Correlation between higher blood flow velocity in the central retinal vein than in the central retinal artery and severity of nonproliferative diabetic retinopathy.

PURPOSE: To assess the correlation between a higher blood flow velocity in the central retinal vein (CRV) than in the central retinal artery (CRA) and the severity of nonproliferative diabetic retinopathy (non-PDR). METHODS: We evaluated both eyes of 20 non-PDR patients with higher peak systolic velocity (PSV) in the CRV than in the CRA unilaterally as determined by color Doppler imaging (CDI). The eyes with higher PSV in the CRV were placed in group D2-H, and the fellow eyes were placed in group D2-L. The stage of non-PDR was determined by the guidelines of the Early Treatment Diabetic Retinopathy Study. Normal subjects and non-PDR patients without higher PSV in the CRV were evaluated as CDI controls. RESULTS: Advanced non-PDR (P=0.001) and cystoid macular edema (P=0.02) were statistically more frequent in group D2-H. The velocities in the ophthalmic artery and the short posterior ciliary artery were not statistically different among all groups. The velocities in the CRA were similar in all non-PDR groups and significantly lower than in the normal subjects (P<0.05). The velocities in the CRV were significantly higher only in group D2-H (P<0.001). CONCLUSION: Higher PSV in the CRV than in the CRA was significantly correlated with the severity of non-PDR, especially in the presence of cystoid macular edema.

Effect of carotid artery stenting on ocular circulation and chronic ocular ischemic syndrome.

BACKGROUND: The authors evaluated the effect of carotid artery stenting (CAS) on ocular circulation and chronic ocular ischemic syndrome. METHODS: We examined 38 patients with carotid artery stenosis (>80%) at its origin treated with CAS. Ocular circulation and symptoms were examined before, within 24 h, and 1 week, 1 month, and 3 months after CAS based on ophthalmic artery color Doppler flow imaging and ophthalmological examinations. RESULTS: Ocular circulation: Before CAS, 13 patients showed reversed ophthalmic artery flow, and 25 antegrade flow. Average peak systolic flow velocity was -0.038 m/s. Within 24 h after CAS, all patients showed antegrade ophthalmic artery flow; reversed flow before CAS was thus resolved. Average peak systolic flow velocity rose significantly to 0.36 m/s (p < 0.05). One week, 1 month and 3 months after CAS, there were no significant changes compared to the findings at 1 week after CAS. Ocular symptoms: Before CAS, 8 patients showed chronic ocular ischemic syndrome. During the follow-up period (mean: 2.8 years), the visual acuity improved in 7 cases. Average retinal artery pressure and arm-to-retina circulation time improved significantly to the normal level (p < 0.05). The other 30 patients complained of recurrent and worsened visual symptoms during the follow-up period. CONCLUSION: CAS was effective in improving ocular circulation, and also improved the chronic ocular ischemic syndrome caused by the severe carotid artery stenosis.

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 > or =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) < or = 0; group B, 0 < PSV(OA) < or = 10; group C, 10 < PSV(OA) < or = 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 A(1)) had a Co-Path from the ipsilateral external carotid artery and 70%-100% OCAD. Eyes with bidirectional reverse flow (group A(2)) 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 C(1) eyes, with normal flow waves, had a Co-Path from the contralateral internal carotid artery and 100% OCAD. Group C(2) 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.

Ocular circulation in diabetic patients with coronary artery disease.

PURPOSE: To evaluate the ocular circulation in diabetic patients with coronary artery disease (CAD). METHODS: Thirty diabetic patients with diabetic retinopathy of grade 20 or 35, as evaluated by the Early Treatment Diabetic Retinopathy Study, were studied. They were divided into those without CAD (15 cases) and those with CAD (over 75% stenosis of carotid artery; 15 cases). All underwent standard ophthalmic examinations and orbital color Doppler imaging. Fifteen healthy controls underwent the same examinations. RESULTS: The peak systolic velocity in the central retinal artery was significantly lower in the two diabetic groups. The end-diastolic velocity in the central retinal artery was significantly lower only in the diabetic patients with CAD. There were no significant intergroup differences in blood flow velocities in the ophthalmic artery, short posterior ciliary artery, and central retinal vein. The blood flow waves were flattened in the diastolic phase for all orbital arteries in significantly more eyes in the diabetic patients with CAD. Echocardiography, performed only in the diabetic patients with CAD, showed that 10 cases (67%) had reduced systolic functions and/or diastolic functions and/or asynergy of the left ventricle. CONCLUSIONS: A decrease in blood flow velocities in the diastolic phase was found in diabetic patients with CAD. The findings indicate that this is probably related to the decrease in cardiac output.

Case of infectious endocarditis predicted by orbital color Doppler imaging.

BACKGROUND: There are no specific ocular findings for infectious endocarditis. We report a case of infectious endocarditis detected by combining orbital color Doppler imaging (CDI) and ophthalmological findings. CASE: A 47-year-old man suffered from lumbar pain and low-grade fever. He had undergone heart surgery for a ventricular septal defect and received blood transfusions 20 years earlier, and he had started interferon therapy for chronic hepatitis C 8 months previously. Systemic examinations suggested either collagen disease, malignant lymphoma, or infectious disease. OBSERVATIONS: The patient underwent a complete ophthalmological examination, including CDI. Ophthalmoscopy showed multiple cotton-wool patches in both eyes and branch retinal artery occlusion in the left eye. Orbital CDI showed that bilateral ophthalmic arteries and central retinal arteries flowed synchronously with abnormal waves composed of three narrow, sharp peaks. These findings were suggestive of a cardiac valve disorder, which can lead to embolisms. Echocardiography established the diagnosis of infectious endocarditis. CONCLUSIONS: To the best of our knowledge, this is the first reported case of infectious endocarditis detected by orbital CDI.

Optic disk manifestation in diabetic eyes with low serum albumin: late fluorescein staining and high blood flow velocities in the optic disk.

PURPOSE: To evaluate ocular findings and blood flow characteristics in diabetes mellitus (DM) patients with low serum albumin (ALB). METHODS: We studied 106 eyes of 53 type II DM patients without proliferative diabetic retinopathy and panretinal photocoagulation. All underwent standard ophthalmic examinations, color Doppler imaging, and serum ALB measurements. The patients were divided into Group 1 (34 cases) with a serum ALB > or =3.8 g/dl and Group 2 (19 cases) with ALB<3.8 g/dl. RESULTS: All of the optic disks appeared normal by Ophthalmoscopy except one case with the lowest serum ALB. The number of optic disks showing late fluorescein staining was significantly higher in Group 2 than in Group 1. Peak systolic velocities in the central retinal artery (CRA, P=0.02) and central retinal vein (CRV, P<0.001) were significantly higher in Group 2, and significantly correlated with the serum ALB value (CRA; r=0.41, P=0.003 and CRV; r=0.60, P<0.001). CONCLUSIONS: We suggest that low serum ALB enhances the permeability of the vessels in or around the optic disk and induces subclinical optic disk edema, which is characterized by late fluorescein staining and high blood flow velocities in the CRA and CRV.

Elevated C-reactive protein associates with early-stage carotid atherosclerosis in young subjects with type 1 diabetes.

OBJECTIVE: To evaluate whether low-grade inflammation contributes to early-stage advanced carotid atherosclerosis in young subjects with type 1 diabetes. RESEARCH DESIGN AND METHODS: The mean and maximum (max) intima-media thicknesses (IMT) of the carotid artery were assessed using ultrasound B-mode imaging in 55 patients with type 1 diabetes (22 men and 33 women, aged 22.1 +/- 3.6 years (+/- SD), duration of diabetes 14.2 +/- 5.7 years) and 75 age-matched healthy nondiabetic subjects (28 men and 47 women). High-sensitive C-reactive protein (hs-CRP) levels were measured with a latex-enhanced immunonephelometer. RESULTS: The patients with type 1 diabetes had significantly higher hs-CRP levels (median 0.35, range 0.05-1.47 mg/l vs. median 0.14, range 0.05-1.44 mg/l; P = 0.001) as well as significantly higher mean IMT and max IMT than the nondiabetic subjects (mean IMT 0.76 +/- 0.09 vs. 0.72 +/- 0.04 mm, P = 0.003; max IMT 0.84 +/- 0.11 vs. 0.77 +/- 0.06 mm, P < 0.0001). Hs-CRP levels were significantly correlated with the mean and max IMT of patients with type 1 diabetes and with the max IMT of nondiabetic patients. Multivariate regression analyses for both diabetic and nondiabetic subjects as a single group showed that hs-CRP levels are independently correlated with the mean IMT and max IMT levels (P = 0.002 and P = 0.023, respectively) as well as with diastolic blood pressure, sex, and duration of diabetes. CONCLUSIONS: Our data indicate that hs-CRP levels are elevated in young patients with type 1 diabetes, possibly corresponding with early-stage advanced carotid atherosclerosis.