Short Posterior Ciliary Arteries Research Articles

Dynamics of rheological and biochemical blood parameters of patients with an intermediate stage of the dry form of age-related macular degeneration before and after serum cascade filtration

BACKGROUND: One of the socially significant ophthalmic diseases is the dry form of the age-related macular degeneration, the key feature of which consists in a slowly progressing damage to the pigment epithelium and the formation of drusen. However, the basic mechanisms of pathogenesis are still not completely clear nowadays. AIM: The aim is, using the data of OCT, OCT-angiography and visometry, to study the dynamics of structural and functional parameters of the macular area, as well as the dynamics of rheological and biochemical blood parameters in patients with an intermediate stage of the dry form of age-related macular degeneration before and after the use of serum cascade filtration. MATERIALS AND METHODS: The study included 63 patients (94 eyes) with an intermediate stage of the dry form of age-related macular degeneration. Patients were randomly separated into two groups. The first (main) group consisted of 34 patients (52 eyes), in whom serum cascade filtration was performed; the second group (control) group included 29 patients (42 eyes) who did not receive any specific treatment. In patients of the main group, before and after the serum cascade filtration course (1 month after the start of follow-up), in 6 and 12 months, in addition to standard ophthalmological examination, as an indicator of the efficacy of performed serum cascade filtration, the ultrasound triplex scanning in color Doppler mapping mode with an assessment of blood flow velocity in the posterior short ciliary arteries, Fourier IR spectroscopy, and the testing of the serum and blood viscosity were performed. Patients in the control group also underwent a similar examination at 1, 6, 12 months after the start of follow-up. RESULTS: According to optical coherence tomography, optical coherence tomography-angiography and visometry data, we found a positive dynamics of structural and functional parameters of the macular retina and an improvement in blood rheological parameters with an increase in microcirculation indices against the background of the serum cascade filtration use in treatment of patients with an intermediate stage of the dry form of age-related macular degeneration. At the same time, a statistically significant difference between the two groups begins at 1 month and persists for 12 months of follow-up, being an evidence of the stabilization of the pathological process. CONCLUSIONS: This study showed that after the serum cascade filtration in patients with an intermediate stage of the dry form of age-related macular degeneration, against the background of an improvement in blood rheological and biochemical parameters, there was an improvement in structural and functional parameters of the macular area, which consisted in a decrease of the volume of the drusenoid retinal pigment epithelium detachment and in a visual acuity amelioration.

Dynamics of rheological and biochemical blood parameters of patients with an intermediate stage of the dry form of age-related macular degeneration before and after serum cascade filtration

BACKGROUND: One of the socially significant ophthalmic diseases is the dry form of the age-related macular degeneration, the key feature of which consists in a slowly progressing damage to the pigment epithelium and the formation of drusen. However, the basic mechanisms of pathogenesis are still not completely clear nowadays. AIM: The aim is, using the data of OCT, OCT-angiography and visometry, to study the dynamics of structural and functional parameters of the macular area, as well as the dynamics of rheological and biochemical blood parameters in patients with an intermediate stage of the dry form of age-related macular degeneration before and after the use of serum cascade filtration. MATERIALS AND METHODS: The study included 63 patients (94 eyes) with an intermediate stage of the dry form of age-related macular degeneration. Patients were randomly separated into two groups. The first (main) group consisted of 34 patients (52 eyes), in whom serum cascade filtration was performed; the second group (control) group included 29 patients (42 eyes) who did not receive any specific treatment. In patients of the main group, before and after the serum cascade filtration course (1 month after the start of follow-up), in 6 and 12 months, in addition to standard ophthalmological examination, as an indicator of the efficacy of performed serum cascade filtration, the ultrasound triplex scanning in color Doppler mapping mode with an assessment of blood flow velocity in the posterior short ciliary arteries, Fourier IR spectroscopy, and the testing of the serum and blood viscosity were performed. Patients in the control group also underwent a similar examination at 1, 6, 12 months after the start of follow-up. RESULTS: According to optical coherence tomography, optical coherence tomography-angiography and visometry data, we found a positive dynamics of structural and functional parameters of the macular retina and an improvement in blood rheological parameters with an increase in microcirculation indices against the background of the serum cascade filtration use in treatment of patients with an intermediate stage of the dry form of age-related macular degeneration. At the same time, a statistically significant difference between the two groups begins at 1 month and persists for 12 months of follow-up, being an evidence of the stabilization of the pathological process. CONCLUSIONS: This study showed that after the serum cascade filtration in patients with an intermediate stage of the dry form of age-related macular degeneration, against the background of an improvement in blood rheological and biochemical parameters, there was an improvement in structural and functional parameters of the macular area, which consisted in a decrease of the volume of the drusenoid retinal pigment epithelium detachment and in a visual acuity amelioration.

Correlation of retrobulbar perfusion deficits with glaucomatous visual field defects.

This study is to evaluate the correlation between retrobulbar perfusion deficits and glaucomatous visual field defects. Eighty-four patients with glaucoma and 17 normal subjects serving as controls were selected. Color Doppler imaging (CDI) was used to measure the changes in blood flow parameters in the retrobulbar ophthalmic artery (OA), central retinal artery (CRA), and short posterior ciliary arteries (SPCAs). Visual field testing was performed using a Humphrey perimeter, categorizing the visual field deficits into four stages according to the Advanced Glaucoma Intervention Study (AGIS) scoring method. Subsequently, the correlation of retrobulbar hemodynamic parameter alterations among glaucomatous patients with varying visual field defects was examined. The higher the visual field stage, the lower the peak systolic velocity (PSV) of the OA, CRA, and SPCAs in glaucomatous patients. The CRA had the highest sensitivity to changes in its PSV. The PSV of the temporal SPCA (TSPCA-PSV) was lower in advanced glaucoma than in early-stage glaucoma. The PSVs of the OA, CRA, and TSPCA, as well as the resistance index of the CRA (CRA-RI), were positively correlated with the visual field index and the mean deviation. Except for that of OA, the PSV of the retrobulbar vessels was negatively correlated with the pattern standard deviation (PSD). The OA-PSV and end-diastolic velocity (EDV) of the CRA and TSPCA were lower in patients with superior visual field defects than in those with inferior visual field defects. Greater severity of visual field defects corresponded to poorer retrobulbar blood flow in glaucomatous patients. Patients suffered significant perfusion impairments in the CRA at the early stage, accompanied by SPCA perfusion disorder at the advanced stage. The presence of a bow-shaped defect in the superior or inferior region of the visual field in moderate-stage glaucoma was closely correlated with retrobulbar vascular EDV. ChiCTR2200059048 (2022-04-23).

Ultrasound indicators of blood flow in the eyes and orbits at different durations of type 1 diabetes mellitus in childhood and adolescence

Diabetic retinopathy is a complication of type 1 diabetes mellitus with high social significance, especially in childhood and adolescence.Aim: To evaluate ultrasound indicators of retrobulbar blood flow at different durations of type 1 diabetes mellitus in childhood and adolescence.Material and Methods. Ultrasound examinations were performed in 70 patients with type 1 diabetes mellitus aged from 5 to 18 years, with disease duration of up to 5 years, from 5 to 10 years, and more than 10 years. The analysis included an assessment of the linear velocity of blood flow and the index of peripheral resistance in the ophthalmic arteries, central arteries and retinal veins, posterior short ciliary arteries, and ophthalmic veins at different times of the duration of type 1 diabetes mellitus.Results. The study revealed a decrease in blood flow velocity in the central retinal arteries, in the posterior short ciliary arteries with an increase in the duration of type1 diabetes mellitus. The greatest decrease in blood flow velocity was recorded in the group with duration of diabetes mellitus of more than 10 years.Conclusion. The obtained data on a decrease in blood flow velocity in the retrobulbar arteries can be used for the assessment and dynamic monitoring of early disorders of the blood supply to the eye and orbit in patients with type 1 diabetes mellitus in childhood and adolescence.

Ocular blood flow in preterm neonates

Retinopathy of prematurity (ROP) is a disorder affecting low birthweight, preterm neonates. In the preterm eye, the retina is not fully developed and neovascularization may occur at the margin between the developed vascular retina and undeveloped avascular retina. Without timely treatment by laser or intravitreal anti-vascular endothelial growth factor (VEGF) therapy, this can lead to tractional retinal detachment and blindness. Visualization of the retina in regular examinations by indirect ophthalmoscopy is hence the current standard of care, but the exams are stressful and interpretation of images is subjective. The upregulation of VEGF in ROP would suggest an increase in ocular blood flow. In this report, we evaluate the potential of ultrafast plane-wave Doppler ultrasound (PWU) to detect increased flow velocities in the orbital vessels supplying the eye in a gentle exam with objective findings. We imaged both eyes of 50 low-birthweight preterm neonates using 18 MHz PWU. Flow velocity in the central retinal artery (CRA) and vein (CRV), and the short posterior ciliary arteries were determined and values at each ROP Stage compared. We found significantly increased velocities in the CRA and CRV in Stage 3 ROP eyes, where intervention would be considered. We compared multivariate models for identifying Stage 3 eyes comprised solely of clinical factors, solely of Doppler parameters, and clinical plus Doppler parameters. The respective models provided areas under their respective ROC curves of 0.760, 0.812, and 0.904. PWU Doppler represents a gentle, objective means for identifying neonates at risk for ROP that could complement ophthalmoscopy.

Spontaneous expulsive choroidal hemorrhage: A rare ocular catastrophe - A case report

Spontaneous expulsive choroidal hemorrhage is described as a sudden accumulation of blood in the potential space between the choroid and sclera, with the source of the blood being the long or short posterior ciliary arteries. It is observed exclusively in the geriatric population with atherosclerotic vessels associated with hypertension.[4] Massive spontaneous choroidal hemorrhage in the absence of surgery or trauma is an infrequent event, described in isolated case reports, and it results in devastating vision loss.[8] We report a case of a 74-year-old patient with uncontrolled hypertension with a sudden loss of vision in the left eye, later diagnosed as spontaneous expulsive choroidal hemorrhage. The patient was treated conservatively with topical steroids, cycloplegics, antibiotics, antiglaucoma medications, and tight bandages with nil visual prognosis. The patient initially refused surgical management and got discharged against medical advice. However, having been mentally prepared, the patient underwent evisceration at a tertiary eye care center nearby.

Boucher-Neuhauser Syndrome: Chorioretinal Changes in a Single Case Over Time.

To describe chorioretinal changes in a single case of Boucher-Neuhauser Syndrome (BNHS) over 45 years of follow-up. Methods: Retrospective chart review was performed. Color fundus photography from 1977 to 2003 was obtained and digitized. Current fundus photography was obtained with widefield imaging. High-resolution spectral-domain optical coherence tomography (OCT) was performed. Genetic analysis was performed using an inherited retinal disorders panel. Results: Fundus examination demonstrated central chorioretinal atrophy with sclerotic choroidal vessels. Short posterior ciliary arteries became more prominent and tortuous over time. Mid-peripheral atrophy extends to the equator and demonstrates a scalloped pattern with islands of atrophy intervening with areas of normal retina. The far periphery remained minimally affected. High-resolution OCT demonstrated outer retinal atrophy and choriocapillaris loss. Genetic testing showed a homozygous variant for PNPLA6 and a heterozygous variant for TYRP1. Conclusion: Chorioretinal changes in BNHS vary in onset and severity. It is important to diagnose this condition in order to begin timely management of visual and systemic sequelae.

Evaluation of Hypoxia and Microcirculation Factors in the Progression of Diabetic Retinopathy.

The purpose of this study was to evaluate comparatively the changes in HIF-1ɑ, EPO, sICAM-1, hemodynamic, and electrophysiological parameters during the progression of non-proliferative diabetic retinopathy (NPDR). This retrospective longitudinal study included 82 patients with NPDR, who were divided into 2 groups: group I (n=40) consisted of patients without progression of NPDR after 1 year and group II (n=42) included patients with the transition of NPDR to proliferative diabetic retinopathy (PDR). The hemodynamics of the eye was assessed by Doppler ultrasonography. The glial hypoxia index Cg was calculated using ERG. The serum levels of hypoxia-inducible factor 1-a (HIF1-α), soluble intercellular adhesion molecule-1 (sICAM-1), and erythropoietin (EPO) were determined by ELISA method. In group II, resistive index (RI), short posterior ciliary arteries (SPCAs) increased significantly from 0.62 ± 0.005 to 0.65 ± 0.007 (P=0.003), being higher than the corresponding parameter in group I (P=0.013). In group II, there was an increase in the hypoxia index Cg (5.56 ± 0.05) relative to the primary indicators and in group I (P<0.001). In group II, HIF1-ɑ, EPO, and sICAM-1 levels after a year significantly increased (0.213 ± 0.02 ng/mL, 37.7 ± 2.4mIU/mL, and 576.3 ± 11.9 ng/mL, respectively) both relative to the main indicators and the values in group I (P<0.001). When EPO exceeds 27.5mIU/mL, a high risk of progression of NPDR to the initial stages of PDR is predicted. The glial Cg index and the level of HIF1-a, EPO in the serum of patients with progression of NPDR were initially higher than in patients without progression of NPDR and have increased during the year, indicating the development of PDR due to more severe hypoxia.

Dynamics of ultrasound indicators of retrobulbar blood flow at different durations of type 1 diabetes mellitus in childhood and adolescence

The results of a study of the dynamics of ultrasound parameters of blood flow in the eye and orbit in patients with type 1 diabetes mellitus in childhood and adolescence are presented. The study included data from 70 patients aged 5 to 18 years, with disease duration up to 5 years, from 5 to 10 years, and more than 10 years. Ultrasound indicators of linear blood flow velocity and peripheral resistance index were analyzed in the ophthalmic arteries, central arteries and veins of the retina, posterior short ciliary arteries, and superior ophthalmic veins at different periods of the duration of type 1 diabetes mellitus. The study revealed a decrease in blood flow velocity in the central retinal arteries and in the posterior short ciliary arteries with increasing duration of type 1 diabetes. The greatest decrease in blood flow velocity was recorded in the group with a duration of diabetes mellitus of more than 10 years. The data obtained can be used to assess and dynamically monitor early disorders of the blood supply to the eye and orbit in patients with type 1 diabetes mellitus in childhood and adolescence.

Study Ocular Hemodynamics in Pregnant Women with Disorders of Carbohydrate Metabolism

Purpose. To study state of ocular hemodynamics in pregnant women with disorders of carbohydrate metabolism using color Doppler imaging. Patients and methods. 147 pregnant women were examined: 40 of them had type 1 diabetes mellitus (DM), 87 had gestational diabetes (GD); in 20 — pregnancy proceeded physiologically. Examination of pregnant women with DM was carried out in each trimester and 3 months after delivery, pregnant women with GD and control groups — once in the third trimester. The parameters of hemodynamics in the central retinal artery (CRA) and in the short posterior ciliary arteries (SPCAs) were studied using color Doppler imaging. Results. It was found that the peak systolic velocity (PSV) in the CRA was significantly lower in the GD and DM groups, while PSV in the SPCAs and end-diastolic velocity (EDV) in the CRA were higher in the control group compared to the GD. In SPCAs, the resistive index (RI) was the highest in the DM group, and the lowest in the GD group. Conclusion. In patients with GD in the third trimester of pregnancy, there is a statistically significant decrease in PSV and EDV in the CRA and SPCAs, combined with a decrease in RI in SPCAs, compared with patients with a physiological course of pregnancy. In patients with diabetic retinopathy (DR) in the third trimester of pregnancy, PSV and EDV in the CRA and SPCAs were significantly lower, and the pulsatility index (PI) and RI were significantly higher compared to pregnant women with DM without DR. In pregnant women with DR during gestation, there was a decrease in PSV and EDV against the background of an increase in RI and PI in the CRA and in the SPCAs. In pregnant women with DM and absence of DR during gestation, there was an increase in PSV, EDV and PI in the CRA and SPCAs from the first to the third trimesters. The revealed features of the state of hemodynamics in the CRA and SPCAs in pregnant women with DM with presence or absence of DR can become the basis for creating criteria for manifestation and progression of DR.

Early and late chorioretinal complications of preeclampsia

Preeclampsia remains a serious problem of obstetric practice, the growth of severe forms of this complication of pregnancy is predicted in the future, which determines the scientific interest of specialists in the search for new markers of preeclampsia to prevent the progression of preeclampsia and maternal mortality. The ocular fundus is an area where vessels can be observed in real time, in addition, the structure of the retina predisposes to the development of edema, up to retinal detachment in severe preeclampsia. In the last decade, new diagnostic equipment has become available to study chorioretinal changes at the stage of preclinical manifestations. In order to study early and late complications of pre-eclampsia from the retina and vasculature, we analyzed domestic and foreign scientific sources published in the last five years. According to a number of authors, changes in the visual organ of varying degrees of severity in preeclampsia occur in 100% of cases. It is established that the key role in the pathogenesis of vascular disorders in preeclampsia belongs to endothelial dysfunction. Preeclampsia may be accompanied by hemorrhagic and ischemic retinal infarcts, retinal pigment epithelium detachment, corkscrew-shaped tortuosity of arterioles in the periphery of the retina, retinal detachment, optic disc edema, less frequently vitreous hemorrhages, lesions of the optic nerve, conjunctiva and cerebral cortex in the area of visual centers, which may resolve against the background of therapy when the patient's general condition improves. However, in some women endothelial dysfunction may persist for many years, the most frequent late complications of preeclampsia are retinal detachment and diabetic retinopathy. Along with traditional methods of ophthalmoscopy of the eye fundus for diagnostics of chorioretinal complications OCT for determination of serous retinal detachment, subretinal deposits and other pathologies of the vasculature, USDG of the central retinal artery, posterior short ciliary arteries, ocular artery for diagnostics of ophthalmologic complications of preeclampsia can be used. As a result of the analysis of scientific data, conclusions are drawn about the association of preeclampsia with the development of certain early and distant chorioretinal complications. The search for new, earlier changes on the ocular fundus may serve for early diagnosis of preeclampsia, prevention of severe complications of pregnancy.

Correlation of Ocular Plane-Wave Doppler With Optical Coherence Tomography Angiography in Preeclampsia.

Preeclampsia (PE) is a severe complication of pregnancy characterized by hypertension, proteinuria and compromised fetal blood supply. The eye, like other end organs, is affected by this systemic condition, but unlike in other organs, ocular media transparency allows high-resolution optical visualization of the vascular structure of the retina. Our aim was to assess how ultrasound-determined ocular blood-flow correlates with vascular structure of the retina and choriocapillaris determined by optical coherence tomography angiography (OCTA). Plane-wave ultrasound and OCTA were performed on both eyes of 40 consecutive subjects consisting of normal controls (n = 11), mild PE (n = 5), severe PE (n = 17) and chronic or gestational hypertension (n = 7) within 72 hours following delivery. From ultrasound, we measured pulsatile flow velocity and resistance indices in the central retinal artery (CRA) and vein, the short posterior ciliary arteries (SPCAs) and choroid. From OCTA, we measured vascular density (VD) in the superficial, deep retina and choriocapillaris. We determined differences in Doppler and OCTA parameters among groups and correlations between ultrasound and OCTA. In severe PE, flow resistance was reduced with respect to controls. Flow velocity and resistance in the and SPCA were moderately correlated with VD in the choriocapillaris and peripapillary retina, but VD in PE did not differ significantly from controls. Although OCTA parameters were moderately correlated with Doppler ultrasound, OCTA did not demonstrate significant differences between PE and controls postpartum.

Nonarteritic anterior ischemic optic neuropathy (nAION)

Nonarteritic anterior ischemic optic neuropathy (nAION) is the second most common degenerative disease of the optic nerve. The pathogenesis remains elusive. Atransient ischemia in the short posterior ciliary arteries not triggered by thromboembolic events is suspected. The typical history of asudden onset of scotoma without associated pain in conjunction with (sectorial) optic disc swelling, an afferent pupillary defect and avisual field defect are of decisive diagnostic importance. The most urgent diagnostic measure is the exclusion of arteritic AION. There are no proven treatment approaches. Frequently used but without clear study results, is the treatment with steroids and secondary prophylaxis with acetylsalicylic acid (ASA). Recurrence in the ipsilateral or contralateral eye is possible.

Orbital Vasculopathy With Unexpected Finding of Calcium Oxalosis in the Context of a Clinical Diagnosis of Optic Neuropathy.

There are few reports of histopathology of any form of optic neuropathy. This article provides histopathologic findings of an adult-onset, nonprogressive optic neuropathy that was diagnosed clinically as nonacute, nonarteritic anterior ischemic optic neuropathy (NAION) but which was found by a pathological study to be associated with diffuse calcium oxalosis that was confined in the involved orbit. This is a case report that includes results of a neuro-ophthalmologic examination and histopathology of a complete autopsy, including en bloc removal of both orbits and the brain. The unaffected orbit/optic nerve served as a control. The affected orbit was serially sectioned into 2,550 increments each separated by 10 μm; the uninvolved orbit was sectioned into 150 equally spaced sections. The main outcome measures were derived from the autopsy, especially from the thin-section histopathologic study of both orbits that focused on blood vessels and the site of neural damage within the optic nerve. The neuro-ophthalmologic examination revealed a unilateral optic neuropathy with pallor of the left optic nerve head that had been documented just before death. The general autopsy showed acute bacterial endocarditis and a recent cerebral hematoma that caused death. Histopathology revealed sectoral loss of optic nerve axons in the left eye. Numerous arterial walls in the left orbit, including short posterior ciliary arteries and the central retinal artery, contained hundreds of crystals with anisotropic, colorful birefringence consistent with calcium oxalosis. Crystals were not found in the right, control orbit or elsewhere in the body. The patient developed an optic neuropathy late in life that was diagnosed by an experienced neuro-ophthalmologist as being most consistent with nonacute, nonarteritic anterior ischemic optic neuropathy. The autopsy identified sectoral loss of optic nerve fibers consistent with that diagnosis. However, the unexpected discovery of calcium oxalate crystals in blood vessels of the involved orbit, which curiously were not present elsewhere in the body, raises a question of their etiological role in this particular optic neuropathy. Whether the crystals were causal, epiphenomenal, or purely incidental to the optic neuropathy cannot be answered by our study.

Features of Ocular Blood Flow in Malignant Arterial Hypertension of Renal Origin

Color Doppler imaging allows a detailed non-invasive assessment of the state of blood flow in the retrobulbar vessels in patients with various vascular pathologies. Malignant hypertension (MH) is a clinical syndrome characterized by severe diastolic arterial hypertension (140 mm Hg or more), leading to ischemic damage to various organs — kidneys, heart, brain, eyes. Patients with MH often present with thrombotic microangiopathy (TMA), a rare life-threatening condition characterized by multiple systemic thromboses of the microvasculature.Purpose: to assess the state of blood flow in retrobulbar vessels by color Doppler imaging in TMA associated with MH.Methods: 10 patients (20 eyes) (age 43.5 ± 6.2 years) with TMA associated with MH underwent a study of the state of blood flow in the vessels of the retrobulbar space by color Doppler imaging. Qualitative and quantitative analyzes of retinal and choroidal circulation were assessed.Results. Analysis of the Doppler spectrum of blood flow in TMA associated with MH revealed a statistically significant increase in maximum systolic (Vsyst) and finale diastolic blood flow velocity (Vdiast) in the ophthalmic artery (OA), as well as Vsyst in the medial short posterior ciliary arteries (SPCA), compared with the control group (p &lt; 0.05). In 2 patients (20 %) of the study group, a significant bilateral decrease in the diastolic component of the spectrum was found up to the isoline (Vdiast = 0) and a maximum increase in the peripheral resistance index (RI = 1.0). Statistically significant correlations were found between some laboratory parameters of blood serum (hemoglobin, lactate dehydrogenase, creatinine), as well as the estimated glomerular filtration rate and hemodynamic parameters in the central retinal artery (CRA), lateral (SPCA) and OA (p &lt; 0.05).Conclusion. The results of the study of ocular hemodynamics using color Doppler imaging in TMA associated with MH are presented for the first time. TMA associated with MH is characterized by a statistically significant increase in the maximum systolic blood flow velocity in the OA and SPCA with the development of an ischemic state in the retinal and choroidal microcirculation in some patients. An increase in TMA activity in MH leads to a change in the microcirculation of the retina and choroid of an ischemic nature. An increase in blood creatinine in patients with TMA with MH is statistically significantly associated with a decrease in systolic blood flow velocity in the CRA.

Doppler ocular ultrasound in patients with type 2 diabetes mellitus

Purpose: To determine ocular blood flow parameters by Doppler ultrasound scanning in type 2 diabetic patients with different stages of diabetic retinopathy. Material and Methods: In this prospective study, forty-five patients (90 eyes) with type 2 diabetes mellitus were divided into three groups of 15 patients each: no diabetic retinopathy group (DR0), non-proliferative retinopathy (NPDR), and proliferative retinopathy (PDR) groups. Doppler indices such as systolic blood flow velocity (Vs), diastolic blood flow velocity (Vd), time-averaged maximum velocity (TAMXV), pulsatility index (PI) and resistivity index (RI) in the ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary arteries (SPCA) were determined. ANOVA was used for quantitative comparisons between the three groups. Results: There was a significant (р less 0.05) decrease in (a) the Vs from 71.1 +- 20.6 cm/s in the DR0 group to 59.9 +- 16.7 cm/s in the NPDR group and 47.4 +- 16.4 cm/s in the PDR group, (b) Vd from 22.1 +- 6.9 cm/s to 17.0 +- 6.6 cm/s and 12.3 +- 5.9 cm/s, respectively; and (c) TAMXV from 37.2 +- 11.3 cm/s to 31.9 +- 9.1 cm/s and 25.3 +- 9.7 cm/s, respectively, and an increase in the RI from 0.69 +- 0.06 cm/s to 0.71 +- 0.09 cm/s and 0.75 +- 0.08 cm/s, respectively, in the OA. In addition, there was a significant decrease in the Vd from 9.9 +- 5.4 cm/s in the DR0 group to 8.1 +- 3.8 cm/s in the NPDR group and 5.5 +- 3.1 cm/s in the PDR group, and an increase in the PI from 1.34 +- 0.16 cm/s to 1.46 +- 0.28 cm/s and 1.54 +- 0.24 cm/s, respectively, and in the RI from 0.71 +- 0.06 cm/s to 0.75 +- 0.07 cm/s and 0.80 +- 0.05 cm/s, respectively, in the CRA. Moreover, there was a significant decrease in the Vd from 4.3 +- 1.6 cm/s in the DR0 group to 3.2 +- 2.0 cm/s in the NPDR group and 3.1 +- 2.2 cm/s in the PDR group, and an increase in the PI from 1.32 +- 0.21 cm/s to 1.37 +- 0.24 cm/s and 1.54 +- 0.26 cm/s, respectively, and in the RI from 0.76 +- 0.04 cm/s to 0.82 +- 0.06 cm/s and 0.82 +- 0.06 cm/s, respectively, in the SPCA. Conclusion: We found that the arteries examined in patients with diabetic retinopathy tended to have decreased blood flow velocities and increased resistivity and pulsatility indices, with the greatest changes observed in patients with PDR. In addition, the difference in mean values of most Doppler indices between the PDR and NPDR groups was larger than that between the NPDR and DR0 groups.

Клиническая оценка наличия взаимосвязи между хориоидальным и ретинальным уровнем гемодинамики у молодых женщин с окклюзионными поражениями ретинальных вен

Purpose. To study the relationship between choroidal and retinal hemodynamics of the eyes in retinal vein occlusion (RVO) in young women to determine the features of their clinical course. Material and methods. The main group included 15 women (15 eyes) with an average age of 39.7 ± 4 years (35–45 years). The control group was formed by 20 somatically healthy women of comparable age. In addition to standard examination methods, all women underwent a comprehensive study of chorioretinal hemodynamics. The linear velocity of blood flow (LVBF) in the posterior short ciliary arteries (PSCA) was evaluated using a multifunctional ultrasound diagnostic device Logiq e, General Electric, USA. Macular blood flow features were studied using an optical coherence tomograph in angiography mode (angio-OCT) RTVue-100, Optovue, Inc., USA. A comparative analysis of the studied indicators between the groups was carried out. Results. The results of the study revealed the presence of an interrelated statistically significant decrease in choroidal and retinal hemodynamics in young women with RVO relative to the group of healthy women (p &lt; 0.001). Conclusion. Taking into account the revealed direct relationship between choroidal and retinal hemodynamics in women with acute respiratory infections, we consider it appropriate and necessary to perform a simultaneous comprehensive study of various components of the hemodynamics of the posterior segment of the eye in the presence of this pathology: LVBF in the PSCA by color Doppler mapping and macular blood flow by angio-OCT. These data can significantly expand the diagnostic capabilities of identifying the severity of the clinical course of acute respiratory infections and help predict the possible formation of neovascularization. Keywords: retinal vein occlusions; young women; chorioretinal hemodynamics; color Doppler mapping; optical coherence tomography in angiography mode

Оценка влияния хирургической реконструкции внутренней сонной артерии на гемодинамику глаза и морфофункциональные показатели зрительного анализатора у пациентов с хронической ишемической нейрооптикопатией, ассоциированной с гемодинамически значимым атеросклеротическим стенозом внутренней сонной артерии

Purpose. To evaluate the effect of carotid endarterectomy (CEA) on eye hemodynamics and morphofunctional parameters of the visual analyzer in patients with chronic ischemic neuropathy (CIN) associated with hemodynamically significant atherosclerotic stenosis of the internal carotid artery (ICA). Material and methods. The study included 50 patients (50 eyes) with unilateral manifestations of CIN. All patients underwent optical coherence tomography (OCT), Doppler ultrasound of the ophthalmic artery (OA), short posterior ciliary arteries (SPCA), central retinal artery (CRA) before and after surgical reconstruction of the ICA. Results. 24 months after CEA of the ICA, in all cases there were significant improvements in blood flow in the OA by 52.8 %, in the SPCA by 26 %, in the CRA by 30.2 %, a decrease in the thickness of the peripapillary layer of retinal nerve fibers by 9.5 % and the layer of ganglionic cells by 8 % relative to baseline (p &lt; 0.05). Conclusion. The causes of CIN progression after ICA CEA can be considered as the consequences of induced reperfusion of the optic nerve structures and the brain. Keywords: chronic ischemic neuroopticopathy, ocular ischemic syndrome, internal carotid artery, carotid endarterectomy

Optic Nerve Ischemia Secondary to Pediatric Orbital Cellulitis.

FIG. 1FIG. 2Diffusion-weighted imaging (DWI) is a specific sequence of magnetic resonance imaging (MRI) that estimates the rate of water diffusion. The apparent diffusion coefficient (ADC) image, on its turn, is a form of quantifying the diffusion of water in DWI. Obstacles to water diffusion include cellularity and ischemia, which are seen with high signal intensity in DWI and low signal intensity in ADC. We describe the case of an 11-year-old boy who presented with left rapid-evolving cellulitis and globe tenting (Fig. 1A, massive left hemifacial and eyelid edema; Fig. 1B, axial computed tomography scan) that resulted in complete visual loss even after urgent cantholysis and drainage of a circumferential orbital abscess (Fig. 1C). On the first postoperative day, DWI (Fig. 2A) and ADC (Fig. 2B; optic nerves ADC values: right 1.034 s/mm2, left: 0.63 s/mm2) showed restricted diffusion along the entire extension of the left optic nerve (ON) indicating ischemia. The authors believe that the optic nerve ischemia resulted from the compression of the optic nerve pial vessels by the acute orbital compartment syndrome. Orbital hypertension also compressed the short posterior ciliary arteries and central retinal artery causing retinal and choroidal ischemia (Fig. 2C,D; optical coherence tomography: edema and complete disorganization of retinal layers). This case highlights that optic nerve ischemia is a mechanism of visual loss in orbital compartment syndromes.

Predictive Model for the Type of Active Retinopathy of Prematurity Based on Data from Angiological Studies

The purpose — to develop a prognostic model of the type of active retinopathy of prematurity (ROP) based on informative prognostic parameters of optical coherence tomography of the retina in angio-mode (OCT-A) and color duplex scanning (CDS) for a reliable choice of patient management tactics.Patients and methods. 30 premature infants (30 eyes) with favorable and unfavorable types of 1–3 stages of active ROP were performed with optical coherence tomography of the retina in angio-mode. Children were born at a gestational age of 25–34 weeks. The birth weight of children was 680–2030 g. 55 premature infants (55 eyes) with active ROP were performed with CDS in modes of color Doppler mapping and pulsed Doppler sonography. Children were born at a gestational age of 25–32 weeks. The birth weight of children was 680–1760 g. ROC analysis was used to estimate the prognostic information content of the quantitative indicators of OCT-A and CDS in relation to the type of active ROP. The discriminant analysis was used to estimate the contribution of the studied quantitative indicators to the intergroup differences in the type of active ROP. A regression model was built to obtain a prediction of a favorable or unfavorable type of disease. The assessment of the acceptability of the model as a whole was carried out according to the index of determination and the level of significance of the resulting model (p &lt; 0.05).Results. The most informative prognostic indicators of the type of active ROP were determined, according to OCT in angio-mode: the area of the foveal avascular zone — and, according to CDS: maximum systolic and end diastolic blood flow velocity in the ophthalmic artery, maximum systolic blood flow velocity in the posterior short ciliary arteries, minimum velocity blood flow in the central retinal vein. On the basis of informative indicators, a reliable prognostic model of the type of active ROP was built, which has two independent variables: the area of the foveal avascular zone and the end diastolic blood flow velocity in the ophthalmic artery. The dependent variable can take values close to 0, which determine the favorable type of the disease, or close to 1, which determines the unfavorable type of the disease.Conclusion. The introduction of the obtained model into clinical practice will allow to objectively determine the unfavorable course of the pathological process at the earliest stages, as well as to carry out early treatment of active ROP.