Early impact of hormone replacement therapy on vascular hemodynamics detected via ocular colour Doppler analysis.

OBJECTIVE: To determine the effects of hormone replacement therapy (HRT) on ocular blood flow. STUDY DESIGN: In a prospective controlled study, 40 healthy women who presented to the menopause clinic between December 2000 and December 2001 were randomly assigned into the study. The HRT-receiving group was administered estradiol 17-valerate 2 mg the first 11 days, and estradiol 17-valerate 2 mg plus ciproterone acetate 1 mg the next 10 days of the monthly cycle for 6 months. The control group did not receive any HRT for 6 months. The ocular colour Doppler analysis were performed at baseline and after 3 and 6 months. The ocular Doppler analysis was performed in the first half of the cycle in the HRT-receiving group. RESULTS: Central retinal artery and ophthalmic artery basal Doppler index (peak systolic velocity, end-diastolic velocity, resistive index and pulsatility index) values of the two groups at the beginning of the study did not show any statistically significant difference. Both the right and the left central retinal artery pulsatility index (PI) values of the study group, who received HRT at the end of the third and sixth months, showed a statistically significant decline (paired-samples test, P < 0.05), while the decrease in the resistive indexes was not significant. CONCLUSION: These results suggest that 6 months of combined hormone replacement therapy with estradiol 17-valerate 2 mg plus ciproterone acetate 1 mg improves ocular vascular Doppler indices which may be a reflection of cerebral vascular status.

Effect of pregnancy on intraobserver and intertechnique agreement in intraocular pressure measurements.

AIM: To evaluate the effect of pregnancy on intraobserver and intertechnique agreement for intraocular pressure (IOP) measurements. MATERIAL AND METHODS: Right eyes of 88 healthy women who were likely to become pregnant and of 94 healthy age-matched females were included in the study. Complete ocular examinations were performed on each eye. IOP measurements were obtained by Goldmann, Schiotz and non-contact tonometers (NCT) during 3-week exam periods before (within 6 weeks of conception) and during pregnancy (first, second and third trimesters) for pregnant cases, and in similar time intervals for control subjects. In each exam period, three readings with each of three separate tonometers were obtained, at least 1 day apart. Intraobserver and intertechnique agreements for IOP measurements were assessed. RESULTS: The mean visual acuity, keratometry and refractive error of both control and pregnant subjects did not change significantly during the study (all p values >0.01). In late pregnancy, pregnant cases demonstrated significant decreases in IOP measurements obtained with each of the three tonometers, and in intraobserver agreement with Goldmann and Schiotz tonometers (all p values <0.01). Intertechnique agreement of both Goldmann and Schiotz tonometers with NCT decreased significantly in the third trimester. Both intraobserver and intertechnique agreement in IOP measurements of control subjects were not found to change significantly during the study (all p values >0.01). CONCLUSION: IOP significantly decreased in the third trimester of pregnancy. Perfect intraobserver agreement in IOP readings of pregnant subjects was obtained with NCT. This may suggest that NCT is a viable option for IOP measurements during the follow-up of pregnant patients at risk for glaucoma.

Menstrual cycle dependent changes in blue-on-yellow visual field analysis of young diabetic women with severe non-proliferative diabetic retinopathy.

PURPOSE: To evaluate menstrual cycle dependent changes on blue-on-yellow visual fields of diabetic women, and to compare the results with those of healthy women. METHODS: Left eyes of 93 normally menstruating women were included in the study, comprising 45 with type-1 diabetes mellitus and severe non-proliferative diabetic retinopathy and 48 healthy controls. All subjects underwent baseline complete ocular examination and achromatic visual field analysis. Blue-on-yellow visual field tests (short-wavelength automated perimetry) were performed in both follicular (days 7-10 of the cycle) and luteal phases (days 3-6 before the bleeding) of two consecutive menstrual cycles. Visual field analyses were performed using Humphrey Field Analyser II with full threshold, central 30-2 program. Visual fields were divided into four regions: superior temporal, inferior temporal, superior nasal and inferior nasal. Visual field mean sensitivity (MS) was calculated for all regions separately. RESULTS: The mean ages of diabetic and control subjects were not significantly different (P > 0.05). Mean MS values of the diabetic group were significantly lower than that of the control group (P < 0.05). Control subjects did not demonstrate any menstrual cycle dependent changes in MS values (P > 0.05). However, diabetic women demonstrated a significant decrease in MS values in the luteal phase (P < 0.05). The decrease in MS was most marked in the nasal visual field (P < 0.05). CONCLUSION: Young diabetic women demonstrated a significant depression in visual field threshold sensitivity in the luteal phase of the menstrual cycle. Nasal visual fields are more prone to have menstrual cycle dependent threshold sensitivity depression. This should be taken into consideration in the clinical assessment of women with advanced diabetes who are at risk of glaucomatous optic neuropathy.

Effects of gestational hypertension on left ventricular geometry.

BACKGROUND: During pregnancy heart rate, stroke volume, cardiac output and left ventricular (LV) mass increase while peripheral vascular resistance decreases. Gestational hypertension (GHT) which is noted in some pregnancies during the third trimester, is considered a temporary condition. Its effects on LV geometry are not known. AIM: To assess the effects of acute pressure overload in GHT on the LV geometry. METHODS: Forty three pregnant women (mean age 28.7+/-8.9 years) with GHT were included in the study (Group A). Blood pressure levels >140/90 mmHg were considered diagnostic for GHT. Fifty six pregnant women (mean age 25.7+/-5.7 years) with normal blood pressure formed the control group (Group B). Transthoracic echocardiography was performed in all subjects before delivery. LV end-systolic (ESD) and end-diastolic (EDD) diameters, LV septal and posterior wall thickness were measured, and LV mass index (MI) as well as relative wall thickness (RWT) were calculated using Devereux and Ganau formulas. LV geometry was defined as normal (N), concentric hypertrophic (CH), eccentric hypertrophic (EH) or concentric remodelling (CR). RESULTS: LVMI and RWT were 138+/-13.8 g/m2 and 0.46+/-0.09 in Group A, and 117+/-15 g/m2 and 0.4+/-0.03 in Group B (p=0.01 and p=0.03). LV geometry patterns were: 38.9% - N, 19.4% - EH, 14% - CH and 27.7% - CR in group A and 78.6% - N, 7% - EH, 5.4% - CH and 9% - CR in normotensive pregnancies (p<0.001). CONCLUSIONS: These findings suggest that LVMI and RWT are greater in GHT compared to normotensive pregnant women. Most frequently observed abnormal geometric patterns are EH and CR.

[Prognostic factors of mitral stenosis during pregnancy]. / Gebelikte mitral darliginin prognostik faktörleri.

OBJECTIVE: To identify characteristics associated with complications during pregnancy in patients with mitral stenosis. METHODS: Thirty-seven pregnant women with mitral stenosis, followed-up from 1998 to 2001 were evaluated. Predictor variables were the mitral valve area (MVA) measured by echocardiogram and functional class (FC) before pregnancy according to NYHA criteria. Progression of functional class, thromboembolism, death, need in medical abortion, cardiac surgery or balloon mitral valvulotomy were accepted as maternal events. Fetal/neonatal events were determined as abortion, fetal or neonatal death, prematurity or low birth weight (p<2.500 g), and extended stay in the nursery or hospitalization in newborn intensive care unit. RESULTS: The mean +/- SD of age of the patients was 24.7+/-5.8 years. The eventful and uneventful patients were similar in age and percentage of first pregnancies. Of patients with an events occuring during gestational period, 37. 5% had class I functional capacity whereas 62.5% had class II/III (p=0.001). A clinical event was noted in 34 % of the patients with sinus rhythm and in all of patients with atrial fibrillation (p=0.007). The mean mitral valve area was 1.11+/-0.23 cm2 in the group with clinical event and 1.6+/-0.27 cm2 in the group without an event (p<0.001). The most frequently observed maternal complication was the worsening of the functional capacity and the most frequent fetal/neonatal complications were prematurity and low birth weight. Mitral valve area and functional capacity were found to be significantly related with maternal complications but not with the fetal/neonatal complications. CONCLUSION: In pregnant women with mitral stenosis, the MVA and the FC are strongly associated with maternal complications but not related to fetal/neonatal events.