Impaired brachial flow-mediated dilation may predict choroidal and retinal nerve fibre layer thickness changes in people with obesity.

CLINICAL RELEVANCE: Choroidal thickness and peripapillary retinal nerve fibre layer (RNFL) changes are known to occur in obesity. Endothelial dysfunction and systemic atherosclerosis may play a role in the pathophysiology of these differences. BACKGROUND: Flow-mediated dilation (FMD) is reduced in patients with endothelial dysfunction, and the ankle-brachial index is a surrogate marker for atherosclerosis. This study was conducted to examine the relationship between systemic vascular parameters (FMD, and ankle-brachial index), subfoveal choroidal thickness, and peripapillary RNFL thickness in obese individuals. METHODS: This observational, cross-sectional study involved 108 total participants who were divided into two groups. One group consisted of 54 obese subjects who each had a body mass index of 30 kg/m2 or more. The other control group contained 54 participants who each had a body mass index of 25 kg/m2 or less but higher than 20 kg/m2 . For each participant, only one eye was examined in this study. Subfoveal choroidal thickness, RNFL thickness, ankle-brachial index, and ultrasound measurement of the brachial artery FMD were performed. FMD was categorised according to receiver operating characteristic analysis, and endothelial dysfunction was defined as an FMD ≤ 7.29%. RESULTS: Subfoveal choroidal and RNFL thicknesses in the temporal quadrant were significantly lower in the obese group (p < 0.05). Lower mean values of subfoveal choroidal and RNFL thicknesses in the temporal and inferior quadrants were observed in subjects with an FMD ≤ 7.29% (p < 0.05). In people with obesity, FMD was positively correlated with subfoveal choroidal thickness (r = 0.322, p = 0.001), inferior RNFL thickness (r = 0.259, p = 0.007), and temporal RNFL thickness (r = 0.297, p = 0.002). However, the ankle-brachial index was not correlated with obesity. CONCLUSIONS: Impaired FMD was associated with reduced subfoveal choroidal and RNFL thicknesses in the temporal and inferior quadrants of people with obesity.

Central retinal vein occlusion after coronary artery bypass surgery: A case report.

OBJECTIVE: The aim of this study is to report a case of central retinal vein occlusion (CRVO) after coronary artery bypass graft (CABG) surgery. In this report, we present the third case in the literature with CRVO after cardiopulmonary bypass (CPB), and the first case after CABG. CASE REPORT: A 59-year-old male patient complaining of chest pain was admitted to our hospital. The patient underwent an elective coronary angiography and was diagnosed with three-vessel coronary artery disease. An uneventful coronary artery bypass graft operation was performed using CPB. On the second postoperative day, the patient described blurring and decreased vision in his left eye, whereas the right eye was normal. The anterior-posterior segment was examined by an ophthalmologist who diagnosed central retinal vein occlusion, using a visual acuity test, fundoscopy. After 5 months of treatment, there has been no improvement in the patient's visual acuity. CONCLUSION: As two previous case reports indicated CRVO can be a rare complication after CPB, this study demonstrated that CRVO can also be a complication of CABG. Therefore, CRVO should always be considered as a potential complication after cardiac surgery.

Predictive factors and management of steinstrasse after shock wave lithotripsy in pediatric urolithiasis--a multivariate analysis study.

OBJECTIVE: To define the predictive factors for the formation of steinstrasse (SS) after shock wave lithotripsy (SWL) and determine the treatment strategies for this complication in pediatric urolithiasis. METHODS: We retrospectively reviewed the data of 341 renal units (RUs) treated with SWL for urolithiasis. The stone location, stone burden, auxiliary procedures, energy level, and number of shock waves were recorded. Statistical analysis was performed to detect the predictive factors for the formation of SS. In addition, the treatment of children with SS was evaluated. RESULTS: The mean age of the children was 8.31 years (range 1-17). Episodes of SS developed in 26 RUs (7.6%). Of the 26 RUs, 20 (77%) were localized in the lower, 5 (19%) in the upper, and 1 (4%) in multiple locations in the ureter. The stone burden was the only statistically significant factor predicting the formation of SS on logistic regression analysis (P = .001). Of the 26 RUs, 17 (65.4%) were successfully managed by repeat SWL monotherapy, 4 (15.4%) were managed with ureteroscopy after failure of SWL, 1 (3.8%) was managed by ureteroscopy monotherapy, and 4 (15.4%) were monitored with conservative management with antispasmodic drug plus hydration therapy. The mean number of SWL sessions was 1.72. CONCLUSION: The incidence of SS development in children after SWL treatment was similar to that in adult series. Our results suggest that the stone burden is a significant predictive factor for the development of SS after SWL in pediatric urolithiasis. Most children with SS could be easily and safely treated by repeat SWL.