The effect of increased intraoperative intraocular pressure on blood flow in the central retinal artery and posterior short ciliary arteries during phacoemulsification

2020 ◽  
pp. 147-148
Author(s):  
R.B. Shliakman ◽  
◽  
Y.V. Takhtaev ◽  
T.N. Kiseleva ◽  
◽  
...  
Keyword(s):  
Blood Flow ◽  
Intraocular Pressure ◽  
Vision System ◽  
Central Retinal Artery ◽  
Ciliary Arteries ◽  
Retinal Artery

Актуальность. Принципом факоэмульсификации является поддержание баланса ирригационно-аспирационных потоков. Баланс достигается за счет различных систем подачи жидкости, позволяющих хирургу задавать и поддерживать постоянный уровень ВГД во время операции. Вопрос об оптимальном безопасном уровне ВГД во время вмешательства на сегодняшний день остается открытым. Цель. Оценить влияние повышенного уровня интраоперационного офтальмотонуса на скорость кровотока в центральной артерии, вене сетчатки, и задних коротких цилиарных артериях. Материал и методы. В исследование было включено 29 пациентов с начальной катарактой. Факоэмульсификация выполнялась на приборе Alcon Centurion vision system на предустановленном интраоперационном уровне ВГД 60 мм.рт.ст. Скорость кровотока измеряли путем дуплексного сканирования в режиме ЦДК трёхкратно: до вскрытия глазного яблока, интраоперационно на уровне ВГД (58.77±8.28 мм.рт. ст) и сразу после герметизации доступа и нормализации ВГД. Каждое измерение сопровождалось контролем ВГД и АД. Результаты. При значении уровня ВГД 58.77±8.28 мм.рт. ст в ЦАС и ЗКЦА отмечалось статистически достоверное снижение максимальной систолической скорости кровотока. С 12,62±3,07 до 9,93±2,77 см/с и снижение конечной диастолической скорости кровотока с 3,94±1,09 до 1,79±1,64 см/с. В 11 из 29 (37,9%) случаев скорость кровотока в ЦАС в диастолическую фазу не регистрировалась. Максимальная систолическая скорость кровотока в ЗКЦЛА снизилась на 22%. Конечная диастолическая снизилась с 5,11±1,83 до 2,97±1,27 см/с. Аналогично, максимальная систолическая скорость кровотока с медиальной стороны упала с 12,37±2,74 до 9,50±1,68 см/с, а конечная диастолическая скорость кровотока снизилась с 4,54±1,35 до 2,73± 0,91 см/с. Скорость кровотока в ЦВС менялась незначительно и не зависела от уровня ВГД. Выводы. На уровне ВГД 58.77±8.28 мм. рт. ст. у человека отсутствуют компенсаторные механизмы ауторегуляции глазного кровотока в ответ на резкое повышение интраоперационного уровня ВГД, вплоть до полного прекращения кровотока в ЦАС в диастолическую фазу, что может приводить к ишемии тканей сетчатки.

Comparision of the effects of subtenon’s and subconjunctival anesthesia on retroorbital hemodynamics

Open Medicine ◽  
2009 ◽  
Vol 4 (1) ◽  
pp. 84-90
Author(s):  
Hasan Cakmak ◽  
Mehmet Coskun ◽  
Huseyin Simavli ◽  
Mehmet Gumus ◽  
Ali Ipek ◽  
...  
Keyword(s):  
Blood Flow ◽  
Pulsatility Index ◽  
Ophthalmic Artery ◽  
Color Doppler ◽  
Central Retinal Artery ◽  
Doppler Imaging ◽  
Cataract Operation ◽  
Anesthesia Group ◽  
Ciliary Arteries ◽  
Retinal Artery

AbstractThe aim of the study was to compare retroorbital blood flow hemodynamics between subconjunctival and sub-Tenon’s anesthesia. This was a prospective, blinded study and included 80 cases. Patients were monitored and treated in the First Ophthalmology Clinic, Ataturk Training and Research Hospital, Turkey. Sub-Tenon’s anesthesia was performed in 42 cases, and subconjunctival anesthesia was performed in 38 cases. Color Doppler imaging to measure ocular blood flow parameters was performed preoperatively and 21 days after cataract operation in each case. Preoperative and postoperative values of resistivity and pulsatility indices in the ophthalmic, central retinal, and short posterior ciliary arteries were compared. Postoperative mean blood flow velocity measurements of ophthalmic artery were not statistically different between the subconjunctival anesthesia group and the sub-Tenon’s anesthesia group (49.63 ± 14.00 vs. 45.85 ± 13.41; P=0.389). Postoperative RI values were higher in the Subtenon’s anesthesia group than in the subconjunctival anesthesia group, but the difference between two groups was not statistically significant (0.81 ± 0.14 vs. 0.74 ± 0.08; P=0.079). The postoperative pulsatility index of the ophthalmic artery, RI of ophthalmic artery, pulsatility index of the central retinal artery, RI of the central retinal artery, and pulsatility index of the posterior ciliary arteries were not significantly different between the subconjunctival and sub-Tenon’s anesthesia groups. In conclusion, the study suggests that postoperative retroorbital blood flow hemodynamics are the same following sub-Tenon’s and subconjunctival anesthesia.

scholarly journals The effect of preset intraoperative intraocular pressure during phacoemulsification on the blood flow velocity in the central retinal artery

2020 ◽  
Vol 12 (4) ◽  
pp. 5-12
Author(s):  
Yuri V. Takhtaev ◽  
Tatyana N. Kiseleva ◽  
Roman B. Shliakman
Keyword(s):  
Blood Flow ◽  
Intraocular Pressure ◽  
Flow Velocity ◽  
Blood Flow Velocity ◽  
Ocular Blood Flow ◽  
Central Retinal Artery ◽  
Doppler Imaging ◽  
Diastolic Phase ◽  
Retinal Artery ◽  
Central Retinal Vein

Aim. To evaluate the effect of preset elevated intraocular pressure (IOP) level during phacoemulsification on central retina artery and central retinal vein hemodynamics and to determine possible compensatory mechanisms of the ocular blood flow autoregulation in response to intraoperational IOP jump. Methods. This prospective study included 23 cataract patients without concomitant ocular vascular conditions (15 women and 8 men) aged from 62 to 83 years. The mean age was 72.5 5.7 years. In all patients, an intraoperational color duplex scanning in the regimens of color Doppler imaging and pulsed wave velocity imaging using ultrasound scanner Logiq S8 (GE). The blood flow was estimated in retrobulbar vessels: central retinal artery, central retinal vein with maximal systolic velocity, end-diastolic velocity of the blood flow, and resistance index (RI). The investigation was performed under IOP control, which was measured using Icare Pro tonometer, and under blood pressure control using patient monitoring system Draeger Vista 120. In the operating room, ocular blood flow was examined three times: immediately before surgery, straight after the surgical incision sealing at preset intraoperational IOP level, and after IOP normalization and repeated sealing of the corneal tunnel. Results. Under preset intraoperational IOP maintenance on 58.01 8.10 mm Hg level, there was a clinically significant (p 0.05) decrease of blood flow velocity in the central retinal artery. In 30.4% of cases, the blood flow velocity in the central retinal artery during diastolic phase was not registered. The flow velocity in central retinal vein did not change significantly, and did not depend on IOP level (p 0.05). Conclusions. At the 5560 mm Hg IOP level, in humans, compensatory blood flow autoregulation mechanisms in response to intraoperational IOP jumps are absent, up to complete blood flow stop in the central retinal artery at the diastolic phase, and this could be a risk factor for retinal ischemia.

Association of systemic cardio-vasculature status with retinal vascular endothelium in diabetes

2020 ◽  
Vol 1 (1) ◽  
pp. 52-57
Author(s):  
Galina Dimitrova ◽  
Keyword(s):  
Blood Flow ◽  
Diabetic Retinopathy ◽  
Optic Nerve ◽  
Arterial Stiffness ◽  
Vascular Endothelium ◽  
Lamina Cribrosa ◽  
Central Retinal Artery ◽  
Diabetic Patients ◽  
Retinal Artery ◽  
Central Retinal Vein

The relationship between diabetic retinopathy and macro-vascular complications in diabetes suggests a pathogenic association between these conditions. Vascular endothelium has been identified as a main site of blood vessel injury in diabetes. Diabetic retinopathy is associated with systemic arterial stiffness and altered vascular endothelium function and structure. Retinal vasculature endothelium at the macula, arterio-venous crossings, and in the optic nerve at the lamina cribrosa region is reported to differ from the endothelium in the rest of the retinal blood vessels. The central retinal artery and vein are in close proximity in the optic nerve where they share a common adventitia; thus, increased arterial wall stiffness and thickness may affect blood flow in the neighboring central retinal vein in this region. Moreover, increased arterial stiffness in small arterial beds is associated with retinal venular widening; it suggests the possibility of central retinal artery compressing the central retinal vein at the lamina cribrosa, thereby compromising venular outflow in the retina of diabetic patients. Altered blood flow in the central retinal vein in the postlaminar region has been detected in patients who experience progression of diabetic retinopathy. Increased hydrostatic pressure in the central retinal vein may play a major role in the pathogenesis of diabetic retinopathy. The aim of this review article is to emphasize this pathogenetic mechanism that has often been overlooked.

Comparison of the autoregulatory mechanisms between central retinal artery and posterior ciliary arteries after thigh cuff deflation in healthy subjects

2011 ◽  
Vol 82 (3) ◽  
pp. 269-273 ◽  
Author(s):  
Semira Kaya ◽  
Julia Kolodjaschna ◽  
Fatmire Berisha ◽  
Leopold Schmetterer ◽  
Gerhard Garhöfer
Keyword(s):  
Healthy Subjects ◽  
Central Retinal Artery ◽  
Cuff Deflation ◽  
Ciliary Arteries ◽  
Retinal Artery

Central retinal artery occlusion after Descemet membrane reposition by intracameral air: A case report

2019 ◽  
pp. 112067211987074
Author(s):  
Ashok Kumar Meena ◽  
Bhushan R Ghodke ◽  
Gautam Singh Parmar
Keyword(s):  
Intraocular Pressure ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Sudden Increase ◽  
Descemet Membrane ◽  
Normal Limits ◽  
Retinal Artery ◽  
Descemet Membrane Detachment

Purpose: To report a case of central retinal artery occlusion after Descemet membrane reposition by intracameral air. Methods: An otherwise healthy 60-year-old woman presented with white mature cataract in her left eye. Ocular exam of both eyes was within normal limits. After an uneventful topical phacoemulsification, a moderate-grade striate keratopathy and non-planar Descemet membrane detachment was noted on first postoperative day, which was confirmed on anterior segment optical coherence tomography. The Descemet membrane was repositioned within 24 h of cataract extraction by intracameral air tamponade (pneumatic descematopexy) under topical anesthesia, and partial air release was done after 2 h. The patient was evaluated for decreased immediate postoperative vision of perception of light. Results: After pneumatic descematopexy, the stromal edema relatively cleared. The intraocular pressure before releasing the intracameral air was 38 mmHg and antiglaucoma medication was started. Dilated fundus exam showed retinal pallor and a cherry-red spot over the macula. A diagnosis of central retinal artery occlusion was confirmed, and thorough systemic workup was done. Systemic investigations were within normal limits. The patient was managed conservatively, but the final visual acuity remained at 1/60. Conclusion: Central retinal artery occlusion is not a reported complication after pneumatic descematopexy for Descemet membrane detachment management. The possible mechanism could be sudden increase in intraocular pressure due to pupil block by air, and thus, ocular surgeries with use of intracameral air for prolonged duration warrants close monitoring of intraocular pressure and its subsequent management.

Vision loss in giant cell arteritis

2021 ◽  
pp. practneurol-2021-002972
Author(s):  
Laura Donaldson ◽  
Edward Margolin
Keyword(s):  
Optic Nerve ◽  
Optic Neuropathy ◽  
Visual Loss ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Ischaemic Optic Neuropathy ◽  
Ciliary Arteries ◽  
Retinal Artery

Almost two-thirds of patients with giant cell arteritis (GCA) develop ocular symptoms and up to 30% suffer permanent visual loss. We review the three most common mechanisms for visual loss in GCA, describing the relevant ophthalmic arterial anatomy and emphasising how ophthalmoscopy holds the key to a rapid diagnosis. The short posterior ciliary arteries supply the optic nerve head, while the central retinal artery and its branches supply the inner retina. GCA has a predilection to affect branches of posterior ciliary arteries. The most common mechanism of visual loss in GCA is anterior arteritic optic neuropathy due to vasculitic involvement of short posterior ciliary arteries. The second most common cause of visual loss in GCA is central retinal artery occlusion. When a patient aged over 50 years has both anterior ischaemic optic neuropathy and a central retinal artery occlusion, the diagnosis is GCA until proven otherwise, and they should start treatment without delay. The least common culprit is posterior ischaemic optic neuropathy, resulting from vasculitic involvement of the ophthalmic artery and its pial branches. Here, the ophthalmoscopy is normal acutely, but MR imaging of the orbits usually shows restricted diffusion in the optic nerve.

scholarly journals Associating the biomarkers of ocular blood flow with lamina cribrosa parameters in normotensive glaucoma suspects. Comparison to glaucoma patients and healthy controls

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248851
Author(s):  
Patrycja Krzyżanowska-Berkowska ◽  
Karolina Czajor ◽  
D. Robert Iskander
Keyword(s):  
Blood Flow ◽  
Ophthalmic Artery ◽  
Lamina Cribrosa ◽  
Ocular Blood Flow ◽  
Central Retinal Artery ◽  
Healthy Controls ◽  
Mean Flow ◽  
Posterior Ciliary Artery ◽  
Retinal Artery ◽  
Ciliary Artery

Purpose To evaluate association between ocular blood flow biomarkers and lamina cribrosa parameters in normotensive glaucoma suspects compared to glaucoma patients and healthy controls. Methods A total of 211 subjects (72 normotensive glaucoma suspects, 70 with primary open-angle glaucoma and 69 controls) were included. Ocular blood flow biomarkers in ophthalmic artery, central retinal artery, as well as in nasal and temporal short posterior ciliary arteries were measured using colour Doppler imaging. Lamina cribrosa position was assessed by measuring its depth, deflection depth, lamina cribrosa shape index and its horizontal equivalent (LCSIH) on B-scan images obtained using optical coherence tomography. Results Ocular blood flow biomarkers in glaucoma patients were statistically significantly reduced when compared to healthy controls in peak systolic velocity (PSV) (P = 0.001 in ophthalmic artery and P<0.001 in central retinal artery) and mean flow velocity (Vm) (P = 0.008 in ophthalmic artery and P = 0.008 in central retinal artery), but not statistically significantly different to that of glaucoma suspects except for PSV in central retinal artery (P = 0.011). Statistically significant correlations corrected for age, central corneal thickness and intraocular pressure were found in glaucoma patients between LCSIH and end diastolic velocity of central retinal artery (P = 0.011), and of nasal short posterior ciliary artery (P = 0.028), and between LCSIH and Vm of central retinal artery (P = 0.011) and of nasal short posterior ciliary artery (P = 0.007). No significant correlations were observed between these parameters in glaucoma suspects and healthy controls. Conclusions Impaired ocular blood flow associated with the deformation of lamina cribrosa was found in glaucoma patients, whereas glaucoma suspects had similar lamina cribrosa shape to glaucoma patients but that deformation was not associated with ocular blood flow biomarkers.

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