Retinal Venous Tortuosity Research Articles

Direct ophthalmoscopy as a screening tool to study retinal vascular changes in acute mountain sickness in response to recent ascent to high altitude: A pilot study.

Background Advanced diagnostics are not easily accessible in austere topographical locations. We documented retinal changes in patients with acute mountain sickness (AMS+) and compared these with asymptomatic individuals (AMS-) with recent induction into high altitude using direct ophthalmoscopy as a screening tool. Methods We evaluated 97 individuals (43 AMS- and 54 AMS+) who were inducted to an altitude 3800 m above sea level by direct ophthalmoscopy after pupillary dilatation, on day 2 of arrival. Results Retinal vein dilatation was seen in 36 (66.7%) AMS+ v. 14 (32.6%) AMS- (p<0.01), hyperaemia of the optic disc in 30 (55.6%) AMS+ v. 14 (32.6%) AMS- (p<0.05), hyperaemia of the optic disc along with retinal vein dilatation in 27 (50%) AMS+ v. 9 (20.9%) AMS- (p<0.01), retinal vein tortuosity in 12 (22.2%) AMS+ v. 3 (7%) AMS- (p<0.02). In AMS+ with retinal vein dilatation 17 (50%) had SpO2 >91% and 19 (79.2%) had SpO2 <91% (p<0.01). An AMS score of >5 was recorded in 25 (69.4%; p<0.001) with venular dilatation and in 19 (52.8%; p<0.001) who were AMS+ with an induction number ≥3 had retinal dilatation. Conclusion Acute hypobaric hypoxia causes retinal venous dilatation, tortuosity and hyperaemia of the optic disc in those with AMS and correlates directly with SpO2 levels. The incidence of retinal vein dilatation increases with frequent re-entry into high altitude and more severe symptoms of AMS. Hence, all those being inducted to high altitude should be screened for retinal vascular changes.

Retinal Changes in a Patient with a Traumatic Orbital Subperiosteal Hematoma and Superior Ophthalmic Vein Compression

Purpose: We describe a case with retinal alterations similar to those of nonischemic central retinal vein occlusion, but also with superior ophthalmic vein compression attributable to a traumatic, subperiosteal orbital hematoma.Case summary: A 13-year-old male presented with left periorbital edema, a decrease in vision, and diplopia after blunt periorbital trauma. In ophthalmological evaluations, the best-corrected visual acuity (BCVA) was 0.4 (20/50) and a severe supraduction limitation was apparent (grade -4). Fundus examination revealed optic disc swelling, retinal vein dilation/tortuosity, and an arteriovenous transit time delay of 26s. Fluorescein angiography evidenced optic disc leakage. Ocular sonography and orbital magnetic resonance imaging revealed a superior subperiosteal hematoma in the left orbit accompanied by superior ophthalmic vein compression. We scheduled emergency hematoma evacuation. One month later, the BCVA had increased to 1.0 (20/20) and ocular movement was no longer limited. Orbital computed tomography showed that the superior ophthalmic vein compression had resolved and that the abnormalities observed in the initial fundus examination and fluorescein angiography had improved.Conclusions: Retinal changes that resemble nonischemic central retinal vein occlusion including retinal venous dilation and tortuosity may develop after a traumatic, orbital subperiosteal hematoma. Compressive obstruction of the superior ophthalmic vein may then be in play. Early surgical intervention featuring hematoma evacuation may prevent irreversible visual deterioration.

Clinical Spectrum of Uveitis Induced by Herpes Simplex Virus with Posterior Pole Involvement at Initial Presentation: A Case Series and Literature Review

ABSTRACT Purpose To report four cases of herpes simplex virus-induced uveitis with posterior pole involvement at initial presentation. Case Presentations In case 1, the posterior pole initially showed dense vitreous hemorrhage from the optic disc, multiple subretinal lesions around the optic disc, and retinal arterial sheath prior to retinal necrosis. In case 2, the posterior pole presented with optic disc edema, retinal venous tortuosity, and arterial sheathing around the optic disc prior to the peripheral retinal necrosis. In case 3 diagnosed with posterior herpetic uveitis, the posterior pole showed retinal arterial sheath and macular structural abnormities. In case 4, the posterior pole demonstrated optic disc swelling, along with perivascular retinal hemorrhage 4 days prior to peripheral retinal necrosis. Conclusions Posterior pole involvement might occur either solely or before the development of peripheral retinal necrosis in patients with herpes simplex virus-induced acute retinal necrosis with and without prior central nervous system herpetic virus infection.

Abstract P55: Retinal Microvascular Parameters Predict Retinal Amyloid Burden and Co-Jointly Predict Verbal Memory

Introduction: Retinal vascular features predict cognitive performance and retinal imaging is a non-invasive tool to study brain health. Patients with Alzheimer’s disease (AD)-related cognitive disorders exhibit both retinal vascular abnormalities and intraretinal accumulation of amyloid-beta (Aβ) plaque. Curcumin-enhanced retinal fluorescence imaging (CRFI) was recently translated as a safe imaging tool for retinal Aβ plaque quantification. In this study, we sought to determine whether and which retinal arterial and venous parameters are predictive of retinal Aβ burden and cognitive Z-scores. Methods: We used scanning laser ophthalmoscopy with RetiaTM (Centervue, Inc) to obtain CRFI in a cohort of patients with cognitive decline. Retinal blood vessels were segmented in a predefined circumpapillary region of interest. For each centerline, vessel tortuosity index (VTI), vessel inflection index (VII), and branching angle (VBA) were quantified, independently for arteries and veins. Additionally, we automatically quantified retinal amyloid count in the supero-temporal quadrant and its subregions: posterior pole (PP), proximal mid-periphery (PMP), and distal mid-periphery (DMP). All quantifications were done blinded to the subjects’ clinical characteristics. Linear regression models were used to assess the correlations between retinal vascular and amyloid parameters. Results: 29 subjects (55% female, mean age 64±6 years) were included in the analysis: 11 had normal cognition, 16 mild cognitive impairment and 2 probable AD. Venous VTI was the only vascular parameter significantly different across levels of Clinical Dementia Rate scores and between cognitively normal and impaired. Venous VBA was a significant predictor of DMP amyloid count (p=0.03). Arterial VII significantly predicted PP amyloid count (p=0.02). VBA predicted Wechsler Adult Intelligence Scale Z-score (p=0.08). The combined VTI-PMP amyloid index significantly predicted Wechsler Memory Scale, California Verbal Learning Test and SF-36 mental component score Z-scores (p&lt;0.05). Conclusion: Retinal venous tortuosity discriminates across cognitive scores and in combination with PMP amyloid count may predict verbal memory and related quality-of-life scores.

Assessment of retinal vascular oxygenation and morphology at stages of diabetic retinopathy in African Americans

BackgroundDiabetic retinopathy (DR) is a microvascular complication of diabetes and a leading cause of blindness in working-age adults. The likelihood of visual impairment associated with DR is two-fold higher in the African-American (AA) compared to non-Hispanic white. Although alterations in retinal vessel oxygenation and morphology have been reported in DR, there is limited knowledge about these vascular changes in AA subjects. The purpose of the current study was to investigate alterations in retinal vascular oxygen saturation (SO2), vessel diameter (D) and tortuosity at severity stages of DR in AA subjects.MethodsA nested case-control study of 56 AA subjects was conducted. Right eyes were grouped as non-diabetic (ND) (N = 26), no clinical DR (NDR) (N = 19), or moderate/severe non-proliferative DR (NPDR) (N = 11). Imaging was performed using a commercially available scanning laser ophthalmoscope. Images were analyzed to determine retinal arterial and venous SO2 (SO2A and SO2V), diameter (DA and DV), and vessel tortuosity index (VTI) (VTIA and VTIV).ResultsSO2V and DV were higher in NPDR compared to ND and NDR groups (P < 0.05). There were no significant differences in SO2A and DA among ND, NDR, and NPDR groups (P > 0.8). Maximum VTIA was higher in diabetics (NDR and NPDR) compared to non-diabetics (P < 0.03). There was no significant difference in maximum VTIV among the 3 groups (P = 0.5).ConclusionsThe findings advance our understanding of DR pathophysiology in the AA population and may propel identification of race-specific retinal vascular biomarkers for improved diagnosis and monitoring of DR.

Ocular Manifestations of Cutis Marmorata Telangiectatica Congenita

To describe the range of ocular manifestations in cutis marmorata telangectatica congenita (CMTC). Multicenter, retrospective, nonconsecutive case series. Patients with a diagnosis of CMTC referred for ophthalmologic evaluation between January 1, 2015, and December 31,2018. Evaluation of ocular findings at presentation, systemic manifestations suggestive of a diagnosis of CMTC, genetic testing, and visual outcomes after treatment. Visual acuity, findings on ophthalmoscopy, and results of fluorescein angiography. Nine patients with CMTC diagnosed clinically based on stereotypical cutaneous vascular malformations were included. The median age at presentation was 8 weeks (range, 2 weeks-4 years). Six patients were female and 3 were male. Avascular retina was identified on dilated fundus examination, fluorescein angiography, or both in 11 eyes of 6 patients. Retinal neovascularization was present bilaterally in 2 patients at presentation. One patient demonstrated retinal venous tortuosity, and another patient showed mild straightening of nasal retinal vessels in both eyes. Two patients (2 eyes) demonstrated retinal detachment (RD). Both were managed surgically. One infant demonstrated RD, whereas the other child showed extensive neovascularization and later progressed to combined tractional-rhegmatogenous detachment. A unique constellation of lacy peripheral capillary anomalies with prominent terminal vascular bulbs was noted in 3 patients. Granular pigment abnormalities were noted in the macula in 5 patients. Two patients demonstrated glaucoma, 1 requiring surgical intervention. Two patients demonstrated features of Adams-Oliver syndrome, with genetic testing identifying a Notch1 mutation in 1 patient. Retinal vascular abnormalities in CMTC may occur more frequently than recognized previously. Given the variability of ocular involvement and the potential for rapidly progressive retinal vascular abnormalities and development of RD, complete ophthalmologic evaluation including measurement of intraocular pressure, gonioscopy, dilated fundus examination, and fluorescein angiography is recommended in infants with suspected CMTC shortly after birth. The distinct pattern of lacy capillary anomalies with prominent terminal bulbs seen in CMTC has not been described in other syndromes of vascular dysgenesis. Therefore, ophthalmic examination may be a valuable method to distinguish CMTC from other disorders demonstrating similar dermatologic and systemic manifestations.

Ocular manifestations of leukaemia: A teaching hospital experience.

Knowledge of the ophthalmic manifestations of leukaemia is important not only because of the frequency with which changes are seen but because the eye often reflects the disease state of the illness, and once identified, prompt referral, early treatment can be instigated, blindness can be averted and a life may be saved. These manifestations are often overlooked because of the underestimation of the magnitude of the ocular sequelae which may be blinding. This study aims to describe the ophthalmic findings in adult leukaemic patients at two teaching hospitals in Lagos, Nigeria. This was a clinic-based, comparison multicentre study conducted at Lagos University Teaching Hospital and Lagos State University Teaching Hospital over a 9-month period of May 2012-January 2013. The cases were newly diagnosed leukaemic patients (acute and chronic) from the haematology clinics. Controls were escorts of apparently normal patients. Detailed ocular examination was carried out after written informed consent was obtained. Analysis was done using SPSS 17. A total of 160 eyes in 80 individuals examined comprised forty cases and forty controls. The results of the cases were compared with the age- and sex-matched controls. Leukaemic-related ophthalmic manifestations were present in 56 eyes (70.0%) of the cases studied. Findings in cases were periorbital oedema in 8 eyes (10%), subconjunctival haemorrhage in four eyes (5%), intraretinal haemorrhage as found in 25 eyes (31.3%), retinal venous tortuosity in 21 eyes (26.3%), Roth spots in 19 eyes (23.8%) and retinal infiltrates in 17 eyes (21.3%). Ophthalmic disorders occur in adult patients living with leukaemia. Prompt initial and periodic ophthalmic evaluation is recommended in all leukaemic patients.

Retinal and Cerebral Microvasculopathy: Relationships and Their Genetic Contributions.

Retinal microvasculopathy may reflect small vessel disease in the brain. Here we test the relationships between retinal vascular parameters and small vessel disease, the influence of cardiovascular risk factors on these relationships, and their common genetic background in a monozygotic twin cohort. We selected 134 cognitively healthy individuals (67 monozygotic twin pairs) aged ≥60 years from the Netherlands Twin Register for the EMIF-AD PreclinAD study. We measured seven retinal vascular parameters averaged over both eyes using fundus images analyzed with Singapore I Vessel Assessment. Small vessel disease was assessed on MRI by a volumetric measurement of periventricular and deep white matter hyperintensities. We calculated associations between RVPs and WMH, estimated intratwin pair correlations, and performed twin-specific analyses on relationships of interest. Deep white matter hyperintensities volume was positively associated with retinal tortuosity in veins (P = 0.004) and fractal dimension in arteries (P = 0.001) and veins (P = 0.032), periventricular white matter hyperintensities volume was positively associated with retinal venous width (P = 0.028). Intratwin pair correlations were moderate to high for all small vessel disease/retinal vascular parameter variables (r = 0.49-0.87, P < 0.001). Cross-twin cross-trait analyses showed that retinal venous tortuosity of twin 1 could predict deep white matter hyperintensities volume of the co-twin (r = 0.23, P = 0.030). Within twin-pair differences for retinal venous tortuosity were associated with within twin-pair differences in deep white matter hyperintensities volume (r = 0.39, P = 0.001). Retinal arterial fractal dimension and venous tortuosity have associations with deep white matter hyperintensities volume. Twin-specific analyses suggest that retinal venous tortuosity and deep white matter hyperintensities volume have a common etiology driven by both shared genetic factors and unique environmental factors, supporting the robustness of this relationship.

Fundus examination of 199 851 newborns by digital imaging in China: a multicentre cross-sectional study

BackgroundThe prevalence of ocular abnormalities of newborn in China has seldom been reported. To report the implementation of digital imaging in ocular screening of all newborns in multiple centres in...

Fundus changes in thalassemia in Egyptian patients

Aim The aim of this study was to evaluate the fundus changes in thalassemic patients in Giza and Fayoum Governorates. Patients and methods Thirty thalassemic patients recruited from the Pediatric Hematology Clinic in Fayoum University Hospital, Misr University Hospital, and NILES Pediatric Clinic were included in the present study. All patients underwent complete ophthalmic examination and laboratory investigations. Results The mean age was 10.7±5.9 (6–36) years. There were 20 male patients (66.7%), with a mean duration of disease of 7.1±7.1 years (3 months to 36 years). Patients were classified on the basis of hemoglobin (Hb) level into two groups: 7 g/dl or less (thalassemia major) and greater than 7 g/dl (thalassemia intermediate and thalassemia minor). There was a significant correlation between cup/disc (C/D) ratio and Hb level (P<0.05) and a nonsignificant correlation with color vision defect, retinal venous tortuosity, and arteriovenous (A–V) crossing changes. A highly significant correlation between serum ferritin and color vision defect (P=0.001), increased cup/disc ratio (P=0.001), venous tortuosity (P=0.001), and A–V crossing changes (P=0.002) was found. Conclusion The majority of the ocular changes depend on the course and severity of thalassemia. Ocular complications can be prevented or delayed by reducing serum iron and ferritin levels with iron-chelating agents.

Hyperhomocysteinemia and Juvenile Open Angle Glaucoma – A Rare Association

Summary A young female diagnosed as juvenile open angle glaucoma was noted to have disc collaterals, retinal venous tortuosity and lens subluxation. Serum homocysteine levels were raised while vitamin B12 was found to be low. A genetic work up showed polymorphism of MTHFR 1298C gene. Heterozygous mutations like these when influenced by various lifestyle or nutritional factors i.e., nutrigenomic presentation, may show subtle manifestations and severe form of systemic disease is rarely present.

Talasemi Majörlü Bir Hastada Deferipron Kullanımına Bağlı Gelişen Katarakt

Thalassemias are a heterogeneous group of autosomal recessive diseases characterized by hypochromic microcytic anemia and occur as a result of defective synthesis of one or more hemoglobin chains. In patients, life-threatening clinical manifestations may occur because of severe iron overload due to frequent blood transfusions. Ocular changes in patients with thalassemia are to be encountered depending on the disease itself or chelator used in the treatment, but not very often. These changes are usually cataracts, optic neuropathy, retinal pigment epithelium (RPE) degeneration, RPE mottling, retinal venous tortuosity, vitreoretinal hemorrhages and obliteration of the iris pattern. Desferrioxamine that is used as the first iron-binding chelating has well-known complications such as optic neuropathy and retinal toxicity. However, Deferiprone that used more common recently has replaced the Desferrioxamine but, there is very little information in the literature about the ocular toxicity of deferiprone. In this case report, we have reported a patient with deferiprone-induced cataract formation in order to draw attention to a little-known complication of the drug.

Quantitative analysis of retinal venous tortuosity in neonatal and premature infants

Objective To measure and analyze the tortuosity of retinal veins in neonatal and premature infants quantitatively. Methods A retrospective clinical study. The fundus images of the left eyes were selected from 30 healthy neonates and 30 premature infants without retinopathy of prematurity underwent RetCam screening. There were 16 premature infants with a history of oxygen inspiration. The tortuosity of superior temporal veins, inferior temporal veins, superior nasal veins, inferior nasal veins was measured separately using a self-developed computer program. Pearson correlation analysis was used to analyze the relationship between tortuosity of retinal veins and birth weight, gestational age and correct gestational age. Results In full-term neonatal infants, the vascular tortuosity of the nasal veins was significantly higher than the temporal veins (t=5.73, P 0.05). There was no correlation between vascular tortuosity of temporal (r=0.179, -0.175) or nasal veins (r=0.055, 0.345) with birth weight or gestational age (P>0.05). In premature infants, the vascular tortuosity of the nasal veins was also significantly higher than the temporal veins (t=5.00, P 0.05). The vascular tortuosity of temporal veins of premature infants was negatively correlated with birth weight (r=-0.375, P 0.05). The vascular tortuosity of the temporal retinal veins of premature infants with a history of oxygen inspiration was significantly higher than premature infants without a history of oxygen inspiration (t=2.517, P 0.05). The vascular tortuosity of the temporal and nasal retinal veins of premature infants was both higher than neonate, but was not statistically significant (t=0.88, 1.50; P>0.05). Conclusions The vascular tortuosity of the temporal veins was greater than the nasal veins in both full-term and premature infants, though no significant difference was found between superior and inferior veins. The vascular tortuosity of temporal veins of premature infants increased as birth weight decreased. The vascular tortuosity of the temporal retinal veins of premature infants with a history of oxygen inspiration was higher than premature infants without a history of oxygen inspiration. Key words: Retinal vein/pathology; Neonatal screening; Infant, premature

Diagnostic Accuracy of Optic Nerve Ultrasonography and Ophthalmoscopy in Prediction of Elevated Intracranial Pressure.

Elevated intracranial pressure (ICP) is a major and potentially lethal disorder in patients admitted to the emergency department (ED). Several methods are being used to investigate for elevated ICP. Here we assessed and compared the diagnostic accuracy of two existing tools of ophthalmoscopy and optic nerve ultrasonography in detection of elevated ICP. 131 participants with probable elevation of ICP referred to the emergency department of Al-Zahra Hospital, Isfahan, Iran, from 2012 to 2014, were enrolled. Brain computed tomography (CT) scan, ultrasonography of optic nerve sheath, and ophthalmoscopy were performed for them. The optic nerves sheath with diameter more than 5 millimeters was considered as elevated ICP. Widening of optic nerve, ocular venous engorgement, blurring, hemorrhage over optic disk, elevation of optic disk, and retinal venous tortuosity were recorded as evidences of ICP rising in ophthalmoscopy. Diagnostic accuracy of the two tools in prediction of ICP rising were compared with the results of brain CT scan as a gold standard. The mean age of participants was 46.29 ± 10 years (77% male). The number of diagnosed elevated ICPs with ophthalmoscopy and ultrasound were 98 (74.8%) and 102 (77.9%) cases, respectively. The calculated sensitivity and specificity of ophthalmoscopy and ultrasonography in detection of ICP rising were 100.0% (95% CI: 88.6-100.0) and 35.4% (95% CI: 26.0-46.2), 100.0% (95% CI: 84.0-100.0) and 31.9% (95% CI: 23.0-41.7), respectively. The present study revealed that bedside ultrasonography of optic nerve sheath and ophthalmoscopy have enough accuracy for the screening of patients with probable elevation of ICP. Of course, it should be considered that despite the high sensitivity of both tools, their specificity is low.

A wide spectrum of phenotypes in a family with renal coloboma syndrome caused by a PAX2 mutation.

Renal coloboma syndrome (RCS) is a rare inherited condition exhibiting a variable clinical phenotype of renal and ocular abnormalities. In 50% of cases, mutations can be found in the transcription factor PAX2. We present three generations of a family with a PAX2 mutation who showed variable eye and renal phenotypes. Renal phenotypes ranged from normal kidneys with the absence of proteinuria to end-stage renal disease (ESRD) at 17 years of age. Eye phenotypes included the typical morning glory anomaly, macular retinal pigment epithelial changes and retinal venous tortuosity. We identified a PAX2 mutation c.228_251dup [p.Ser77_Gly84dup] which segregated with the phenotype in an autosomal dominant fashion. A molecular genetic diagnosis allowed identification and management of at-risk family members. Given the phenotypic variability, clinicians need to consider the possibility of RCS in patients with a family history of chronic kidney disease (CKD) or eye disease.

Vitreoretinal traction in impending branch retinal vein occlusion: A pathogenetic role?

A 25-year-old woman noticed floaters in her left visual field since a few days earlier. She was positive for the heterozygous A1298C mutation on MTHFR gene, betafibrinogen gene –455G/A polymorphism, and 4G/5G plasminogen activator inhibitor-1 (PAI-1). Blood test and a systemic workup did not reveal any abnormality. Blood pressure was 120/80 mmHg. Visual acuity was 20/20 in both eyes. Following a complete ophthalmologic examination an impending upper temporal branch retinal vein occlusion (BRVO) was diagnosed ( Fig. 1). The patient was followed for one month without any particular treatment. Visual acuity remained unchanged and ophthalmic examination demonstrated improvement in the retinal vascular configuration with complete resolution of retinal hemorrhages, venous tortuosity and congestion ( Fig. 2). BRVO is the second most common vascular disorder of the retina, after diabetic retinopathy. It typically occurs at an arteriovenous (AV) crossing, where the retinal arteriole and venule share a common adventitial sheath (1). Although the pathogenesis of BRVO is not clear, there is evidence suggesting a multifactorial process including genetic, environmental and local factors. Mechanical narrowing of venous lumen may alter the normal blood flow downstream of the AV crossing, leading to turbulent flow. The preexisting endothelial vascular damage from different systemic Figure 1: Findings at first presentation of the patient. A) Fundus photograph of the left eye showing a moderate tortuous and engorged upper temporal retinal vein (white arrows), with some small flame-shaped retinal hemorrhages along the territory of the affected vessel (black arrows). B) Fluoresceingraphy disclosed delayed venous filling and a localised partial obstruction in the venous lumen near optic nerve (arrow). C) SD-OCT directed to the site of obstruction revealed a vitreovascular traction (arrow) and tissue elevation (asterisks) by an obliquely directed posterior hyaloids. D) SD-OCT dense protocol of false-color maps provided qualitative information of perivascular edema, showing an intense red colour at the involved blood vessel segment. A B

Posterior subcapsular opacity in two patients with thalassaemia major following deferiprone consumption

Several studies have noted a variety of ophthalmologic changes occurring in patients with thalassaemia major, such as cataract, angioid streaks, retinal venous tortuosity and degeneration of the re...

Case report: Bilateral simultaneous central retinal vein occlusion in Waldenström's macroglobulinemia

Background We report a case of bilateral simultaneous central retinal vein occlusion (CRVO) in Waldenström's macroglobulinemia. Methods We report the case of a 60-year-old woman who presented with decreased vision in both eyes. Results Ophthalmoscopic examination showed scattered retinal hemorrhages and venous tortuosity with macular edema bilaterally. The patient had a history of hypertension and was under investigation for lethargy, recurrent epistaxis, and fainting episodes. Serum protein electrophoresis showed an M-spike in the gamma region. Bone marrow trephine biopsy confirmed the diagnosis of Waldenström's macroglobulinemia. The patient was treated with plasmapheresis and subsequent chemotherapy, resulting in improvement of ocular and systemic symptoms. Conclusions We report this case to emphasize that in any case of bilateral CRVO, hyperviscosity should be suspected. Serum electrophoresis along with coagulation profiles should be performed as a standard practice in patients with bilateral simultaneous CRVO.

Quantitative evaluation of the retinal venous tortuosity in chronic anaemic patients affected by beta-thalassaemia major.

Retinal venous tortuosity (RVT) is a common finding in patients affected by different forms of chronic anaemia. The aims of this study were to quantify RVT in anaemic patients with beta-thalassaemia major and to verify whether it is related to some of the following parameters: patient's age, ferritin plasma level, and Desferrioxamine (DFX) daily dosage. A retrospective study was carried out. In total, 36 consecutive thalassaemic patients, treated with polytransfusion regimen and DFX, were age- and sex-matched with a control group of 36 normal subjects. All subjects bilaterally underwent red-free fundus photography, centred on the optic disc. The four main retinal veins were measured with a computer-assisted method. Mean venous length in the thalassaemic group was significantly greater than that observed in the control group (P <0.001). In thalassaemic patients, no significant correlations between retinal venous length and, respectively, plasma ferritin level and DFX daily dosage were documented. Statistical analysis demonstrated a very significant association between patient's age and increased RVT only in thalassaemic patients (P <0.001). Our findings demonstrate that patients with beta-thalassaemia major have increased RVT, as compared to normal subjects. In this selected anaemic population, patient's age, closely related to anaemia duration, is the only variable responsible for the RVT increment. This clinical sign indicates a long-standing duration of anaemia.

Retinal abnormalities associated with anemia.

The incidence of clinically apparent retinal changes in 35 anemic patients and 35 age- and sex-matched control subjects was studied. Retinal photographs of all subjects were obtained. From these, all vascular and extravascular retinal lesions were noted. No retinal abnormalities were observed in the control subjects. Seven (20%) of the anemic patients exhibited extravascular lesions. There was no relationship detected between the occurrence of these changes and the severity or the cause of the anemia. Employing the assumption that true venous length for a given net distance traveled correlates with the degree of venous tortuosity, venous length over a standard radial distance from the optic disc was assessed with a curvometer. A significant negative correlation was determined between venous length and the level of hematocrit, thereby implying that retinal venous tortuosity is directly related to severity of anemia.