppler ultrasound is a useful tool in monitoring the hemodynamic changes in cerebral circulation in PE.

Performance of ophthalmic artery Doppler velocimetry in the complementary diagnosis of preeclampsia

Objectives To calculate the accuracy (A) and establish the best cutoff value for ophthalmic artery (OA) Doppler velocimetry indexes in patients diagnosed with preeclampsia (PE), compared with healthy pregnant women. Methods This prospective experimental study enrolled 268 women: 133 with PE and 135 healthy pregnant women. All patients were evaluated by OA Doppler sonography, bilaterally, to assess their pulsatility index (PI), resistance index (RI), peak systolic velocity (PVS), second peak systolic velocity (P2), end-diastolic velocity (EDV), and peak ratio (PR). Means were compared using Student’s T-test. Receiver Operating Characteristics (ROC) curve was used to establish the cutoff value and estimate the sensitivity (S), specificity (Sp), accuracy (A) of all variables, and a significance of 95% was adopted. Results ROC curve analysis showed that P2 and PR were superior to the other parameters for PE diagnosis. We tested two cutoff values: (1) using PR ≥0.70, obtained A: 88.72%, S: 81.95%, and Sp: 95.48% and (2) using PR ≥0.75, and A: 86.24%, S: 74.43%, and Sp: 99.24%. By adopting P2 ≥ 21.5 cm/s, we obtained A: 87.59%, S: 84.96%, and Sp: 90.22% and when the cutoff point was P2 ≥ 22 cm/s, there was a slight decrease in A to 86.46% and S to 81.20%, with Sp: 91.89.3%. Conclusion Ophthalmic artery Doppler demonstrated to be an effective and high-performance imaging method for the diagnosis of PE and the indexes P2 and PR demonstrated superior accuracy to the other Doppler parameters assessed. Higher performance occurred when the cutoff values with greater specificity were adopted, PR ≥ 0.75 and P2 ≥ 22 cm/s, considering that the proposed OA Doppler is to be a complementary method for preeclampsia.

A comparative control study of ophthalmic artery Doppler velocimetry in patients with primary open angle glaucoma in Kano, Nigeria

Objective: The objective of the study is to sonographically determine the hemodynamic changes in ophthalmic arteries of patients with primary open angle glaucoma (POAG) at Kano, Nigeria.Subjects and Methods: We conducted a prospective case–control study at Aminu Kano Teaching Hospital, Nigeria, on 108 newly diagnosed POAG and 108 control subjects. Intraocular pressure (IOP) and Doppler ultrasound velocimetry of ophthalmic arteries were assessed. Peak systolic velocity (PSV), end diastolic velocity (EDV), resistive indices (RIs), pulsatility indices (PIs) and systolic/diastolic (S/D) ratios of the ophthalmic arteries were evaluated and documented.Results: The mean IOP values of POAG group in the right and left eyes were higher than the values of the right and left eyes of the control group. This was statistically significant (P = 0.000). The mean PSV, EDV, RI, PI, and S/D values in the POAG group of the right and left eyes were lower than values for the right and left eyes of the control group, which was also statistically significant (P = 0.000). The IOP showed positive correlation with PSV and EDV in both eyes of POAG cases but negative correlation with PI and S/D in both eyes in the POAG group. It however correlated positively with RI in the right eye and negatively with RI in the left eye.Conclusions: The study showed significant differences between ophthalmic artery Doppler indices of patients with POAG and the healthy control subjects.

Optic nerve sonography and ophthalmic artery Doppler velocimetry in healthy pregnant women: an Australian cohort study.

Maternal ocular sonography offers a window into cerebrovascular and intracranial pressure changes in pregnancy. This study aimed to determine the Doppler velocimetric variables of the ophthalmic artery, and the mean diameter of the optic nerve sheath (ONSD), in an Australian cohort of healthy pregnant women. A prospective observational cohort study of healthy women with uncomplicated singleton pregnancies in the third trimester was undertaken in a tertiary maternity service. A single prenatal ultrasonographic examination was performed on all participants, with a postnatal examination performed on a subgroup with uncomplicated deliveries. Fifty women were examined at a mean gestation of 35 weeks. The mean ± SD Doppler variables in the ophthalmic artery were peak systolic velocity (PSV) 41.89 ± 13.13 cm/s, second peak velocity 20.63 ± 8.97 cm/s, end diastolic velocity 9.29 ± 5.13 cm/s, pulsatility index 1.97 ± 0.53, resistive index 0.78 ± 0.07, peak ratio (second peak velocity/PSV) 0.49 ± 0.12, while the mean ONSD was 4.34 ± 0.4 mm. None of these variables had a demonstrable relationship with gestation or mean arterial pressure (MAP), nor did the sheath diameter have a relationship with any of the Doppler variables. The ocular sonographic variables observed in this population are similar to those reported in other cohorts. No clear relationship could be identified in this cohort between ophthalmic artery Doppler variables and the ONSD, and between each of these variables and gestation or MAP.

Magnesium sulfate and ophthalmic artery Doppler velocimetry in patients with severe preeclampsia: a case series

BackgroundIn the present study, we used Doppler velocimetry in the ophthalmic artery to evaluate the hemodynamic status of the intracranial vasculature. This is the first time in the literature that indices of ophthalmic artery Doppler sonography of women with preeclampsia were evaluated before and after the use of magnesium sulfate to prevent eclampsia.Case presentationIndices of ophthalmic artery Doppler sonography of six women with severe preeclampsia at 27 to 33 weeks of gestational age were evaluated before and after the use of magnesium sulfate (10 minutes, 30 minutes, and 60 minutes after the magnesium sulfate loading dosage. The patients’ ages were 26 years (patient 01), 29 years (patient 02), 20 years (patient 03), 21 years (patient 04), 20 years (patient 05), and 19 years (patient 06). The ethnic group of patients 01 and 04 was white and the ethnic group of patients 02, 03, 05 and 06 was mulatto.ConclusionsThe apparent increase in resistance index and pulsatility index values, although there is no statistical significance in this series of cases, and the decrease in peak ratio values after the administration of magnesium sulfate reflect an increase in the impedance to flow in the ophthalmic artery and consequently a reduction in cerebral perfusion after the use of magnesium sulfate. This may explain how magnesium sulfate protects women with severe preeclampsia against cerebral damage and prevents acute convulsions in these patients. We believe that this case series report may have a broader clinical impact across medicine because the mechanism of how magnesium sulfate can protect patients and prevent acute convulsions is controversial.

17 Ophthalmic artery dopplervelocimetry and pregnancy outcomes in preeclampsia

Objective To evaluate the association of a Dopplervelocimetric measure of the maternal ophthalmic artery – mesodiastolic/systolic velocity peak ratio (PR) – with adverse pregnancy outcomes in preeclamptic pregnancies Methods Prospective cohort of 58 preeclamptic women submitted to Doppler measures of ophthalmic artery (OA), performed by the same examiner, using a linear transducer with color Doppler applied on the region medial to the optic nerve. The PR results were classified as normal (PR ⩾ 0.99). Assistant physicians were blinded to OA Doppler results. The two primary outcomes were (1) a composite of adverse maternal conditions – central nervous injury, as eclampsia or posterior reversible encephalopathy syndrome, HeLLP syndrome; hypertensive crisis; maternal admission at intensive care unit or maternal death – and (2) a composite of adverse perinatal results – birthweight 2500g; preterm birth Results The higher the PR levels, the more incident were maternal adverse outcome (p = 0.004) as a composite, and hypertensive crisis after hospital admission (p = 0.004) as a secondary end-point. Perinatal adverse outcome were not associated with PR (p = 0.73), but in the highly abnormal PR group ( ⩾ 0.99), babies were born earlier (p = 0.008) and weighing less (p = 0.013). All women in the highly abnormal PR group had an adverse outcome. Conclusions Mesodiastolic/systolic velocity peak ratio of maternal OA ⩾ 0.99 in preeclampsia could identify women at the highest risk of an adverse outcome and the pregnancies with the most preterm delivery.

Maternal ophthalmic artery Doppler velocimetry in pre-eclampsia in Southwestern Nigeria.

BackgroundPre-eclampsia (PE) poses a serious challenge to maternal and fetal health in Africa. It is associated with hemodynamic changes that may affect the internal carotid/ophthalmic artery circulation with consequent neuro-ophthalmic manifestations. Ophthalmic artery Doppler (OAD) ultrasound is an important tool that can be used to detect hemodynamic changes in PE and monitor its severity. In this study, we evaluated hemodynamic changes on OAD ultrasound in the ophthalmic arteries of pre-eclamptic women and compared these with values in healthy pregnant women.MethodsOAD parameters, such as, peak systolic velocity, peak diastolic velocity, end diastolic velocity, pulsatility index, and peak ratio, were measured on transorbital triplex ultrasound scan with a 7–10 MHz multifrequency linear transducer in 42 consenting pre-eclamptic patients and 41 pregnant controls matched for maternal age, gestational age, and parity at the Department of Radiology, University College Hospital, Ibadan. Univariate, bivariate, and receiver operating characteristic curve data analyses were performed. P<0.05 was considered to be statistically significant.ResultsMean resistivity index, pulsatility index, and peak systolic velocity were significantly lower in pre-eclamptic patients than in the controls. Mean peak diastolic velocity, end diastolic velocity, and peak ratio were significantly higher in the pre-eclamptic group. The receiver operating characteristic curve showed that the resistivity index (sensitivity 75%, specificity 77.8%) could distinguish mild from severe PE while the peak ratio (sensitivity 90.5%, specificity 81.3%) could accurately detect PE.ConclusionOAD ultrasound can be used to monitor patients with PE for early detection of progression to severe forms before cerebral complications develop. OAD screening of patients at high risk for PE can also detect early changes of hemodynamic derangement.

Predictive value of ophthalmic artery Doppler velocimetry in relation to development of pre‐eclampsia

To test the hypothesis that ophthalmic artery Doppler velocimetry is predictive of the development of pre-eclampsia (PE). This was a prospective cohort study that included pregnant women in the second trimester who had risk factors for PE. Seven ophthalmic artery Doppler parameters, in addition to uterine artery (UtA) Doppler and clinical variables, were investigated for their prognostic value with respect to PE. A total of 347 women were recruited, of whom 40 developed PE. A comparison of the mean ophthalmic artery Doppler parameter values between women with and those without PE showed statistically significant differences in several parameters: peak systolic velocity, end-diastolic velocity, mean velocity, peak mesodiastolic velocity (PMDV) and peak ratio. After adjusting for confounding variables, only PMDV remained statistically significant (P < 0.001), with an area under the receiver-operating characteristics curve (AUC) of 0.73. The best cut-off for predicting PE was a PMDV of > 22.11 cm/s, with sensitivity of 70%, specificity of 75%, positive likelihood ratio of 2.8, negative likelihood ratio of 0.4, positive predictive value of 28% and negative predictive value of 95%. The AUC increased from 0.72 to 0.78 when the PMDV was incorporated into a prediction model based on clinical variables, demonstrating that this marker increased the discriminatory capability of the model. The performance of ophthalmic artery Doppler was similar to that of UtA Doppler for predicting PE. Additionally, the AUC increased significantly from 0.82 to 0.88 when the PMDV was incorporated into the model containing clinical variables and UtA Doppler indices. A high ophthalmic artery PMDV in the second trimester of pregnancy is an independent predictor of PE that increases the discriminatory ability of clinical markers, as well as of models that include clinical variables and UtA Doppler indices.

Valor Preditor Da Dopplervelocimetria Da Artéria Oftálmica Em Relação Ao Desenvolvimento De Pré-Eclâmpsia / Predictive Value of Ophthalmic Artery Doppler Velocimetry in Relation to the Development of Preeclampsia

Valor Preditor Da Dopplervelocimetria Da Artéria Oftálmica Em Relação Ao Desenvolvimento De Pré-Eclâmpsia / Predictive Value of Ophthalmic Artery Doppler Velocimetry in Relation to the Development of Preeclampsia

Ophthalmic Artery Doppler Velocimetry Values in Pregnant Women at Risk for Preeclampsia

To describe the ophthalmic artery (OA) Doppler parameters in pregnant women at risk for preeclampsia in the second trimester, and compare them to reference values described in women with healthy pregnancies; to evaluate the influence of gestational age ranges on the Doppler parameters.

Estudo do perfil hemodinâmico da artéria oftálmica em gestantes com diabetes mellitus gestacional

To evaluate the hemodynamic patterns of the ophthalmic artery by Doppler analysis in women with gestational diabetes mellitus (GDM), comparing them to normal pregnant women. A prospective case-control study that analyzed the ophthalmic artery Doppler indices in two groups: one consisting of 40 women diagnosed with GDM and the other of 40 normal pregnant women. Included were pregnant women with GDM criteria of the American Diabetes Association-2012, with 27 weeks of pregnancy to term, and excluded were women with hypertension, use of vasoactive drugs on or previous diagnosis of diabetes. Doppler analysis was performed in one eye with a 10 MHz linear transducer and the Sonoace 8000 Live Medison® equipment. The following variables were analyzed: pulsatility index (PI), resistance index (RI), peak velocity ratio (PVR), peak systolic velocity (PSV) and end diastolic velocity (EDV). To analyze the normality of the samples we used the Lillefors test, and to compare means and medians we used the Student's t-test and Mann-Whitney test according to data normality, with the level of significance set at 95%. The median and mean values with standard deviation of the variables of the ophthalmic artery Doppler velocimetry group GDM and normal pregnant women were: IP=1.7±0.6 and 1.6±0.4 (p=0.7); IR=0.7 and 0.7 (p=0.9); RPV=0.5±0.1 and 0.5±0.1 (p=0.1), PSV=33.6 and 31.9 cm/sec (p=0.7); VDF=6.3 and 7.9 cm/sec (p=0.4). There was no significant difference in the means and medians of these variables between the two groups of pregnant women. The ophthalmic artery hemodynamic patterns, analyzed by means of a Doppler technique remained unchanged in the group of pregnant women with GDM compared to the group of normal pregnant women, suggesting that the time of exposure to the disease during pregnancy was too short to cause significant vascular disorders in the central territory.

P77 Maternal ophthalmic artery Doppler velocimetry in pregnancies complicated by hypertension disorders

To examine nicotine (N) and cotinine (C) effects on trophoblast cells (TCs) and human umbilical vein endothelial cells (HUVEC) secretion of soluble fms-like tyrosine kinase (sFlt-1), soluble endoglin (sENG), placental growth factor (PlGF), transforming growth factor-beta (TGF-beta) and vascular endothelial growth factor (VEGF).Human placentas and umbilical cords were collected from uncomplicated pregnancies at term from a total of 24 non-smoking women with a history of normal blood pressure. TCs and HUVEC were cultured for 24 h with C or N (from 10−12 to 10−7 M).sFlt-1, sENG, PlGF, TGF-beta and VEGF release and messenger RNA (mRNA) expression were evaluated by ELISA and real-time polymerase chain reaction (PCR), respectively.N and C reduced sFlt-1, sENG and PlGF release by TCs and TGF-beta release by HUVEC. Conversely, N and C increased PlGF secretion, while N alone increased sFlt-1 release by HUVEC. N and C were able to modulate VEGF mRNA expression in HUVEC.Our results suggest that N and C affect the balance of some important vasoactive factors released by TCs and HUVEC. This might be one of the possible mechanism through which smoke reduces the risk of hypertensive disorders during pregnancy as well as contributes to the well known detrimental effects of smoking on fetal development.

Ophthalmic artery Doppler velocimetry in healthy pregnancy

Objectives To establish normative data for ophthalmic artery Doppler parameters throughout a healthy pregnancy, to investigate the possible correlation between these Doppler measurements and gestational age, and to test intraobserver variability. Methods A prospective cross-sectional study was performed to assess various Doppler parameters in 276 healthy women between 20 and 39 weeks of gestation. The following measurements were obtained: pulsatility and resistance indices (PI, RI), peak systolic velocity (PSV), peak diastolic velocity (PDV), end diastolic flow velocity (EDFV), and peak ratio (PR). Quantile regression was used to estimate reference values throughout pregnancy and P < 0.05 was considered significant. The intraclass correlation coefficient (Intra-CC) was used to calculate intraobserver variability. Results The 5th and 95th prediction intervals for each gestational age are presented. No significant correlation was detected between Doppler indices and gestational age. Intra-CC was excellent (0.996). Conclusions Reference values were generated for ophthalmic artery Doppler measurements, and they did not vary significantly during healthy pregnancy.

P79Maternal ophthalmic artery Doppler velocimetry in type 1 diabetes during pregnancy

BackgroundOur purpose was to evaluate whether maternal ophthalmic artery pulsatility index (PI) in normotensive pregnancies with type 1 diabetes is different from that in normal normotensive pregnancies.MethodThe ophthalmic artery in 15 normal normotensive pregnant women, and 13 normotensive pregnant women with type 1 diabetes was studied once with colour Doppler flow imaging and pulsed Doppler ultrasonography after 16 weeks gestation. The heart rate, mean arterial blood pressure, and ophthalmic artery PI were calculated in each group.ResultsThe PI (1.94 ± 0.45) in normotensive pregnant women with type 1 diabetes was significantly lower than that (2.73 ± 0.32) in normal normotensive pregnant women (P &lt; 0.0001). There was no significant difference in maternal heart rate or mean arterial blood pressure between the two groups.ConclusionThese results suggest that vascular resistance in the maternal orbital circulation is reduced in pregnancies with type 1 diabetes that are normotensive. The lower PI in pregnant women with type 1 diabetes should be interpreted as orbital vascular vasodilatation, indicating orbital hyperperfusion or hyperaemia.

Maternal ophthalmic artery doppler velocimetry in type 1 diabetes during pregnancy.

Our purpose was to evaluate whether maternal ophthalmic artery pulsatility index (PI) in normotensive pregnancies with type 1 diabetes is different from that in normal normotensive pregnancies. The ophthalmic artery in 15 normal normotensive pregnant women, and 13 normotensive pregnant women with type 1 diabetes was studied once with colour Doppler flow imaging and pulsed Doppler ultrasonography after 16 weeks gestation. The heart rate, mean arterial blood pressure, and ophthalmic artery PI were calculated in each group. The PI (1.94 +/- 0.45) in normotensive pregnant women with type 1 diabetes was significantly lower than that (2.73 +/- 0.32) in normal normotensive pregnant women (P < 0.0001). There was no significant difference in maternal heart rate or mean arterial blood pressure between the two groups. These results suggest that vascular resistance in the maternal orbital circulation is reduced in pregnancies with type 1 diabetes that are normotensive. The lower PI in pregnant women with type 1 diabetes should be interpreted as orbital vascular vasodilatation, indicating orbital hyperperfusion or hyperaemia.

Maternal ophthalmic artery Doppler velocimetry in normotensive pregnancies and pregnancies complicated by hypertensive disorders

OBJECTIVE: Our objective was to compare maternal ophthalmic artery pulsatility index values in normotensive pregnancies and pregnancies complicated by hypertensive disorders. STUDY DESIGN: The ophthalmic artery in 17 normotensive nonpregnant women, 29 normotensive pregnant women, 9 patients with mild preeclampsia, 6 with severe preeclampsia, 6 with transient hypertension, and 9 with chronic hypertension was studied with color Doppler flow imaging and pulsed Doppler ultrasonography. The mean arterial blood pressure and the ophthalmic artery pulsatility index were calculated in each group. RESULTS: The pulsatility index (1.17 ± 0.08) in severe preeclampsia was lowest among the groupsp < 0.05), whereas that (2.92 ± 0.59) in normotensive pregnant women was highest among the groups(p < 0.05). The pulsatility index (1.47 ± 0.30) in mild preeclampsia was significantly lower than that (1.89 ± 0.27) in transient hypertension (p < 0.05). There was no significant difference in pulsatility index between mild preeclampsia and chronic hypertension (1.69 ± 0.49) or between transient hypertension and chronic hypertension. The pulsatility index inversely correlated well with the mean arterial blood pressure (R2 = 0.645, p < 0.0001). CONCLUSIONS: These results suggest that the lower pulsatility index should be interpreted as orbital vascular vasodilation, indicating orbital hyperperfusion or hyperemia. Changes in pulsatility index in the ophthalmic artery may be indicative of similar changes in other cerebral vessels. (Am J Obstet Gynecol 1997;177:174-8)