The use of Digital Subtraction Angiography in The Evaluation of Carotid Cavernous Sinus Fistulas

Intravenous digital subtraction angiography (IV-DSA) is a safe, rapid procedure that can be performed on an outpatient basis and provide diagnostic information comparable to conventional angiography. This paper reviews the initial experience with intravenous digital subtraction angiography in the evaluation of five cases of carotid cavernous sinus fistulas. An illustrated example will be presented.     

Identification of Intraorbital Arteries in Pediatric Age by High Resolution Superselective Angiography

Purpose: Angiography is a powerful tool to identify intraorbital arteries. However, the incidence by which these vessels can be identified is unknown. Our purpose was to determine such incidence and which angiographic approach is best for the identification of each artery.

Methods: A retrospective study of 353 angiographic procedures (via ophthalmic artery and/or external carotid artery) carried out on 79 children affected by intraocular retinoblastoma was made to investigate the arterial anatomy in 87 orbits. For each intraorbital artery two parameters were calculated: the angiographic incidence, as the percentage of times a given artery was identified, and the visibility index, as the ratio between the angiographic incidence and the true anatomic incidence.

Results: All collaterals of the ophthalmic artery could be spotted. Most of them were identified with a high angiographic incidence; some of them were less easily identified because too thin or because frequently shielded. The visibility index paralleled the angiographic incidence of most arteries. However, the lacrimal and meningolacrimal arteries had a higher visibility index suggesting that their identification was more frequent than the angiographic incidence alone could suggest. Statistical analysis demonstrated that the lacrimal artery and some muscular branches had higher chances to be identified if the angiography of the ophthalmic artery was accompanied by the study of the external carotid system.

Conclusion: This work provides an objective measure of how powerful angiography is to identify intraorbital arteries as well as useful references for professionals who need to operate in the orbit.     

Digital subtraction carotid angiography and retinal arterial obstruction

Thirty-one consecutive patients with retinal arterial obstruction were studied with digital subtraction angiography (DSA). Among the 29 patients in whom DSA was technically acceptable, 45% (13/29) demonstrated evidence of carotid stenosis or an atherosclerotic plaque ipsilateral to the eye with the retinal arterial obstruction. In 21% of cases (6/29 patients) the stenosis was 60% or greater. The incidences of carotid atherosclerosis were similar among the central and branch retinal arterial groups.     

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

Purpose

To investigate and classify the ophthalmic artery (OA) flow patterns in patients with occlusive carotid artery disease (OCAD).

Methods

Forty-three patients (52 eyes) with documented OCAD of ≧70% underwent orbital color Doppler imaging. The eyes were first divided into four groups by peak systolic velocity in OA (PSV_OA): group A, PSV_OA ≦ 0; group B, 0 < PSV_OA ≦ 10; group C, 10 < PSV_OA ≦ 40; and group D, PSV_OA > 40?cm/s, then further classified by the shape of the OA flow wave. The groups were then compared with respect to the collateral pathway (Co-Path), severity of the OCAD, and systemic diseases.

Results

Eyes with unidirectional reverse flow (group A₁) had a Co-Path from the ipsilateral external carotid artery and 70%–100% OCAD. Eyes with bidirectional reverse flow (group A₂) had no Co-Path, 75% OCAD, and impending ischemic heart disease (IHD). Group B eyes had dome-shaped OA flow waves with no Co-Path and 99%–88% OCAD. Group C₁ eyes, with normal flow waves, had a Co-Path from the contralateral internal carotid artery and 100% OCAD. Group C₂ eyes, with triangular-shaped flow waves, had no Co-Path, 93%–70% OCAD, and IHD. Group D eyes had normal high flow waves with no Co-Path, 75% OCAD, and hypertension.

Conclusions

The OA flow patterns were variously affected by collateral pathway, severity of OCAD, and systemic diseases.?Jpn J Ophthalmol 2006;50:224–228 © Japanese Ophthalmological Society 2006     

Hemodynamics of Ophthalmic Artery and Central Retinal Artery and Correlation with Other Factors in Patients with Primary Open Angle Glaucoma

Objective : To investigate the hemodynamics of ophthalmic artery (OA) and central retinal artery (CRA) in patients with primary open angle glaucoma(POAG) and analyse the correlation between hemodynamics of OA and CRA and other factors.Methods:The hemodynamics of OA and CRA in normal persons (102 eyes) and glaucoma-tous patients (102 eyes) were measured by Colour Doppler Image (GDI). The linear correlation analysis was made between OA and CRA about each of the following parameters: the peak systolic flow velocity (Vmax), the end diastolic velocity (Vmin). The multiple step-wise regression analysis was taken to investigate the correlation between each of the following hemodynamics of OA and CRA; Vmax and Vmin in 74 eyes with POAG and each of the following related factors in hemorrheology; whole blood apparent viscosity at low, medium and high shear rate, plasma viscosity and hematocrit. The multiple linear regression was applied to investigate the correlation between each of the following hemodynamics of     

Ophthalmic manpower in India-need for a serious review

An attempt has been made to estimate the number of ophthalmic surgeons (OSs) in India, their distribution amongst the constituent states/union territories, and imbalances in the urban (big and small cities) and rural areas. With an ophthalmic surgeon:population ratio of 1:107,000 (similar to that in the UK), an increasing amount of blindness in India, the output by ophthalmic surgeons continues to be low. Whereas the shortage of surgeons has been recognised as a critical problem by the National Programme for Control of Blindness, recommendations made at various forums have been restricted only to increasing production of existing surgeons. The key issues relating to OSs in India are uneven distribution, under utilisation and increasing demands on the ophthalmologist's time, due to advancement in clinical ophthalmology in recent years. Serious intervention to streamline distribution and improve utilisation of OSs in government and private sectors is necessary to effectively counter the current menace of blindness. Another option-creating an exclusive cadre of cataract surgeons trained to perform intracapsular cataract extraction (ICCE) for a period of four months in the medical colleges-has been recommended.     

缺血性脑血管病患者眼动脉及其主要分支的数字减影血管造影观察

目的 观察缺血性脑血管病(ICVD)患者的眼动脉及其主要分支的数字减影血管造影(DSA)解剖特征.方法 对32例ICVD患者行DSA全脑血管造影检查,分别行颈总动脉、颈内外动脉和椎基底动脉造影,对眼动脉起点、经行和主要分支的特征进行观察.结果 32例ICVD患者经DSA检查,除1侧颈内动脉闭塞外,其余63侧颈动脉未发现中、重度狭窄.63侧眼动脉均起自于颈内动脉床突上段、眼段.其中,58侧眼动脉呈单支,起自于颈内动脉;5侧眼动脉呈双支,一支起自颈内动脉,另一支中有4侧起自脑膜中动脉(颈外动脉分支),1侧起自大脑前动脉(颈内动脉分支).眼动脉的主要分支有视网膜中央动脉和睫状后动脉;泪腺动脉和眼肌动脉;筛前、后动脉,眶上动脉,鼻背动脉,滑车上动脉,眼睑动脉.各分支起点变异较大.结论 DSA检查提示,ICVD患者眼动脉主要起自于颈内动脉并为单支,但也存在双支情况.眼动脉主要分支起点变异较大.     

Seven Years of HAART Impact on Ophthalmic Management of HIV-Infected Patients

Purpose: The widespread use of highly active antiretroviral therapy (HAART) has changed the clinical picture of HIV-associated eye disease. We evaluated the incidence of ocular manifestations of HIV infection since the introduction of HAART. Methods: Between January 1996 and December 2002, we examined 539 HIV-infected patients in our hospital. Follow-up of the patients was performed in case of ophthalmologic symptoms, regardless of current immunologic status, or for screening. Results: A total of 217 patients (40.3%) had HIV-associated eye disease. Of these patients, 42.0% had no eye symptoms. Fifty-eight (10.8%) of the 539 patients had cytomegalovirus (CMV) retinitis, most of whom had CMV retinitis before receiving HAART. Four patients developed immune-recovery uveitis. A total of 145 patients (26.9%) had HIV-related microangiopathy and 96 (17.8%) had dry-eye syndrome. Conclusion: The introduction of HAART had a major impact on the medical history of patients with HIV-related eye disease with improved survival time and decreased morbidity.     

Anterior Synechiolysis with Healon Needle and Ophthalmic Viscosurgical Devices after Anterior Lamellar Dissection in Penetrating Keratoplasty

Purpose: We described a technique to perform anterior synechiolysis with a healon needle and Viscoat® ophthalmic viscosurgical devices (OVDs) through anterior lamellar dissection in penetrating keratoplasty. Methods: OVDs were gently injected between iridocorneal adhesions with a healon needle to make a blunt dissection after anterior lamellar corneal dissection. Anterior synechiolysis at 360 degrees was completed with a healon needle and OVDs. Subsequently, the deep corneal lamella was cut with right and left Troutman-Katzin corneal scissors. 24 interrupted sutures were made with 10-0 nylon suture to implant the donor cornea. Results: In two eyes from two patients, with corneal opacity and nearly total anterior synechiae, clear grafts and relatively deep anterior chambers were achieved. Penetrating keratoplasty with anterior synechiolysis was thus successful with a healon needle and OVDs through lamellar dissection. Conclusions: Anterior synechiolysis with a healon needle and OVDs through lamellar dissection is a safe and efficient technique for keratoplasty in patients with corneal opacity with anterior synechiae.     

A Study of the Association Between Retinal Vessel Geometry and Optical Coherence Tomography Angiography Metrics in Diabetic Retinopathy

PurposeThe purpose of this study was to investigate whether optical coherence tomography angiography (OCTA) metrics are related to retinal vessel geometry parameters in diabetic retinopathy (DR).MethodsIn total, 119 eyes (119 patients) were included in this retrospective cross-sectional study. Retinal vessel geometry parameters were analyzed using semi-automated software. OCTA metrics were analyzed using automated manufacturer-provided algorithms. Associations between the severity of DR and retinal vessel geometry parameters and OCTA metrics were evaluated. Multivariable regression analyses were performed to evaluate associations between retinal vessel geometry parameters and OCTA metrics after adjusting for clinical characteristics and DR severity.ResultsDR severity was negatively associated with the following: arteriole–venular ratio (P = 0.039), arteriolar network fractal dimension (FDa; P = 0.003), arteriolar junctional exponent deviation (P = 0.037), venular junctional exponent deviation (P = 0.036), vessel area density (VAD) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP; P < 0.001, both), vessel length density (VLD) of the SCP and DCP (P < 0.001, both), and foveal avascular zone (FAZ) circularity (P < 0.001). DR severity was positively associated with the central retinal venular equivalent caliber (P = 0.005), arteriolar branching coefficient (BCa; P = 0.010), venular branching coefficient (P = 0.007), and FAZ size (P = 0.002). In multivariable regression analyses, the following retinal vessel geometry parameters and OCTA metrics were associated: FDa with VAD of the SCP (β = 0.40, P < 0.001), FDa with VLD of the SCP (β = 0.01, P < 0.001), and BCa with FAZ circularity (β = −1.02, P = 0.001).ConclusionsIn DR, changes in retinal arteriolar geometry parameters were significantly associated with OCTA metrics, which reflect DR pathophysiology.     

Role of OCT Angiography in the Detection of Retinal Vascular and Macular Abnormalities in Subjects with Asteroid Hyalosis

Purpose: To study the role of Optical coherence tomography (OCT) Angiography (OCTA) in detecting retinal vascular and macular abnormalities as compared to Fundus Fluorescein Angiography (FFA) in subjects with Asteroid hyalosis (AH).

Methods: In a prospective study, patients with AH underwent OCTA and FFA. AH graded as Grade 1 in 8 (optic disc, second order vessels visible), Grade 2 in 4 (optic disc, first-order vessels visible), Grade 3 in 11 (hazy view of optic disc) and Grade 4 (no view of fundus) in 2 eyes.

Results: A total of 20 patients (25 eyes) with AH were included. In comparison to FFA, OCTA was able to similarly detect Diabetic Retinopathy changes such as Neovascularization, microaneurysms, capillary dropout, and foveal avascular zone extent in vascular occlusion in all grades of AH.

Conclusion: OCTA, a noninvasive imaging tool, could detect various retinal vascular and macular abnormalities in patients with all grades of AH in comparison to FFA.     

Ultrasound assessment of short‐term ocular vascular effects of intravitreal injection of bevacizumab (Avastin®) in neovascular age‐related macular degeneration

Acta Ophthalmol. 2010: 88: 641–645

Abstract.

Purpose: Angiogenic inhibitors, alone or combined with other therapies, are believed to represent a promising treatment for neovascularization in age‐related macular degeneration (wet AMD). They can maintain or improve visual acuity (VA), at least for the first 2 years. However, evolution to retinal atrophy cannot be ruled out and it may be useful to assess the effects of antiangiogenic therapy on retinal and choroidal circulation. Methods: We carried out a pilot study in 15 patients with wet AMD. Time‐averaged mean blood flow velocities (BFVs) in the central retinal, temporal posterior ciliary and ophthalmic arteries (CRA, TPCA and OA) were measured by ultrasound imaging before and 4 weeks after a single intravitreal injection of 1.25 mg bevacizumab in 0.05 ml. Patients underwent two ophthalmic examinations, before and 4 weeks after injection, including VA measurement and optical coherence tomography (OCT3) examination. Results: In treated eyes, bevacizumab injection was followed by a significant improvement in VA (from 20/125 to 20/80; p = 0.0214), and a decrease in mean central macular thickness (from 392 ± 96 μm to 271 ± 50 μm; p = 0.0038). Mean BFV decreased by 10% in the CRA (p = 0.0226), 20% in the TPCA (p = 0.0026) and 20% in the OA (p = 0.0003). No effect was observed in fellow eyes. Conclusions: Intravitreal bevacizumab acutely improved VA and reduced central macular thickness in wet AMD. Ultrasound imaging revealed that BFVs decreased in all retrobulbar arteries, suggesting that after local diffusion, bevacizumab exerts a short‐term regional effect. Bevacizumab might therefore induce hypoperfusion of the whole eye, which may correspond to a vascular side‐effect.     

CRAO患者黄斑区视网膜血管密度及其与视网膜循环时间的关系

目的:利用光学相干断层扫描血管成像(OCTA)观察视网膜中央动脉阻塞(CRAO)急性期患者黄斑区视网膜血管密度,并分析其与眼底荧光素血管造影(FFA)视网膜循环时间的关系。方法:回顾性病例分析。纳入2019-01/2021-03就诊于陕西省眼科医院且临床诊断为CRAO急性期(病程≤7d)的患者43例43眼,均行FFA、OCTA、最佳矫正视力(BCVA)等检查及溶栓治疗。将治疗前OCTA显示患眼视网膜血管血流信号较对侧健眼增强或不变的患者纳入A组,OCTA显示患眼视网膜血管血流信号较对侧健眼降低的患者纳入B组。应用Image J软件处理OCTA图像评估治疗前黄斑区视网膜血管密度,FFA检查记录治疗前患眼视网膜循环时间。结果:A组患者患眼和对侧健眼视网膜血管密度均高于B组(25.08%±4.40%vs 12.24%±3.41%,25.72%±2.70%vs 17.89%±4.55%,均P<0.001),B组患者视网膜动脉主干-末梢充盈时间(FT)[96(20.50,193.50)s]较A组[11(5.00,19.50)s]延长(P<0.001)。病程、对侧健眼视网膜血管密度、F...     

原发性急性闭角型青光眼铜蓝蛋白变化和氧化损伤的初步观察

目的探讨原发性急性闭角型青光眼患者血浆铜蓝蛋白和氧化损伤的变化。设计实验研究。研究对象50例年龄45~70岁原发性急性闭角型青光眼患者及20例年龄和性别相匹配的健康成年人对照者。方法采用总抗氧化能力和铜蓝蛋白含量试剂盒,测定血浆总抗氧化能力和铜蓝蛋白含量的变化及丙二醛(MDA)含量和超氧化物歧化酶(SOD)活性。主要指标总抗氧化能力、铜蓝蛋白含量、MDA含量和SOD活性。结果原发性急性闭角型青光眼患者总抗氧化能力、SOD活性较正常对照组明显下降,分别为(5.37±1.29)、(9.28±0.98)kU/L;(58.45±20.21)、(79.26±18.02)U/ml;P均<0.05;而铜蓝蛋白含量、MDA含量较对照组明显增加,分别为(76.72±19.32)、(52.38±13.53)mg/dl;(689.76±189.34)、(472.21±181.72)nmol/ml;P均<0.05。结论原发性急性闭角型青光眼患者存在氧化损伤、铜蓝蛋白增加与抗氧化能力下降,可能与青光眼的视功能损害有关。     

Inner Macular Changes in Fellow Eye of Patients With Unilateral Idiopathic Epiretinal Membrane

PurposeWe evaluated a series of fellow eyes (FEs) in patients affected by unilateral idiopathic epiretinal membrane (IERM) with spectral-domain optical coherence tomography (SD-OCT) and OCT angiography (OCT-A) to determine if a previous defect in the inner retina is present before the mechanical damage to the inner limiting membrane (ILM) caused by posterior vitreous detachment.MethodsIn patients with IERM (N = 39), ganglion cell layer (GCL) thickness in FEs was assessed with SD-OCT; in a subgroup (N = 25) the vessel density (VD) at the superficial (SCP) and deep capillary plexus (DCP) was assessed with swept-source OCT-A (SS-OCT-A). These values were then compared with 30 age-matched healthy control eyes (CEs). The statistical analyses used SPSS software version 15.0 (SPSS, Inc., Chicago, IL, USA). Data collected underwent 1-way ANOVA. A level of P < 0.05 was accepted as statistically significant.ResultsThe GCL thickness in the FEs was significantly lower than in CEs, with a significant thinning in all sectors except temporal ones (mean P < 0.001, superior P = 0.0002, superonasal P < 0.001, inferonasal P < 0.001, and inferior P = 0.002). The VD was significantly lower in the FEs in all sectors of SCP (mean P = 0.009, inner ring P = 0.028, and outer ring P = 0.007).ConclusionsGCL and SCP are significantly reduced in the FEs. These data suggest that a vascular defect in the SCP could cause a cellular loss in the inner retina that may determine the cascade events leading to the IERM proliferation; the diagnosis in a preclinical phase could provide a treatment strategy to prevent the progression of the disease.     

应用光学相干断层成像术测量正常人黄斑视网膜厚度的初步研究

目的：应用光学相干断层成像术（ｏｐｔｉｃａｌ ｃｏｈｅｒｅｎｃｅ ｔｏｍｏｇｒａｐｈｙ,ＯＣＴ）测量我国正常人贡斑视网膜神经上皮层（ｒｅｔｉｎａｌ ｎｅｕｒｏｓｅｎｓｏｒｙ ｌａｙｅｒ）和色素上皮层（ｒｅｔｉｎａｌ ｐｉｇｍｅｔ ｅｐｉｔｈｅｌｉｕｍ,ＲＰＥ）与脉络膜毛细血管层的厚度。方法：用ＯＣＴ对６０例（１２０眼）正常人进行经黄斑中央小凹水平和垂直扫描,扫描长度４ｍｍ,测量并计算黄斑中央小凹;     

外科治疗对合并缺血性眼病的颈动脉狭窄患者眼动脉血流动力学的影响及疗效评价

目的：:利用彩色多普勒超声仪（CDFI）对伴有缺血性眼病的颈动脉狭窄患者行颈动脉内膜切除术（CEA）或颈动脉支架成形术（CAS）前、后颈部血管及眼部血管的血流动力学检查,以探讨外科手术治疗对眼动脉血流动力学的影响,并比较CEA和CAS这2种不同的外科手术治疗方法对缺血性眼病的疗效。方法：:前瞻性临床研究。收集2017年...     

OCTA定量分析新疆不同民族健康人黄斑区血流参数的差异

目的：通过光相干断层扫描血管成像(OCTA)测量新疆维吾尔族、汉族、哈萨克族、回族健康人黄斑区浅层毛细血管丛(SCP)血流密度(VD)、深层毛细血管丛(DCP)VD以及黄斑中心凹无血管区(FAZ)面积、周长、圆度指数等参数,探讨国内不同民族间健康人黄斑区血流参数的差异性。

方法：选取2022-12/2023-03于伊犁哈萨克自治州友谊医院眼科中心就诊且符合纳排标准的四族健康受试者各80例80眼共320眼为研究对象。根据族别分组编号,使用自动验光仪及IOL生物测量仪获取等效球镜及眼轴,使用DRI Triton OCT检测仪获取黄斑区3 mm×3 mm范围的血流图像并通过内置的IMAGENET6软件对图像进行分析获取各项血流参数,对比不同民族间各项血流参数的差异以及性别、年龄、眼轴对不同民族人群黄斑区血流参数的影响。

结果：四组性别、年龄、眼轴、屈光度、图像质量(IQ)无差异(均P>0.05)。族别差异：SCP中,维吾尔族下方VD大于哈萨克族,回族下方VD大于汉族、哈萨克族,汉族、回族鼻侧VD大于维吾尔族,哈萨克族中央凹VD大于汉族、回族,哈萨克族FAZ面积小于其它3个民族,汉族、回族FAZ周长大于哈萨克族,回族FAZ圆度指数小于其它3个民族; DCP中,维吾尔族中央凹VD大于汉族、回族,哈萨克族中央凹VD大于汉族、回族,哈萨克族FAZ面积、周长小于其它3个民族,哈萨克族FAZ圆度指数大于其它3个民族(均P<0.05)。性别差异：SCP中,汉族女性FAZ面积、周长大于男性,回族女性FAZ圆度指数大于男性(均P<0.05); DCP中,四族女性旁中央凹VD及整体VD均大于男性(均P<0.05)。年龄相关性分析：SCP中,年龄与哈萨克族FAZ圆度指数呈负相关; DCP中,年龄与汉族、哈萨克族、回族旁中央凹、整体VD呈负相关(均P<0.05)。眼轴相关性分析：SCP中,眼轴与哈萨克族、回族中央凹VD,回族旁中央凹VD,维吾尔族、哈萨克族、回族整体VD呈负相关,与哈萨克族FAZ面积、周长呈正相关; DCP中,眼轴与维吾尔族、哈萨克族、回族中央凹VD、回族整体VD呈负相关,与哈萨克族、回族FAZ面积、周长呈正相关(均P<0.05)。

结论：维吾尔族、汉族、哈萨克族、回族健康人群间黄斑区血流参数存在差异,其中哈萨克族FAZ面积、周长明显小于其它三族。黄斑区血流参数与性别、年龄、眼轴相关。     

Combination of AIBP,apoA-I,and Aflibercept Overcomes Anti-VEGF Resistance in Neovascular AMD by Inhibiting Arteriolar Choroidal Neovascularization

PurposeAnti-VEGF resistance represents a major unmet clinical need in the management of choroidal neovascularization (CNV). We have previously reported that a combination of AIBP, apoA-I, and an anti-VEGF antibody overcomes anti-VEGF resistance in laser-induced CNV in old mice in prevention experiments. The purpose of this work is to conduct a more clinically relevant study to assess the efficacy of the combination of AIBP, apoA-I, and aflibercept in the treatment of anti-VEGF resistance of experimental CNV at different time points after laser photocoagulation.MethodsTo understand the pathobiology of anti-VEGF resistance, we performed comprehensive examinations of the vascular morphology of laser-induced CNV in young mice that are highly responsive to anti-VEGF treatment, and in old mice that are resistant to anti-VEGF therapy by indocyanine green angiography (ICGA), fluorescein angiography (FA), optical coherence tomography (OCT), and Alexa 568 isolectin labeled choroid flatmounts. We examined the efficacy of the combination therapy of AIBP, apoA-I, and aflibercept intravitreally delivered at 2, 4, and 7 days after laser photocoagulation in the treatment of CNV in old mice.ResultsLaser-induced CNV in young and old mice exhibited cardinal features of capillary and arteriolar CNV, respectively. The combination therapy and the aflibercept monotherapy were equally effective in treating capillary CNV in young mice. In old mice, the combination therapy was effective in treating anti-VEGF resistance by potently inhibiting arteriolar CNV, whereas aflibercept monotherapy was ineffective.ConclusionsCombination therapy of AIBP, apoA-I, and aflibercept overcomes anti-VEGF resistance in experimental CNV in old mice by inhibiting arteriolar CNV.