Role Of Colour Doppler Imaging In Early Diagnosis Of Diabetic Retinopathy

Diabetic retinopathy is the most common cause of vision loss among people with diabetes and a leading cause of blindness among working-age adults in India. It is a form of microangiopathy, and is the most common ocular complication seen in diabetic patients. Diabetic retinopathy progresses from non proliferative to proliferative retinopathy. The non proliferative retinopathy is the milder form and it is reversible. As the progression to proliferative retinopathy happens, the patients are symptomatic and become irreversible. Vascular changes and subsequent ocular hemodynamic changes are critical events in the pathogenesis of diabetic retinopathy. Colour doppler imaging is one of the most widely used and well-established techniques for assessing ocular blood flow velocities in the retro bulbar vessels. This is a non-invasive, painless imaging method with highly reproducibility. Estimation of orbital blood flow velocity from colour doppler imaging of the ophthalmic artery and central retinal artery is a technique offering great potential for the identification of early retinopathy in diabetic patients.

Graves’ ophtalmopathy and dysthyroid optic neuropathy: Imaging studies for diagnosis

The diagnosis of Graves’ ophtalmopathy (GO) is based on clinical examination, laboratory tests (indicating thyroid dysfunction and inflammatory and autoimmune unbalance) and imaging studies (such computed tomography, magnetic resonance imaging, ultrasound and colour Doppler imaging). Imaging studies can be helpful in establishing the certain diagnosis of GO, because they provide objective morphological findings of the orbital structures. An important role of imaging studies is revealed in differential diagnosis versus other orbital diseases and can be also used to evaluate the progression of the disease and follow-up after clinical or surgical treatment.

Colour Doppler imaging of retrobulbar circulation in different severity of glaucoma optic neuropathy

Aims: To compare retrobulbar hemodynamic measured by colour Doppler imaging (CDI) in patients with a different severity of glaucoma and to correlate variables CDI with the structural parameters of the retina and optic disc.Material and methods: Of 89 eyes studied, 31 had preperimetric, 29 early, 12 moderate and 17 advanced glaucoma. Peak systolic velocity (PSV), end-diastolic velocity (EDV), resistance index (RI) in ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary arteries (SPCAs) were evaluated by CDI and compared between study groups. Retinal nerve fibre layer thickness (RNFL) and optic disc parameters measured with optical coherent tomography (OCT) were correlated with the Doppler variables.Results. In eyes with advanced, moderate and early glaucoma EDV SPCAs were significantly lower as well as RI SPCAs were significantly higher compared to the eyes with preperimetric glaucoma. In eyes with advanced and moderate glaucoma RI CRA (0.74 and 0.71) were significantly higher than in eyes with preperimetric glaucoma (0.68) (p=0.014 and 0.026). In eyes with advanced glaucoma PSV OA and PSV CRA were significantly lower than in eyes with preperimetric glaucoma (32.5 vs. 40.7 cm/s p=0.034 and 8.25 vs. 9.7 cm/s p=0.022, respectively). Positive, variable correlations were found between RNFL and EDV of all measured arteries (0.21<R<0.50, p<0,05).Conclusions: Statistically significant alterations in the Doppler parameters of retrobulbar arteries in association with thinning of the RNFL were observed in patients with glaucoma along with a greater severity of optic neuropathy.

Bilateral Bizarre Vulvar Swellings in a Teenager: A very rare Entity of Aggressive Angiomyxoma

Background: Aggressive angiomyxoma (AA) is a rare mesenchymal neoplasm that commonly occurs in perineal region of females. Case Report: A 17 years female presents with bilateral bizarre vulvar swellings, gradually increasing in size for 2 years, painful for 1 week. Sonographic evaluation revealed bilateral well-defined hypoechoic lesions with internal vascularity and cystic areas. Magnetic resonance imaging (MRI) demonstrated these lesions to be iso-intense to skeletal muscles on T1-weighted images (T1WI) and hyperintense on T2-weighted images (T2WI). These were surgically excised and sent for histopathology that confirmed these lesions to be AA. Discussion: AA is an uncommon neoplasm of mesenchymal origin that arises mainly in the perineal soft tissue of adults. It occurs predominantly in females with a peak incidence in fourth decade. [1] In our case the patient was a teenager. In females it may present as a vulvar nodule, polyp or may even be mistaken for a Bartholin’s or labial cyst. In males it involves analogous sites including inguino-scrotal region. [4] Most of the reported cases include solitary unilateral lesions. Conclusion: Our case is unique because the patient was in her teenage and presented with bilateral vulvar angiomyxomas that showed internal vessels on colour doppler imaging.

Age-related changes in retrobulbar circulation: a literature review

Introduction The advances in research methods used in ophthalmology allow for an increasingly accurate examination of the eyes, as well as the morphology and function of the vessels. Colour Doppler imaging is still the first-line method for the analysis of parameters of retrobulbar circulation. Therefore, the aim of this work was to present the current state of knowledge about anatomical and functional age-related changes in retrobulbar arteries. Methods A literature search was performed mainly based on the PubMed database. Results The anatomy of retrobulbar arteries, histological background of age-related vascular changes, age-related changes in retrobulbar blood flow in the ophthalmic artery, central retinal artery, short posterior ciliary arteries, and the reference values for the age-dependent retrobulbar circulation parameters measured by colour Doppler imaging are discussed in this review. Conclusion The age of the subject should always be taken into account when interpreting the parameters of retrobulbar blood flow measured by colour Doppler imaging.

Non-invasive measurement techniques for quantitative assessment of optic nerve head blood flow

Diseases of the optic nerve head involving changes in blood flow are common. However, the pathophysiology is not always fully understood. Several non-invasive methods for measuring optic nerve head blood flow are available, but currently no gold standard has been established. Methods for measuring blood flow in optic neuropathies including colour Doppler imaging, retinal function imager, optical coherence tomography angiography and laser speckle flowgraphy are reviewed. Ultrasound colour Doppler imaging is a fast measurement technique where several different parameters, especially the blood flow velocity, can be calculated. Though used for many years in ophthalmology, its use is not standardized and it requires significant observer skills. The retinal function imager is a direct method where the haemoglobin in erythrocytes is visualized and blood flow velocities in retinal vessels are calculated from a series of photos. The technique is not suitable for direct measurement of blood flow within the optic nerve head. Laser speckle flowgraphy uses a laser light which creates a light scatter pattern in the tissue. Particles moving in the area causes changes in the speckle pattern from which a relative blood flow can be estimated. It is, however, not known whether optic nerve head microcirculation is measurable with the technique. Optical coherence tomography angiography uses multiple scans to evaluate blood flow with good reproducibility but often problems with artefacts. The technique is continuously being refined and increasingly used in research as a tool for the study of blood flow in retinopathies and optic neuropathies. Most of the conducted studies are based on small sample sizes, but some of the methods show promising results in an optic nerve head blood flow research setting. Further and larger studies are required to provide standardized and comparable measurements before one or more of the methods can be considered clinical helpful in daily practice.