Orbital Color Doppler Imaging Research Articles

Assessment of orbital hemodynamic changes in primary open angle glaucoma by color Doppler imaging

To assess changes in orbital vessels by Color Doppler Imaging (CDI) in patients with Primary Open Angle Glaucoma (POAG). This cross-sectional study included 120 subjects-60patients with POAG and 60controls, all of whom underwent full ophthalmological examinations and orbital CDI. The Ophthalmic Artery (OA), Central Retinal Artery (CRA) and Ciliary Arteries (CA) were identified, and for each of them, we measured Peak Systolic Velocity (PSV), End Diastolic velocity (EDV) and Resistivity Index (RI). The PSV of the OA and CRA were significantly lower in patients with POAG compared to normal controls (P<0.0001, <0.009 respectively). The EDV in the OA, CRA and CA were significantly lower than in normal controls (P<0.0001). The RI of the OA, CRA and CA were significantly higher in patients with POAG compared to controls (P<0.0001). The EDV of the OA showed significant negative correlation with duration of glaucoma (r=-0.37, P<0.042). The EDV of the CA showed significant negative correlation with intraocular pressure (IOP) (r=-0.86 and P value 0.0001). The PSV and EDV of the CRA showed significant negative correlation with IOP (r=-0.45, r=-0.73, P values 0.011, and 0.0001 respectively), and the RI of the CRA showed significant positive correlation with IOP (r=0.42 and P value 0.021). CDI is a feasible, noninvasive, safe tool for the assessment of hemodynamic changes in the orbital arteries of POAG patients. The orbital arteries showed significantly lower flow velocities and increased resistivity indices in patients with POAG compared to the control group, and these changes were correlated with glaucoma duration and IOP.

Changes in oxygen saturation and the retinal nerve fibre layer in patients with optic neuritis associated with multiple sclerosis in a 6-month follow-up.

PurposeOptic neuritis (ON) is an inflammatory demyelinating disorder of the optic nerve, which can be the first manifestation of multiple sclerosis (MS). The main goal was to assess changes in the retinal nerve fibre layer (RNFL) and in retinal oxygen saturation [arterial (AS), venous (VS) and arterio‐venous (A‐V) difference] in the affected and unaffected eye.MethodsFifty patients with ON due to MS within 3 months of onset of symptoms were enrolled (17 males, mean age 35.3). All patients were examined at baseline (V1) and after 6 months (V2) using optical coherence tomography (OCT) to get RNFL values; automatic retinal oximetry to obtain saturation values; and ultrasound to exclude arterial stenosis, and orbital colour Doppler imaging was performed in the ophthalmic artery.ResultsAt V1, AS was significantly increased in affected eye compared to unaffected eye (99.5% versus 98.0%, p = 0.03). Significant decrease in A‐V difference from baseline was detected in both eyes for ON eye: 32.0% versus 29.0%, p = 0.004; for fellow eye: 31.4% versus 30.0%, p = 0.04. We did not observe any changes in retinal vessel diameter. There were no changes observed in blood flow in ophthalmic artery. At V1, there were no significant differences in RNFL, and significant loss of RNFL was confirmed in the affected eye at V2 (95 μm versus 86 μm, p = 0.0002) and in comparison with the fellow eye (86 μm versus 94 μm, p = 0.0002). There were no correlations between RNFL and saturation values at V1, although at V2, there was a negative correlation between the RNFL and AS (Spearman's rho = −0.480, p = 0.003) and between the RNFL and VS (rho = −0.620, p = 0.00007).ConclusionRetinal oximetry is altered in both eyes in MS patients with unilateral ON. During the course of the disease, the retinal oxygen consumption decreases to a different degree in each eye and this change is not completely followed by changes in the RNFL thickness, suggesting either sub‐clinical ON or systemic effects in the clinically unaffected eye. Since this is the first and initial longitudinal evaluation of the saturation changes in MS patients, the clinical value of these findings needs to be deeper evaluated in the future studies.

Color Doppler imaging in thyroid eye disease and its correlation to disease activity

ABSTRACTPurpose: To evaluate alterations in orbital color Doppler imaging (CDI) parameters and their correlation to disease activity and severity in patients with thyroid eye disease (TED).Methods: Seventy-six orbits of 45 TED patients and 40 orbits of 40 normal controls were enrolled in this cross-sectional study. According to clinical activity score (CAS), patients were categorized to active (CAS ≥ 3) or inactive disease (CAS < 3). Patients were also classified as having mild, moderate or severe disease. Peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index (RI) in ophthalmic artery and central retinal artery, and maximum and minimum velocity in superior ophthalmic vein and central retinal vein were determined in all subjects.Results: There was a significant difference in maximum velocity of superior ophthalmic vein and EDV and RI of ophthalmic artery between patients with TED and normal subjects. Superior ophthalmic vein maximum and minimum velocity and ophthalmic artery RI were significantly higher in patients with active disease than inactive cases. Disease severity did not affect the blood flow parameters independently. A cutoff point of 3.99 cm/s in superior ophthalmic vein maximum velocity yielded a sensitivity of 91.2% and specificity of 81.2% in detecting active disease.Conclusion: Retrobulbar blood flow is altered in TED and is related to disease activity. Superior ophthalmic vein maximum velocity could be helpful in differentiation of active and inactive cases.

Efficacy of Orbital Color Doppler Imaging and Neuroimaging in the Diagnosis of Carotid Cavernous Fistulas.

To evaluate the diagnostic sensitivity and specificity of orbital color Doppler imaging (CDI) and conventional neuroimaging (CT/MRI) compared with cerebral angiography in patients with carotid-cavernous fistulas (CCFs). The study design was a retrospective patient chart and imaging review. The authors reviewed 655 charts of all patients who underwent CDI and neuroimaging (CT/MRI) between 2006 and 2015 at one institution. Sixty patients had a presumptive diagnosis of CCF without thrombosis. Thirty-seven patients with 43 events met the inclusion criteria of the study. The diagnostic sensitivity of the 3 noninvasive imaging modalities (CDI, CT, MRI) for CCF was compared with the gold standard 6-vessel cerebral angiography. Significance testing was performed using the 2-tailed Fisher test. Color Doppler imaging had high sensitivity (96.8%) but low specificity (41.7%) for the diagnosis of CCFs with anterior orbital findings. A negative CDI had more diagnostic value than a positive CDI. While an arterial wave form in the superior ophthalmic vein was the most common finding of CCF on CDI, enlargement of the superior ophthalmic vein was the only statistically significant finding. Posterior cortical venous drainage was noted in about 10% of the patients with indirect (low-flow) fistulas, who presented with unilateral orbital signs and symptoms, a finding not previously reported in the literature. Color Doppler imaging is a useful noninvasive, radiation-free modality for diagnosis of CCF with anterior drainage, with higher sensitivity than CT or MRI, but equivalent specificity. A significant limitation of CDI is the lack of usefulness in diagnosing fistulas with posterior cortical venous drainage, which carry a risk of intracerebral hemorrhage and stroke. In this series, 10% of unilateral CCFs with anterior orbital signs and symptoms showed angiographic evidence of posterior cortical venous drainage.

Spectrum of Retinal Vascular Diseases Associated With Paracentral Acute Middle Maculopathy

To evaluate the spectrum of retinal diseases that can demonstrate paracentral acute middle maculopathy and isolated ischemia of the intermediate and deep capillary plexus. Retrospective, multicenter, observational case series. This is a retrospective case series review of 9 patients (10 eyes) from 5 centers with paracentral acute middle maculopathy lesions and previously unreported retinal vascular etiologies. Case presentations and multimodal imaging, including color photographs, near-infrared reflectance, fluorescein angiography, spectral-domain optical coherence tomography (SD OCT), and orbital color Doppler imaging, are described. Baseline and follow-up findings are correlated with clinical presentation, demographics, and systemic associations. Five men and 4 women, aged 27-66 years, were included. Isolated band-like hyperreflective lesions in the middle retinal layers, otherwise known as paracentral acute middle maculopathy, were observed in all patients at baseline presentation. Follow-up SD OCT analysis of these paracentral acute middle maculopathy lesions demonstrated subsequent thinning of the inner nuclear layer. Novel retinal vascular associations leading to retinal vasculopathy and paracentral acute middle maculopathy include eye compression injury causing global ocular ischemia, sickle cell crisis, Purtscher's retinopathy, inflammatory occlusive retinal vasculitis, post-H1N1 vaccine, hypertensive retinopathy, migraine disorder, and post-upper respiratory infection. Paracentral acute middle maculopathy lesions may develop in a wide spectrum of retinal vascular diseases. They are best identified with SD OCT analysis and may represent ischemia of the intermediate and deep capillary plexus. These lesions typically result in permanent thinning of the inner nuclear layer and are critical to identify in order to determine the cause of unexplained vision loss.

OCULAR HEMODYNAMICS IN NON-EXUDATIVE AGE RELATED MACULAR DEGENERATION

Purpose: To explore changes in retrobulbar ocular blood flow dynamics in patients with nonexudative age- related macular degeneration (ARMD). Materials and Methods: 52 patients (M=28, F=24) with ARMD and 45 age-matched healthycontrols (M=23, F=22) were included in our evaluation. Full ophthalmic examination and orbitalcolor Doppler imaging was performed in both eyes. Peak systolic and end-diastolic velocities,resistive and pulsatility indices were considered as Doppler blood flow parameters in ourevaluation. Central retinal, ophthalmic, temporal posterior ciliary and nasal posterior ciliaryarteries measurements were taken. Results: The mean age was 65.90 ± 2.05 in ARMD and 60.95 ± 1.34 in thecontrol group. Pulsatility and resistive indices in ophthalmic arteries of ARMD patients weresignificantly higher than the control group. The peak systolic and end-diastolic velocities innasal and temporal posterior ciliary arteries were significantly lower whereas pulsatility andresistive indices were significantly higher in ARMD compared to the control group. Peak systolicand end-diastolic velocities and resistive indices were significantly higher in ARMD cases,especially in posterior ciliary arteries supplying the choroid. Conclusion: Perfusion defects of the retrobulbar vasculatures were significantly higher inARMD compared to the healthy controls

Role of Color Doppler Imaging in Early Diagnosis and Prediction of Progression in Glaucoma

This longitudinal and prospective study analyzes the ability of orbital blood flow measured by color Doppler imaging (CDI) to predict glaucoma progression in patients with glaucoma risk factors. Patients with normal perimetry but having glaucoma risk factors and patients in the initial phase of glaucoma were prospectively included in the study and divided, after a five-year follow-up, into two groups: “Progression” and “No Progression” based on the changes in the Moorfields regression analysis (MRA) classification of Heidelberg retina tomograph (HRT). An orbital CDI was performed in all patients and the parameters obtained were correlated with changes in HRT. A logistic discrimination function (LDF) was calculated for ophthalmic artery (OA) and central retinal artery (CRA) parameters. Receiver operating characteristics curves (ROC) were used to assess the usefulness of LDFs to predict glaucomatous progression. A total of 71 eyes were included. End-diastolic velocity, time-averaged velocity, and resistive index in the OA and CRA were significantly different (P < 0.05) between the Progression and No Progression groups. The area under the ROC curves calculated for both LDFs was of 0.695 (OA) and 0.624 (CRA). More studies are needed to evaluate the ability of CDI to perform early diagnosis and to predict progression in glaucoma in eyes.

Colour Doppler imaging evaluation of blood flow parameters in the ophthalmic artery in acute and chronic phases of optic neuritis in multiple sclerosis

Optic neuritis (ON) is a common manifestation of multiple sclerosis (MS). It is caused by the immune-mediated inflammation of the optic nerve. Some vascular factors that may influence blood flow in the ophthalmic artery (OA) have also been suggested as factors in the pathogenesis of ON. The purpose of our study was to evaluate blood flow velocities and resistance (RI) and pulsatile (PI) indices in the OA in both orbits in patients in the acute and chronic phases of unilateral ON and to compare these with equivalent findings in healthy control subjects. Orbital colour Doppler imaging (CDI) was performed in 40 consecutive MS patients during acute unilateral ON prior to corticosteroid treatment. Optic neuritis was diagnosed on the basis of clinical presentation and facultative assessment of visual evoked potentials (VEPs). The peak systolic (PSV) and end-diastolic (EDV) velocities and RI and PI were measured in the OA in both eyes. We compared results from affected and unaffected orbits using the paired t-test. The same measurements were performed in 114 MS patients with a history of acute unilateral ON that occurred > 1 year prior to ultrasound examination. We also measured the same parameters in the middle cerebral arteries (MCAs) on both sides in all subjects in both groups. The same measurements were obtained in healthy controls. The PSV (p < 0.0001), RI (p < 0.0001) and PI (p < 0.0001) in the OA in the eye affected with acute ON were significantly higher than in the unaffected eye. There was no difference in EDV in the OA between affected and unaffected eyes (p > 0.05) in the group with acute ON. We did not observe any significant differences between eyes in either blood flow velocities or the RI or PI (p > 0.05) in the group in the chronic phase of ON or in the control group. All the parameters in the MCAs on both sides were normal in both the acute and chronic groups, as well as in the control group. Pathophysiological changes during acute unilateral ON influence orbital haemodynamics, as is indicated by increased PSV, RI and PI in the OA in eyes affected with ON. However, these changes do not persist over longer periods.

Orbital color Doppler imaging in embolic central retinal artery obliteration associated with neovascular glaucoma.

To describe the detection of an embolism in the retrobulbar circulation using orbital color Doppler imaging (OCDI) in a patient with an inaccessible fundus because of neovascular glaucoma. Review of the clinical, laboratory, photographic, and orbital color Doppler imaging records of a patient with central retinal artery occlusion (CRAO) associated with neovascular glaucoma. A 42-year-old man had no light perception in the left eye secondary to neovascular glaucoma. The fundus was not visible because of corneal edema. Orbital color Doppler imaging established the diagnosis of embolic CRAO as the cause of neovascular glaucoma. Orbital color Doppler imaging is an important diagnostic procedure for establishing CRAO as the cause of neovascular glaucoma when the fundus is not accessible. This noninvasive technology enables differentiation of embolic disease from other conditions as the cause of CRAO.

Optic Neuropathy Mimicking Normal Tension Glaucoma Associated with Internal Carotid Artery Hypoplasia

Enlargement (excavation) of the right optic disc was discovered in a 41-year-old woman during an examination to fit her for contact lenses. She was initially diagnosed with normal tension glaucoma (NTG) in that eye and subsequently treated with topical medication. However, Goldmann perimetry results indicated there were changes in the temporal visual field that were not typical for glaucoma. In addition, magnetic resonance angiography (MRA), three-dimensional computed tomographic angiography (3D-CT) and orbital color Doppler imaging (CDI) results revealed the presence of segmental hypoplasia and stenosis of the right cervical internal carotid artery (ICA). The patient therefore had ipsilateral coexisting ICA hypoplasia and optic neuropathy. We postulate that the visual field change in this patient was due to an ischaemic event in the optic nerve that was related to a congenital anomaly of the right cervical ICA.

Orbital color Doppler imaging in Behçet’s disease with or without ocular involvement

To investigate the value of color Doppler imaging (CDI) of orbital vasculature in the assessment of ocular involvement in patients with Behçet's disease (BD) without clinical ophthalmologic abnormalities. CDI of the orbital vessels were performed on 26 eyes of 13 patients who were diagnosed as having BD with ocular involvement (group 1), 65 eyes of 33 patients who had BD without ocular involvement (group 2) and 40 eyes of 20 healthy volunteers (group 3). Peak systolic (PSV) and end-diastolic (EDV) blood flow velocities and resistivity index (RI) measurements were obtained for the ophthalmic artery (OA) and central retinal artery (CRA). The mean velocity of the central retinal vein (CRV) was also measured. For the OA, PSV and EDVs were significantly lower and RIs were significantly higher in group 2 than in control subjects. In group 1, only the EDVs of OA were significantly lower than in healthy subjects. For the CRA, PSV and EDVs were significantly lower, and RIs were significantly higher in both BD groups than those in group 3. When group 1 and group 2 were compared, the differences between PSV, EDV and RI measurements for the CRA and OA were statistically insignificant. There was no significant difference in blood flow velocity of the CRV between the three groups. Major hemodynamic changes were observed in the ophthalmic vasculature of Behçet's patients with or without ocular involvement by CDI. CDI may detect ocular blood flow alterations before initial clinical manifestations.

Classification of Ophthalmic Artery Flow in Patients with Occlusive Carotid Artery Disease

To investigate and classify the ophthalmic artery (OA) flow patterns in patients with occlusive carotid artery disease (OCAD). Forty-three patients (52 eyes) with documented OCAD of > or =70% underwent orbital color Doppler imaging. The eyes were first divided into four groups by peak systolic velocity in OA (PSV(OA)): group A, PSV(OA) < or = 0; group B, 0 < PSV(OA) < or = 10; group C, 10 < PSV(OA) < or = 40; and group D, PSV(OA) > 40 cm/s, then further classified by the shape of the OA flow wave. The groups were then compared with respect to the collateral pathway (Co-Path), severity of the OCAD, and systemic diseases. Eyes with unidirectional reverse flow (group A(1)) had a Co-Path from the ipsilateral external carotid artery and 70%-100% OCAD. Eyes with bidirectional reverse flow (group A(2)) had no Co-Path, 75% OCAD, and impending ischemic heart disease (IHD). Group B eyes had dome-shaped OA flow waves with no Co-Path and 99%-88% OCAD. Group C(1) eyes, with normal flow waves, had a Co-Path from the contralateral internal carotid artery and 100% OCAD. Group C(2) eyes, with triangular-shaped flow waves, had no Co-Path, 93%-70% OCAD, and IHD. Group D eyes had normal high flow waves with no Co-Path, 75% OCAD, and hypertension. The OA flow patterns were variously affected by collateral pathway, severity of OCAD, and systemic diseases.

Ocular circulation in diabetic patients with coronary artery disease

To evaluate the ocular circulation in diabetic patients with coronary artery disease (CAD). Thirty diabetic patients with diabetic retinopathy of grade 20 or 35, as evaluated by the Early Treatment Diabetic Retinopathy Study, were studied. They were divided into those without CAD (15 cases) and those with CAD (over 75% stenosis of carotid artery; 15 cases). All underwent standard ophthalmic examinations and orbital color Doppler imaging. Fifteen healthy controls underwent the same examinations. The peak systolic velocity in the central retinal artery was significantly lower in the two diabetic groups. The end-diastolic velocity in the central retinal artery was significantly lower only in the diabetic patients with CAD. There were no significant intergroup differences in blood flow velocities in the ophthalmic artery, short posterior ciliary artery, and central retinal vein. The blood flow waves were flattened in the diastolic phase for all orbital arteries in significantly more eyes in the diabetic patients with CAD. Echocardiography, performed only in the diabetic patients with CAD, showed that 10 cases (67%) had reduced systolic functions and/or diastolic functions and/or asynergy of the left ventricle. A decrease in blood flow velocities in the diastolic phase was found in diabetic patients with CAD. The findings indicate that this is probably related to the decrease in cardiac output.

Case of Infectious Endocarditis Predicted by Orbital Color Doppler Imaging

There are no specific ocular findings for infectious endocarditis. We report a case of infectious endocarditis detected by combining orbital color Doppler imaging (CDI) and ophthalmological findings. A 47-year-old man suffered from lumbar pain and low-grade fever. He had undergone heart surgery for a ventricular septal defect and received blood transfusions 20 years earlier, and he had started interferon therapy for chronic hepatitis C 8 months previously. Systemic examinations suggested either collagen disease, malignant lymphoma, or infectious disease. The patient underwent a complete ophthalmological examination, including CDI. Ophthalmoscopy showed multiple cotton-wool patches in both eyes and branch retinal artery occlusion in the left eye. Orbital CDI showed that bilateral ophthalmic arteries and central retinal arteries flowed synchronously with abnormal waves composed of three narrow, sharp peaks. These findings were suggestive of a cardiac valve disorder, which can lead to embolisms. Echocardiography established the diagnosis of infectious endocarditis. To the best of our knowledge, this is the first reported case of infectious endocarditis detected by orbital CDI.

Acute Optic Neuritis in Multiple Sclerosis: Evaluation of Hemodynamics in the Ophthalmic Artery with Colour Doppler Imaging

Background: Optic neuritis (ON) is a common manifestation of multiple sclerosis. It occurs because of the immune-mediated inflammation of the optic nerve. Some vascular factors that could influence the blood flow in the ophthalmic artery (OA) have been suggested in the pathogenesis of ON as well. The purpose of our study was to evaluate blood flow velocities and resistance (RI) and pulsatile (PI) indexes in the OA in patients with acute unilateral ON. Materials and methods: Orbital color Doppler imaging was performed in 27 consecutive patients during acute unilateral ON prior to corticosteroid treatment. ON was diagnosed on the basis of clinical presentation, acute unilateral loss of vision, and assessment of visual evoked potentials (VEP). The peak-systolic velocity (PSV) and the end-diastolic velocity (EDV) and RI and PI were measured in the OA on both sides. We compared results from affected and unaffected orbits, using the paired t-test. We also measured the same parameters in the middle cerebral arteries (MCA) on both sides. Results: The PSV (p < 0.0001), RI (p < 0.0001), and PI (p < 0.0001) in the OA on the side affected by acute ON were significantly higher compared to the unaffected side. There was no difference in EDV in the OA between affected and unaffected sides (p > 0.05). All the parameters in the MCA on both sides were normal. Conclusion: Pathophysiological changes during acute unilateral ON influence the orbital hemodynamics as documented by increased PSV, RI, and PI in the OA on the side affected by ON.

Use of Orbital Color Doppler Imaging for Detecting Internal Carotid Artery Stenosis in Patients with Amaurosis Fugax

Purpose: To determine whether orbital color Doppler imaging (CDI) can be used to detect internal carotid artery stenosis (ICAS) in patients with amaurosis fugax (AF). Methods: Twenty patients with AF (20 symptomatic eyes) and 14 normal controls (14 randomly selected eyes) were studied. The AF patients were divided by magnetic resonance angiography or carotid arteriography into those without ICAS (Group 1, n = 14), and those with ICAS (Group 2, n = 6). The peak systolic velocities (PSV) and end diastolic velocities (EDV) of the ophthalmic artery (OA) and the central retinal artery (CRA) were determined by orbital CDI, and the values were compared between the three groups. Results: There were no significant differences in the PSV and EDV of the CRA between the three groups. However, the PSV and EDV of the OA were significantly lower in Group 2 than in the other two groups. From the distribution of PSV-OA and EDV-OA in AF patients, Group 2 could be separated from Group 1 by the PSV-OA value of 10 cm/s. Conclusions: The PSV-OA of 10 cm/s can be used to identify AF patients with ICAS. It is concluded that orbital CDI is a valuable method for detecting ICAS in AF patients.

Embolic central retinal artery occlusion detected by orbital color Doppler imaging.

Embolic central retinal artery occlusion detected by orbital color Doppler imaging.

Embolic central retinal artery occlusion detected by orbital color doppler imaging

ObjectiveTo describe the detection of emboli to the retrobulbar circulation using orbital color Doppler imaging in patients with central retinal artery occlusions (CRAO) without visible retinal emboli. DesignNoncomparative, retrospective, observational case series. Patients and methodsTwenty-nine patients with CRAO, without funduscopic evidence of embolic material within the retinal arterioles, underwent neuroophthalmic examination and evaluation with orbital color Doppler imaging. Main outcome measuresThe detection of retrobulbar plaques using orbital color Doppler imaging. ResultsNine of 29 (31%) patients with CRAO demonstrated hyperechoic retrobulbar plaques. All nine patients had visual acuity of counting fingers or worse at presentation. Six of the nine patients (67%) had a history of hypertension, and seven (78%) had coronary artery disease as vascular risk factors for arterial occlusive disease. Two of the nine patients (22%) subsequently died from cardiac-related events. ConclusionsThis study demonstrates that orbital color Doppler imaging is an important diagnostic procedure for establishing embolism as the cause of CRAO when no emboli are visible in the retinal circulation. This noninvasive technology enables prompt differentiation of embolic disease from arterial occlusion caused by intrinsic atherosclerosis, vasospasm, or vasculitis from giant cell arteritis. Recognition of emboli has important management implications for these patients.

Estudo da circulação retrobulbar e do campo visual após dose única oral de citrato de sildenafil (Viagra®)

Objetivo: Estudar os efeitos na circulação retrobulbar e no campo visual de uma dose oral única de 100 mg de citrato de sildenafil (Viagra®). Métodos: Um estudo duplo-mascarado e controlado por placebo foi realizado em 10 voluntários do sexo masculino, com idade média de 27,7 + 5,68 anos. O olho direito de cada voluntário foi submetido aos exames de Doppler colorido de órbita e análise de campo visual por meio de perimetria computadorizada (Humphrey, programa 30-2, estratégia "Full Threshold") em 3 ocasiões: "baseline", 1 hora após placebo e 1 hora após 100 mg de sildenafil via oral. No campo visual, analisaram-se o limiar foveal e o "mean deviation" (MD) nas 3 ocasiões. No Doppler colorido, medimos a velocidade sistólica máxima (VSM), a velocidade diastólica final (VDF) e o índice de resistência (IR) da artéria central da retina (ACR) e da artéria oftálmica (AO) nas 3 ocasiões. Resultados: A administração do sildenafil não alterou significativamente o limiar foveal e o "mean deviation" em relação ao "baseline" e ao placebo. Houve um aumento significativo da velocidade sistólica máxima e velocidade diastólica final na artéria oftálmica após a administração do citrato de sildenafil (p<0,001). Não houve alteração significativa dos parâmetros hemodinâmicos na artéria central da retina e no índice de resistência da artéria oftálmica. Conclusões: A administração de 100 mg de citrato de sildenafil promoveu um aumento da velocidade de fluxo sanguíneo na artéria oftálmica de indivíduos normais e não promoveu alteração significativa no limiar foveal e "mean deviation" da campimetria computadorizada.

Normal-tension glaucoma with reversed ophthalmic artery flow

PURPOSE: To describe a case of normal-tension glaucoma with bilateral complete occlusion of the internal carotid artery. METHODS: A 58-year-old man who had a 2-year history of normal-tension glaucoma in the left eye presented with ocular ischemic syndrome. To evaluate the orbital circulation, cerebral angiography and color Doppler imaging were performed. RESULTS: Cerebral angiography showed bilateral complete occlusion of the internal carotid artery and collateral blood supply through the right and left ophthalmic arteries, in which the flow was reversed. Moreover, color Doppler imaging revealed lower blood flow velocities in the left central retinal and short posterior ciliary arteries, suggesting a steal phenomenon. CONCLUSION: Normal-tension glaucoma in the present case may be caused by chronic reduction of retrobulbar blood flow resulting from a steal phenomenon.