Retinal Vascular Findings Research Articles

Vitreous abnormalities in a patient with Gaucher disease

Purpose: To report a case and management of vitreous abnormalities in a patient with Gaucher disease. Methods: Case report. Results: A 28-year-old female with a known diagnosis of Gaucher disease presented to our retina service with complaints of “blurry” vision in both eyes. Ophthalmic examination revealed a Snellen visual acuity of 20/70 OD and 20/20 OS. The anterior segment examination was unremarkable bilaterally; however, the vitreous was notable for multiple yellowish-white vitreous opacifications in both eyes. Fluorescein angiography revealed the opacities but was otherwise unremarkable in terms of retinal vascular findings. Swept-source optical coherence tomography confirmed the position of these vitreous abnormalities to be directly anterior to and in contact with the retinal nerve fiber layer. She subsequently underwent 23-gauge pars plana vitrectomy to remove the vitreous debris; Triamcinolone Acetate (Kenalog) was used intraoperatively to visualize the posterior hyaloid. The cassette was sent for pathological analysis, which revealed amorphous vitreous material with occasional lymphocytes and histiocytes. Her post-vitrectomy Snellen visual acuity was 20/40 OD with pinhole to 20/25, and the patient reported resolution of her subjective symptoms. Her opacities had not recurred as of last follow-up. Conclusion: Vitreous abnormalities in Gaucher disease are an extremely rare and uncommon ophthalmologic finding. As our case demonstrates, vitrectomy can be an appropriate surgical approach for improving vision in these patients.

Retinal Vascular Findings in Sickle Cell Retinopathy

Sickle cell disease (SCD) is a common inherited blood disease that develops due to hemoglobin (Hb) dot mutation that reduces the oxygen-carrying ability of erythrocytes. In hypoxia, this mutated abnormal Hb causes "sickling" of erythrocytes, and subsequent episodes of hypoxia, acidosis, inflammation, vaso-occlusive crises, and hemolysis cause progressive damage to many organs, including the brain, kidneys, lungs, bones, heart, and eyes. Systemic and ocular findings vary in SCD. Sickle Cell C Disease and Sickle beta-Thalassemia forms of SCD have mild systemic diseases; however, both cause severe ocular diseases. In the posterior segment of the eye, SCD can cause optic neuropathy, retinopathy, maculopathy, and choroidopathy. Retinal vascular findings include tortuosity in retinal vessels, “silver wire” arterioles, angioid streaks, arterial and venous occlusions, arteriovenous anastomoses, and retinal neovascularizations (NVs). Fundus fluorescein angiography (FFA), optical coherence tomography (OCT), and OCT angiography are used in the diagnosis. NVs and the enlargement and irregularity of foveal avascular zone (FAZ) in FFA, macular temporal retinal thinning in OCT, FAZ enlargement, and the reduction in densities of macular capillary in OCT angiography are the main findings. This article is aimed to review the retinal vascular findings encountered in Sickle Cell Retinopathy.

Choroidal and Retinal Vascular Findings in Patients with COVID-19 Complicated with Pneumonia: Widefield Imaging

The purpose of this study was to analyze choroidal and retinal vascular alterations of both the macula and midperiphery areas in patients hospitalized for COVID-19 infection complicated with pneumonia within 30 days from discharge. A total of 46 eyes of 23 subjects with a history of symptomatic COVID-19 infection and recent hospitalization for pneumonia were enrolled in this observational study. Patients had not been previously vaccinated against COVID-19. A group of patients homogenous for age and sex was enrolled as controls. Microvascular retinal and choroidal features of the enrolled patients were studied with widefield optical coherence tomography angiography (OCT-A). Perfusion parameters in terms of the vessel density (VD) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) and the choroidal vascularity index (CVI) on enhanced depth imaging (EDI) mode OCT scans were analyzed. Our cohort of patients showed a trend of reduction in VD, significantly in the SCP VD of the superior and inferior midperiphery sectors, whereas the CVI did not show significant differences between the cases and controls. Moreover, a positive correlation between CVI and vessel density in the deep capillary plexus in the macular area (VD-DCP-MAC) was found. The systemic disease due to COVID-19 can also involve the retina and choroid with multiple mechanisms: ischemic and inflammatory. Our study showed changes in perfusion occurring in the eyes of patients with a recent hospitalization for COVID-19 complicated with pneumonia and without any possible ocular effect due to the vaccines. There is still the need to better comprise how long COVID-19 actually affects vascular changes in the eye.

The clinical use of ultra – Wide field imaging and intravenous fluorescein angiography in infants with retinopathy of prematurity

PurposeTo investigate the potential benefits and practicality of ultra – wide field (UWF) imaging and intravenous UWF fluorescein angiography (IV UWF – FA) in infants with retinopathy of prematurity (ROP) using an Optos® California device. MethodsThis retrospective study involved 46 infants with a history of ROP who underwent UWF imaging with or without IV UWF – FA. ROP characteristics were identified using UWF color imaging. Retinal vascular findings following treatment were also assessed at IV UWF – FA analysis. All imaging sessions were performed under topical anesthesia without sedation. Main outcomes were the appearance of ROP at UWF color imaging and IV UWF–FA analysis, including status of ROP, neovascularizations, presence of plus disease, retinal vascular details, and resolution after treatment. ResultsSeven (three girls) of the 46 infants (22 girls) underwent IV UWF–FA. Twelve IV UWF–FA sessions were performed in total. The oldest infant during IV UWF–FA analysis was at 55 postmenstrual weeks. Clinical characteristics of disease were easily identified at UWF color imaging. IV UWF–FA images also clearly revealed non-perfused retinal areas, fluorescein leakage, macular edema, retinal vascular abnormalities, and the status of the peripheral vascular termini. Complications of IV UWF–FA occurred in one infant in the form of patchy yellow skin discoloration around the injection site which completely disappeared on the first day following the procedure. ConclusionsProviding a high resolution panoramic view of the retina in a single image capture with no need for contact with the cornea appear to represent potential advantages of UWF imaging in infants with ROP. IV UWF–FA also seems to be a safe procedure which can be performed under topical anesthesia and that shows detailed retinal vascular alterations in patients with ROP.

Retinal vascular findings in patients with COVID-19.

Purpose:The purpose of this study was to compare the retinal vascular caliber of COVID-19 patients with that of healthy subjects.Methods:This was a prospective case–control study. Forty-six patients who had COVID-19 were successfully treated, and 38 age- and gender-matched healthy subjects were enrolled in this study. Fundus photography was taken using fundus fluorescein angiography (FA; Visucam 500; Carl Zeiss Meditec, Jena, Germany). Retinal vascular caliber was analyzed with IVAN, a semi-automated retinal vascular analyzer (Nicole J. Ferrier, College of Engineering, Fundus Photography Reading Center, University of Wisconsin, Madison, WI, USA). Central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and artery–vein ratio (AVR) were compared between groups.Results:The mean age was 37.8 ± 9.5 years in the COVID-19 group (n = 46) and 40 ± 8 years in the control group (n = 38) (p = 0.45). The mean CRAE was 181.56 ± 6.40 in the COVID-19 group and 171.29 ± 15.06 in the control group (p = 0.006). The mean CRVE was 226.34 ± 23.83 in the COVID-19 group and 210.94 ± 22.22 in the control group (p = 0.044). AVR was 0.81 ± 0.09 in the COVID-19 group and 0.82 ± 0.13 in the control group (p = 0.712).Conclusion:Patients who had COVID-19 have vasodilation in the retinal vascular structure after recovery. As they may be at risk of retinal vascular disease, COVID-19 patients must be followed after recovery.

Retinal vascular development in an immature retina at 33\u201334\xa0weeks postmenstrual age predicts retinopathy of prematurity

In preterm birth, the immature retina can develop a potentially blinding disorder of the eye known as retinopathy of prematurity (ROP). The vaso-proliferative phase of ROP begins at an approximate postmenstrual age (PMA) of 32 weeks. There is little or no evidence of an association between ROP development and retinal status in the early vaso-proliferative phase. We aimed to evaluate the retinal vascular findings of infants at 33–34 weeks PMA to determine their risk of ROP. We reviewed 130 serial wide-field retinal images from 65 preterm infants born before the gestational age of 31 weeks. ROP occurred more frequently in infants having a leading vascular edge within posterior Zone II. This was in contrast to normal infants, who are characterized by complete retinal vascularization up to Zone II at 34 weeks PMA. The probability of ROP development in preterm infants with retinal edge hemorrhage was 24.58 times higher than in preterm infants without retinal edge hemorrhage. Eyes with ROP that required treatment showed significantly delayed retinal vascularization accompanied by pre-plus disease. In conclusion, retinal status in the early vaso-proliferation phase might determine the risk of ROP.

PERIPHERAL RETINAL ANGIOGRAPHIC FINDINGS IN MACULAR TELANGIECTASIS TYPE 2.

To evaluate the retinal periphery in patients with idiopathic juxtafoveal telangiectasis or macular telangiectasis Type 2 (MacTel2), using widefield fluorescein angiography. Single-center, retrospective, observational case series of 50 eyes of 50 patients with MacTel2 and 50 eyes of 50 age-matched controls. Thirty-seven eyes in the MacTel2 group (74%) showed peripheral capillary nonperfusion or dropout, compared with 37 eyes in the control group (74%, P = 1.0). Morphologically, the MacTel2 group trended toward having a higher proportion of pruning-type capillary dropout (44%) compared with controls (28%), but this was not statistically significant (P = 0.12). Patients with MacTel2 had a higher incidence of microaneurysms compared with controls (MacTel2 56%; controls 42%; P = 0.048), independent of age or systemic risk factors. There was no difference in the incidence of venous-venous shunts (MacTel2 10%; controls 10%; P = 1.0), arteriovenous shunts (MacTel2 14%; controls 18%; P = 0.60), venous tortuosity (MacTel2 60%; controls 66%; P = 0.58), or arterial tortuosity (MacTel2 54%; controls 68%; P = 0.20), which was mild in most cases. We note a high incidence of peripheral vascular and retinal findings in both patients with MacTel2 and age-matched controls, using widefield fluorescein angiography. Patients with MacTel2 had significantly more microaneurysms, independent of age or other systemic risk factors.

Widefield Fluorescein Angiography in the Fellow Eyes of Patients with Presumed Unilateral Persistent Fetal Vasculature

To examine the retinal vascular findings on widefield fluorescein angiography (FA) in the fellow eyes of patients with unilateral persistent fetal vasculature (PFV). Retrospective case series. Consecutive patients with unilateral PFV evaluated by a single physician at an academic medical center from February 1, 2011, to November 30,2018. Clinical and demographic information, including age, gender, race, ethnicity, affected eye, subtype, stalk origin, complications on presentation, length of follow-up, and examination findings, was reviewed using the electronic medical record. Fluorescein angiograms of the affected and fellow eyes were reviewed by 2 authors for characteristic retinal vascular abnormalities. Agreement between the authors' scores was analyzed using Cohen's Kappa. Fluorescein angiography abnormalities, including peripheral vessel avascularity, aberrant circumferential vessels, terminal supernumerary branching, regional capillary dropout, terminal bulbing, abnormal choroidal flush, abnormal vessel straightening, and peripheral vessel leakage or dilation. Inclusion criteria were met by 41 patients. The average age at initial visit was 10.0 months. The average length of follow-up was 36.4 months. Abnormalities on FA were seen in 31 (75.6%) fellow eyes: peripheral vessel avascularity in 27.5 (67.1%), aberrant circumferential vessels in 20 (48.8%), terminal supernumerary branching in 17 (41.5%), regional capillary dropout in 9 (22.0%), terminal bulbing in 6 (14.6%), abnormal choroidal flush in 3.5 (8.5%), and abnormal vessel straightening and peripheral vessel leakage in 2.5 (6.1%). Statistical analysis disclosed an overall observed agreement of 93.4% among the raters (κ = 0.84, P < 0.0001). Retinal vascular abnormalities seen in patients with unilateral PFV were present in the majority of fellow eyes. This suggests that unilateral PFV may in fact be a bilateral, asymmetric process, but the clinical significance of these subtle findings is not known.

FLUORESCEIN ANGIOGRAPHY FINDINGS IN UNILATERAL PERSISTENT FETAL VASCULATURE.

This study aims to examine retinal vascular findings for affected eyes and contralateral eyes as well in typical cases of unilateral persistent fetal vasculature. We retrospectively reviewed all patients evaluated at Chang Gung Memorial Hospital, Linkou, for unilateral persistent fetal vasculature between January 2008 and July 2017. All patients underwent fluorescein angiography (FA) examination under general anesthesia. FA was performed using RetCam 3 (Clarity Medical Systems, Inc, Pleasanton, CA). Ten patients (eight male and two female) were identified as having adequate clinical data for the final analysis. The mean age at diagnosis was 13.7 ± 17.2 months (range 1-58). The mean axial length was shorter in the affected eyes as compared to the fellow eyes (17.27 ± 2.8 vs. 20.2 ± 1.7 mm; P = 0.024). In the affected eyes, nine cases (90.0%) showed a concomitant retrolental stalk, avascular peripheral retina, regional capillary dropout, and absence of foveal avascular zone. Hyperfluorescent stalk was seen in seven cases (70.0%). Four eyes (40.0%) showed leaking vessels. Terminal supernumerary branching was seen in two cases (20.0%). Popcorn hyperfluorescence was noted in one case (10.0%). In the fellow eyes, peripheral avascular zone was noted in nine eyes (90.0%), of which six (60.0%) had peripheral zones greater than two-disk diameters. Seven eyes (70.0%) presented with regional capillary dropout and abnormal choroidal filling. Three eyes (30.0%) had abnormal vessel straightening. Aberrant circumferential vessels and leaking spots were seen in two eyes (20.0%). Regional dilation of disk vessels, peripheral vessel dilation, and terminal bulbing were noted in one eye (10.0%). The mean best-corrected visual acuity of the fellow eyes was 20/39 (0.29 in logarithm of the minimum angle of resolution). Retinal vascular abnormalities in the affected eyes and fundoscopically normal fellow eyes of unilateral persistent fetal vasculature patients were found in 100% and 90.0% of patients, respectively. Fellow eyes had some subtle abnormalities that were only revealed through FA. These unilateral persistent fetal vasculature cases were still bilaterally affected.

OCT Angiography Assessment of Retinal Microvascular Changes in Diabetic Eyes in an Urban Safety-Net Hospital

To determine whether quantitative OCT angiography (OCTA) parameters can be used to distinguish among eyes at various stages of diabetic retinopathy (DR) in an urban safety-net hospital population. Prospective cross-sectional study. Three hundred twenty-nine eyes from 329 patients were included in this study: 90 nondiabetic patients, 170 diabetic patients without DR, 57 diabetic patients with mild to moderate nonproliferative DR (NPDR), and 12 diabetic patients with severe NPDR to proliferative DR. Patients underwent OCTA imaging and ultra-widefield fundus photography at Zuckerberg San Francisco General Hospital and Trauma Center between April and October 2018. For participants with diabetes, imaging was classified according to DR severity by a telemedicine reading center. Eight OCTA parameters were analyzed. Perfusion density and vessel length density (VD) were examined from both the superficial capillary plexus (SCP) and deep capillary plexus. The other 4 parameters were examined only from the SCP. Total extrafoveal avascular area (tEAA) was based on the area of absent capillary vessels. Foveal avascular zone (FAZ)-related metrics consisted of FAZ area, FAZ circularity index, and FAZ acircularity index. Area under the receiver operating characteristic curve (AUC) for OCTA parameters to distinguish among groups according to DR severity. All OCTA parameters demonstrated a significant relationship with DR severity (P < 0.05). No significant difference was found when comparing nondiabetic participants versus diabetic participants without retinopathy. The FAZ area was the only metric that demonstrated a significant difference between genders: mean of 0.29±0.12 mm2 in men and 0.34±0.13 mm2 in women (P < 0.001). Receiver operating characteristic curve analyses showed that tEAA had the highest AUC when comparing various stages of the disease. In this urban, public hospital population, quantification of retinal vascular findings with OCTA imaging was a useful means of distinguishing patients according to DR severity. Because these results were similar to those of other tertiary referral centers, it would be reasonable to perform further DR-related OCTA studies in this population and expect generalizable results.

Identification of Eyes At Risk for Severe Retinopathy of Prematurity (ROP) by Third Year Ophthalmology Residents in a Tertiary Hospital

Objective: The aim of the present study is to determine the efficiency of third year ophthalmology residents from a tertiary hospital in performing preliminary retinal examination to identify eyes at risk retinopathy of prematurity on the basis of retinal fundus findings up to International Classification of Retinopathy of Prematurity (ICROP) Zone II. Methods: This is a single-center, cross-sectional, prospective comparative research conducted from June to October 2015 at a tertiary training hospital in the Philippines. All infants referred for retinopathy of prematurity screening within the study period where included. The presence of retinal vessel dilatation and tortuosity were identified by third year ophthalmology residents using indirect funduscopy. The residents’ fundus findings were then compared to that of a retina consultant who is proficient in the diagnosis and management of retinopathy of prematurity (ROP). The Kappa index was used to rate inter-observer agreement. The correlation between ROP risk factors and the presence of abnormal retinal vessels were assessed using odd ratio computations. Fisher’s exact test was used to determine the correlation between retinopathy of prematurity and the presence of retinal dilatation and tortuosity. The McNemar’s test was also applied to determine significant differences in the retinal findings of the consultant and ophthalmology residents. Results: A total of 82 eyes of 41 premature infants were evaluated to determine if retinal findings observed by ophthalmology residents were comparable to that of a retina consultant. Odds ratios show that age of gestation, birth weight, and history of blood transfusion are significantly associated with the presence of retinopathy of prematurity. Retinal vessel tortuosity and dilatation are also more common among infants diagnosed with retinopathy of prematurity. There was no significant difference between the retinal vascular findings of the retina consultant and the third year ophthalmology resident in terms of identifying retinal vessel dilatation and tortuosity (P &lt; 0.05). Conclusion: After sufficient and in-depth ophthalmology training, third year ophthalmologists, who will be general ophthalmologists in the future, can reliably identify eyes at risk for severe retinopathy of prematurity on the basis of retinal vascular dilatation and/or tortuosity.

Volume-Rendered Optical Coherence Tomography of Retinal Vein Occlusion Pilot Study

To investigate the retinal vascular findings and associated cystoid edema in the central macula of eyes with retinal vein occlusion using volume-rendered angiographic and structural optical coherence tomography. Observational case series. In this retrospective study 12 eyes of 12 consecutive patients, 3 with branch and 9 with central retinal vein occlusion, were imaged in 27 sessions with optical coherence tomography (OCT) using split-spectrum amplitude decorrelation. The structural OCT data were segmented for cystoid spaces and integrated into the angiographic data for subsequent volume rendering. The inner and deep vascular plexus were analyzed in relation to cystoid macular edema with retention of depth information. Retinal vascular flow abnormalities were demonstrated by flow voids with abnormal vascular morphology in the inner vascular layer and varying flow loss in the deep vascular plexus. Areas of cystoid edema were associated with topographically co-localizing flow voids in the deep vascular layer. Treatment with intravitreous anti-vascular endothelial growth factor injections resulted in resolution of edema but no change in flow patterns in either the inner or deep plexus. Recurrence of edema happened in the same areas of altered inner and absent deep vascular plexus flow signal. Cystoid macular edema in retinal vein occlusion occurred in relation to altered inner plexus and absent deep vascular plexus flow. This pattern of cystoid fluid accumulation is similar to that seen in diabetic retinopathy and may represent an important underlying pathophysiologic foundation for cystoid macular edema in retinal vascular diseases.

RETINAL AND CHOROIDAL VASCULATURE IN BIRDSHOT CHORIORETINOPATHY ANALYZED USING SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY.

To describe retinal and choroidal vascular changes in eyes with birdshot chorioretinopathy using optical coherence tomography angiography. Patients underwent imaging using the AngioVue prototype software of the RTVue XR spectral domain optical coherence tomography device (Optovue, Inc) between September and December 2014. Two trained patients evaluated the optical coherence tomography angiography images for changes in the retinal and choroidal vasculature in the posterior pole. Four of eight eyes (50%) had birdshot lesions in the posterior pole as demonstrated on fundus photography. All of these eyes demonstrated the areas of decreased choroidal blood flow below the disrupted retinal pigment epithelium. Larger choroidal vessels bordered the birdshot lesions. All eyes analyzed showed retinal thinning, telangiectatic vessels, and an increased intercapillary space. Capillary dilatations and loops were each seen in 7 of 8 eyes (88%). Optical coherence tomography angiography provides precise microvascular detail of the retinal vasculature and choriocapillaris that allows for the noninvasive visualization of the birdshot lesions and changes in the inner retina. The optical coherence tomography angiography images delineated widespread retinal vascular findings not previously described in the literature. In the future, optical coherence tomography angiography could be a useful tool to evaluate the natural history of birdshot chorioretinopathy, its progression, and the effect of treatment in these patients.

Volume-Rendered Optical Coherence Tomography of Diabetic Retinopathy Pilot Study

To investigate the retinal vascular findings and associated anatomic abnormalities in the central macula of eyes with diabetic retinopathy using volume-rendered angiographic and structural optical coherence tomography. Observational case series. In this retrospective study 25 eyes of 14 consecutive patients were imaged with optical coherence tomography (OCT) using split-spectrum amplitude decorrelation. The structural OCT data were segmented for cystoid spaces and integrated into the angiographic data for subsequent volume rendering. The opacity of various vascular layers could be decreased to improve visualization of deeper structures and the images could be rotated about 3 axes. The inner and deep vascular plexus were analyzed in relation to structural changes such as cystoid spaces and disorganization of the retinal inner layers. Retinal vascular flow abnormalities manifested by large flow voids in the inner vascular layer with retention of large vessels and confluent areas of flow loss in the deep plexus. Areas of cystoid edema were associated with topographically colocalizing flow voids in the deep vascular layer. In eyes with no edema isolated abnormalities of the deep plexus were associated with thinning of the inner nuclear layer and abnormalities of both layers were associated uniformly with the OCT findings of disorganization of the retinal inner layers. Widespread vascular abnormalities in diabetic retinopathy could be delineated along with the corresponding anatomic changes in the retina using volume-rendered angiographic and structural OCT. This method of imaging offers potential to improve visualization of vascular disorders of the eye.

The predictive value of retinal vascular findings for carotid artery atherosclerosis: are further recommendations with regard to carotid atherosclerosis screening needed?

Vascular retinopathy is the consequence of vascular disease, and the retina is the only place where the arteries can be visualized directly. The purpose of this study was to evaluate the predictive value of retinal vascular findings for carotid artery atherosclerosis. From December 2009 to January 2011, the carotid intima-media thickness (IMT) and total plaque area (TPA) were measured in 179 consecutive patients, who received a fundoscopic examination. The patients were divided into groups as follows: normal retinal artery (normal; n = 44), diabetic retinopathy (DR; n = 25), retinal artery occlusion (RAO; n = 17), retinal vein occlusion (RVO; n = 67), and hypertensive retinopathy (HTN-R; n = 26). The subjects were classified according to the presence of an increased (≥ 1 mm) IMT and plaque. The values of the mean carotid IMT in the patients with vascular retinopathy (DR, 0.87 ± 0.14 mm; RAO, 1.18 ± 0.47 mm; RVO, 0.84 ± 0.14 mm; HTN-R, 0.90 ± 0.20 mm) were significantly increased compared with those in the normal subjects (0.77 ± 0.13 mm). A total 77 of 135 vascular retinopathy patients demonstrated an increased IMT (57 %), and 97 vascular retinopathy patients had carotid artery plaque (72 %). The relative risk of vascular retinopathy in the prediction of an increased IMT and the presence of plaque was 2.79 and 3.95, respectively. Although The TPA was significantly increased in the patients with RAO (1.87 ± 2.67 cm(2)) and RVO (0.27 ± 0.23 cm(2)) compared with the normal subjects (0.18 ± 0.23 cm(2), all Ps < 0.05), there was no significant difference in the ipsilateral carotid IMT and TPA of the affected eye compared with that of the contralateral eye. In conclusion, vascular retinopathy demonstrated a good predictive value in identifying asymptomatic carotid artery atherosclerosis, and this was not confined to the ipsilateral carotid artery of the affected eye. Further recommendations with regard to carotid atherosclerosis screening in patients with vascular retinopathy should be considered.

Correlation between penile cavernosal artery blood flow and retinal vascular findings in arteriogenic erectile dysfunction

Arteriogenic erectile dysfunction (ED) is a target organ disease of atherosclerosis, and therefore might be a predictor of systemic atherosclerosis. Being systemic, it might be possible to evaluate the extent of atherosclerosis from retinal vascular findings. We investigated the possible correlation between penile cavernosal artery blood flow and retinal vascular findings in patients with arteriogenic ED. Sixty patients with ED were divided according to the peak systolic velocity (PSV) in their penile cavernosal arteries into two groups; Group A included 30 patients with PSV less than 25 cm/sec, and Group B included 30 patients with PSV more than 35 cm/sec. Blood flow in the penile cavernosal artery was measured with color Doppler ultrasonography. All patients were assessed by ocular fundus examination under amydriatic conditions to evaluate retinal vascular atherosclerotic changes using Hyman's classification. Evidence of retinal vascular atherosclerotic changes was found in 19 patients (63.3%) in Group A and in 10 patients (33.3%) in Group B. Our study confirms the possibility of predicting penile arterial vascular status in patients with ED from their retinal vascular findings by using amydriatic simple, practical funduscopy.

Gallium scintigraphy in the investigation of retinal inflammatory vasculopathy

Editor, Retinal inflammatory vasculopathy can be a sight-threatening manifestation of systemic inflammatory disease. Despite extensive investigation, the etiology of inflammatory retinal vasculopathy in many cases remains elusive. In the absence of a medical history suggestive of systemic disease, the utility of systemic evaluation can have a low diagnostic yield.(George et al., 1996). The use of whole-body gallium-67 scintigraphy, however, may shed light on the etiology of inflammatory retinal vasculopathy in such cases. We report the findings of four consecutive patients who presented over a two year period with retinal inflammatory vasculopathy without any signs or symptoms of systemic disease. Three patients were African-American and one was Caucasian, with an age range of 42–59 years. All patients exhibited inflammatory changes of the retina including periphlebitis, peripheral nonperfusion, aneurysmal changes, macular edema, and neovascularization. Anterior uveitis was absent in all cases, but unilateral mild vitritis associated with papillitis was seen in one patient. Serum angiotensin converting enzyme (ACE) levels were normal in all patients. Radiological examinations to detect pulmonary disease including chest x-ray, high-resolution chest CT, and whole-body gallium-67 scanning were negative. All patients tested negative for anti-Ro and anti-La antibodies, which excluded the diagnosis of Sjogren syndrome. Syphilis testing (FTA-ABS) was also negative. Three patients had negative reaction to purified protein derivative (PPD) skin testing, while one patient had a remote history of a positive PPD test that had been treated with isoniazid (INH). Investigations for hypercoagulability, sickle cell disease, and connective tissue disease were negative. Gallium-67 scintigraphy, however, showed in all 4 cases characteristic bilateral increased uptake in the lacrimal glands that in 2 out of 4 cases was associated with concurrent parotid gland involvement. The retinal vascular findings in our series of patients have been previously described in patients with sarcoidosis,(Rothova and Lardenoye, 1998; Steahly, 1988; Verougstraete et al., 2001) and are considered suggestive of ocular sarcoidosis. However, the patients in our series did not have elevated ACE levels or pulmonary involvement on chest imaging typically associated with systemic sarcoidosis. They did, however, have extrapulmonary gallium-67 uptake in the lacrimal glands with additional involvement of the parotid glands in 2 cases. The lacrimal glands are the most common extrapulmonary site of gallium-67 uptake, and the most characteristic pattern of extrapulmonary gallium uptake is the “panda sign” (bilateral lacrimal and parotid gland uptake).(Sulavik et al., 1990). Increased gallium-67 uptake in the lacrimal and parotid glands is not specific for sarcoidosis but can also be seen in tuberculosis, lymphoma, and Sjogren syndrome. The bilateral involvement, African-American predominance, negative serological testing, and negative PPD skin testing or prior treatment for tuberculosis in our series made these alternate diagnoses unlikely The patients in our series were presumed to have an isolated ocular form of sarcoidosis without any systemic involvement. Three patients with periphlebitis and macular edema were treated with a periocular injection of triamcinolone, while one patient with peripheral neovascularization was treated with scatter laser photocoagulation and mycophenolate mofetil. All patients had complete resolution of their disease, supporting an inflammatory etiology for their clinical findings. The utility of gallium-67 scintigraphy in the routine investigation of sarcoidosis has not been established. However, gallium-67 scintigraphy may be useful in a select group of patients with retinal vasculopathy suggestive of sarcoidosis with a normal systemic work-up including serum ACE and chest imaging. The finding of lacrimal gland involvement with or without salivary gland involvement may suggest the diagnosis of an isolated ocular form of sarcoidosis in these cases. Diagnosis of sarcoidosis ultimately requires histological confirmation. Biopsy of the lacrimal and/or salivary glands, guided by the results of gallium-67 scintigraphy, may be warranted in cases like those presented in this report.

A possible link between the pseudoexfoliation syndrome and coronary artery disease

This is a collaborative case-control study from Ophthalmology and Cardiology departments of a tertiary care hospital, designed to explore the relationship between coronary artery disease (CAD) and pseudoexfoliation syndrome (PEX). In all, 50 patients with CAD proven by coronary angiography, and 50 controls with normal coronary angiographic findings were compared in terms of PEX, other vascular diseases, and retinal vascular findings. chi2-test and Student's t-test were used for statistical analysis. The number of patients with PEX among CAD (+) patients was substantially larger than controls. In all, 28 of 50 CAD (+) patients and only 12 of 50 CAD (-) patients had PEX. PEX was significantly associated with CAD (P=0.001). When all patients were regrouped according to the presence of PEX, patients with PEX did not differ from patients without PEX in terms of age (P=0.360) and sex (P=0.507), but the prevalence of CAD was higher (P=0.001) and fundoscopic findings of vascular diseases were significantly more prominent (P=0.0001) in PEX (+) patients. We demonstrated statistically significant difference in the prevalence of PEX in CAD patients, and also in the prevalence of CAD in PEX (+) individuals. These were striking differences. We should consider the possibility of the presence of PEX in CAD patients; and the predisposition of PEX (+) persons for CAD, which necessitates a fundus examination for findings of systemic vascular diseases.

Retinal vascular findings and penile cavernosal artery blood flow.

To assess the correlation between retinal vascular findings and penile cavernosal arterial blood flow, as it is probable that systemic atherosclerotic vascular disease is important in male erectile dysfunction (ED), and being systemic, it might be possible to evaluate the extent of atherosclerosis from retinal vascular findings. The study included 75 patients with ED; any with a history of pelvic injury, pelvic surgery, or diabetes mellitus were excluded. All patients gave fully informed consent. Ocular fundus photographs were taken with an automatic-focus fundus camera under amydriatic conditions. Three ophthalmologists, unaware of the patients' detailed data, evaluated the photographs using Hyman's classification to evaluate retinal vascular findings. Blood flow in the penile cavernosal artery was measured with colour Doppler ultrasonography, and the peak systolic velocity used as a haemodynamic variable. Correlations among the peak systolic velocity, retinal vascular findings and vascular risk factors (including hypertension, age, cigarette smoking, and hyperlipidaemia) were investigated using multivariate analysis. Of the 75 patients, 72 (96%) had both right and left retinal vascular images of sufficient quality for evaluation; 37 were classified as normal and 35 as Grade I, while no patient was Grade II. From a logistic regression multivariate analysis, the peak systolic velocity was the only significant factor correlating with retinal vascular findings, with an odds ratio of 3.34. In contrast, hypertension, age, cigarette smoking and hyperlipidaemia did not correlate significantly with the retinal vascular findings. Similarly, the retinal vascular finding was the only significant factor correlating with the peak systolic velocity of cavernosal blood flow (odds ratio 3.28) and again hypertension, age, cigarette smoking and hyperlipidaemia were not significant factors. These findings support the assumption that penile erectile function is one of the diseases of atherosclerosis, and emerges nearly simultaneously with retinal vascular disease. It is possible to predict penile arterial conditions in patients with ED from their retinal vascular findings. Thus, amydriatic fundoscopy, a simple practical examination, may be helpful for primary physicians in diagnosing and treating ED.

Retinal microangiopathies overlying pigment epithelial detachment in age-related macular degeneration.

To evaluate alterations in the retinal vasculature overlying pigment epithelial detachments (PED) in exudative age-related macular degeneration (ARMD) using indocyanine green and fluorescein angiography. Forty-one patients (41 eyes) with a clinical diagnosis of exudative ARMD with PED underwent simultaneous fluorescein and indocyanine green angiography, also under high (10 degrees ) magnification. Vascular abnormalities in the retina were compared between patients with vascularized (n = 34, group 1) and nonvascularized (n = 7, group 2) PED on indocyanine green angiography and correlated with the size of the PED and the presence of serous retinal detachment. In all, 67 vascular abnormalities were found by indocyanine green angiography and only 22 by fluorescein angiography; this finding was statistically significant (P < 0.0001). The finding of retinal vasculopathy (32 patients in group 1 and two patients in group 2) was directly correlated with the presence of choroidal neovascularizations (P = 0.002). There was also a direct correlation between the presence of choroidal neovascularization and size of the PED (P = 0.03). The number of retinal vascular findings was not significantly correlated with serous elevation of the retina. Retinal vasculopathies may be observed in eyes with PED and are detectable by indocyanine green and fluorescein angiography.