Doppler ultrasound-based evaluation of hemodynamic changes in the ophthalmic artery and central retinal artery in patients with type 1 diabetes mellitus without retinopathy and with mild non-proliferative retinopathy.

Aim: Determination of blood flow parameters in the ophthalmic artery and central retinal artery using Doppler ultrasound in patients with type 1 diabetes mellitus without fundus signs of diabetic retinopathy and with mild non-proliferative retinopathy. Material and methods: To eliminate the impact of other systemic factors on vascular flow, the study enrolled a total of 80 patients with type 1 diabetes mellitus, aged between 18 and 45 years. The study participants did not have any diabetic complications or other systemic or ocular comorbidities. The control group comprised 81 healthy individuals within a similar age range. Color Doppler ultrasound examinations of the ophthalmic artery and central retinal artery were performed to evaluate selected blood flow parameters including peak systolic velocity, end-diastolic velocity, and resistance index. Results: Patients with type 1 diabetes mellitus exhibited statistically significant decrease in both systolic and end-diastolic velocities in the central retinal artery, accompanied by an elevation in resistance index, compared to the control group. The study revealed differences in blood flow parameters between the patients without fundus changes and those exhibiting mild non-proliferative retinopathy. Specifically, patients with retinopathy showed a significant decrease in both systolic velocity and end-diastolic velocity in the central retinal artery. No differences were observed for the same parameters in the ophthalmic artery. When analyzing the patients' blood flow parameters in relation to the degree of diabetes control, as determined by glycated hemoglobin levels, a statistically significant reduction in systolic velocity was identified in both the ophthalmic and central retinal arteries in the group with poorly controlled diabetes. Conclusions: Examination of the orbital vessels using Doppler ultrasound in patients with type 1 diabetes mellitus holds promise as an effective method for early detection of vascular abnormalities.

Doppler imaging of orbital vessels in the assessment of the activity and severity of thyroid-associated orbitopathy.

Patients with symptoms of thyroid-associated orbitopathy are classified on the basis of the clinical activity score (CAS) proposed by Mourits in 1989. Despite its undoubted clinical usefulness, it has several limitations which can decide about the success or failure of the implemented treatment. Numerous reports mention the presence of hemodynamic changes in orbital and bulbar vessels in the course of an orbitopathy called Graves' disease. The usage of Doppler sonography in the diagnosis of numerous ophthalmologic vascular diseases suggests that changes in thyroid-associated orbitopathy can correlate with the activity and severity of the disease. This paper presents the overview of the state-of-the-art concerning the usefulness of Doppler imaging in patient selection for the treatment of thyroid-associated orbitopathy. It has been shown that the velocity of blood flow in the superior ophthalmic vein, which is the most susceptible to changes in anatomical conditions in the enclosed orbital space, decreases in a statistically significant way. A decrease in blood flow velocity is closely associated with the active stage of the disease whereas reverse flow or its absence attest to severe orbitopathy and constitute a risk factor of ocular neuropathy. The activity of the inflammatory process in the eyeball is also confirmed by an increase in peak systolic velocity (PSV) in the ophthalmic artery and central retinal artery as well as end-diastolic velocity (EDV) in the ophthalmic artery. Resistance index values decrease in the ophthalmic artery and increase in the central retinal artery mainly in cases with considerable expansion of the extraocular muscles.

Color Doppler imaging of the retrobulbar vessels in diabetic retinopathy.

Diabetes is a metabolic disease characterized by elevated blood glucose level due to impaired insulin secretion and activity. Chronic hyperglycemia leads to functional disorders of numerous organs and to their damage. Vascular lesions belong to the most common late complications of diabetes. Microangiopathic lesions can be found in the eyeball, kidneys and nervous system. Macroangiopathy is associated with coronary and peripheral vessels. Diabetic retinopathy is the most common microangiopathic complication characterized by closure of slight retinal blood vessels and their permeability. Despite intensive research, the pathomechanism that leads to the development and progression of diabetic retinopathy is not fully understood. The examinations used in assessing diabetic retinopathy usually involve imaging of the vessels in the eyeball and the retina. Therefore, the examinations include: fluorescein angiography, optical coherence tomography of the retina, B-mode ultrasound imaging, perimetry and digital retinal photography. There are many papers that discuss the correlations between retrobulbar circulation alterations and progression of diabetic retinopathy based on Doppler sonography. Color Doppler imaging is a non-invasive method enabling measurements of blood flow velocities in small vessels of the eyeball. The most frequently assessed vessels include: the ophthalmic artery, which is the first branch of the internal carotid artery, as well as the central retinal vein and artery, and the posterior ciliary arteries. The analysis of hemodynamic alterations in the retrobulbar vessels may deliver important information concerning circulation in diabetes and help to answer the question whether there is a relation between the progression of diabetic retinopathy and the changes observed in blood flow in the vessels of the eyeball. This paper presents the overview of literature regarding studies on blood flow in the vessels of the eyeball in patients with diabetic retinopathy.

[Diagnostics and pharmacological treatment of ocular cicatrical pemphigoid]. / Diagnostyka i leczenie zachowawcze ocznego pemfigoidu bliznowaciejacego.

Ocular cicatricial pemphigoid (OCP) is an autoimmune disease characterize by mucous membrane fibrosis and skin changes resulting with scarring. The pathogenic mechanisms of ocular cicatricial pemphigoid are incompletely understood. Antibasement membrane antibodies which lead to subepithelial blistering, granulation tissue and inflammatory infiltrate formation in the substantia propria are thought to be the main pathophysiological mechanisms in cicatricial pemphigoid. It has been found eosinophils and increased collagen type I and III. Human leukocyte antigen HLA-DR2, HLA-DR4 and DQw7 genotypes have been identified as conferring increased susceptibility to the development of this disease. Ocular cicatrical pemphigoid (OCP) is one of the forms of bullous pemphigoid. Initial symptoms of ocular pemfigoid are not characteristic. Conjunctival fibrosis may cause severe entropion, trichiasis, symblepharon, dry eye syndrome, corneal epithelial erosions or ulceration. Secondary glaucoma is one of the most frequent complications. Ocular cicatricial pemphigoid may be chronic, acute, or subacute disease with periodic exacerbation of conjunctival inflammation. The treatment in this disease are topical drops or ointment (lubricants, corticosteroids, antibiotics, antiglaucomatous). Oral dapsone and corticosteroids may control the activity of the disease. In other progressive cases immunosuppressive drugs must be used (azathioprine, cyclophosphamide, methotrexate, mycophenolan mofetil, daclizumab, intravenous immunoglobulin therapy). To make an early diagnosis of ocular cicatricial pemphigoid, biopsy and immunohistochemical analysis of conjunctiva should be performed in every case of persistent conjunctival inflammation.