Differential-diagnostic approach in assessing the nature of the course of partial atrophy of the optic nerve

Purpose. To determine the diagnostic criteria for the progressive nature of the course of non-glaucomatous etiology of ONA according to the data of electrophysiological and Doppler studies. Material and methods. In accordance with the purpose of the study, 3 groups were formed of 95 patients aged 37 to 72 years, (average age 56±9 years), 53 of them were men and 42 were women. Clinical data of three clinical groups were compared, of which the first group with stationary ONA, the second with progressive ONA, and the third control group, without pathology of the retina and optic nerve. Results. It was revealed that the progressive nature of the course of non-glaucomatous ONA is influenced by changes in indicators such as electrical lability of the optic nerve, maximum systolic and end diastolic blood flow velocity in the ophthalmic artery and in the lateral posterior short ciliary arteries. Conclusion. The results formed the basis for our development of a method for assessing the course of ONA. Key words: partial atrophy of the optic nerve, electrophysiological studies, Doppler studies.

Vision loss in giant cell arteritis

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.

En-face analysis of short posterior ciliary arteries crossing the sclera to choroid using wide-field swept-source optical coherence tomography

To study the topographic distribution of the short posterior ciliary arteries (SPCA) entry sites into the choroid in normal eyes using structural en-face swept source optical coherence tomography (SS-OCT). Retrospective analysis of SS-OCT scans (wide-field structural SS-OCT 12 × 12 mm) of 13 healthy subjects was performed. Cross-sectional swept-source OCT scans derived from a volume scan were represented as en-face image display following the Choroid-Scleral Interface to obtain en-face OCT. SPCAs in their last scleral location before choroidal entrance were identified manually, counted and localized by two masked observers. Correlations between two masked observers were analyzed using inter- and intra-class correlation. Accuracy for the choroidal inner and outer border segmentation was 95–99%. Eighteen eyes from 13 normal subjects were included for SPCA analysis. The mean number of arteries was 13.8 ± 3.5 per eye. Thirty-six percent were in the center of the posterior pole image; however, 21% were in the temporal part of the posterior pole. Median accuracy of the detection is 0.94. The correlation between the two observers was fair (0.54). Our algorithm allows visualization of the SPCA at the posterior pole of the eye using wide-field en-face SS-OCT. It can also help the clinicians to study the SPCAs in numerous ocular diseases, particularly its relationship with focal choroidal diseases.

Topographic Analysis of Short Posterior Ciliary Arteries Using Wide-Field Swept-Source En-Face Optical Coherence Tomography

Purpose: To study the topographic distribution of the short posterior ciliary arteries (SPCA) entry sites into the choroid in normal eyes using structural en-face swept source optical coherence tomography (SS-OCT). Methods: Retrospective analysis of SS-OCT scans (wide-field structural SS-OCT 12x12mm) of 13 healthy subjects was performed. Cross-sectional swept-source OCT scans derived from a volume scan were represented as en-face image display following the Choroid-Scleral Interface to obtain en-face OCT. SPCAs in their last scleral location before choroidal entrance were identified manually, counted and localized by two masked observers. Correlations between two masked observers were analyzed using inter- and intra- class correlation. Results: Accuracy for the choroidal inner and outer border segmentation was 95-99%. Eighteen eyes from 13 normal subjects were included for SPCA analysis. The mean number of arteries was 13.8±3.5 per eye. Thirty-six percent were in the center of the posterior pole image; however, 21% were in the temporal part of the posterior pole. Median accuracy of the detection is 0.94. The correlation between the two observers was fair (0.54).Conclusion: Our algorithm allows visualization of the SPCA at the posterior pole of the eye using wide-field en-face SS-OCT. It can also help the clinicians to study the SPCAs in numerous ocular diseases, particularly its relationship with focal choroidal diseases.

Macular edema after retinal vein occlusions. Macular morphometry and chorioretinal hemodynamics

This review article summarizes current data on the pathogenesis of macular edema after retinal vein occlusions (RVOs) and patterns of macular morphometry and chorioretinal hemodynamics. RVOs account for 60% of acute vascular eye diseases. The major cause of vision loss in RVOs is macular edema which results from subclinical inflammation characterized by leukostasis and enhanced expression of adhesion molecules and production of cytokines increasing retinal capillary permeability. The association between the severity of macular edema and vitreous levels of pro-inflammatory mediators (IL-1β, IL-6, TNF-α, MCP-1, and VEGF) is established. Cystic lesions and detachment of the neuroepithelium (75%) are typical for macular edema after RVOs. Impaired chorioretinal hemodynamics (as demonstrated by a significant reduction of vascular density in the superficial and deep vascular plexus, significant decrease in peak diastolic flow velocity, and increase in resistivity index in the ophthalmic artery and short posterior ciliary arteries) is also reported. The paper addresses etiological factors of RVOs and pathogenesis of macular edema, technical tools for vital assessment of the retina, and choroidal/retinal hemodynamics. This provides great opportunities for a complex in-depth study of the development and course of macular edema to identify potential predictors of its development and persistence. Keywords: retinal vein occlusions, macular edema, morphometry, chorioretinal hemodynamics. For citation: Fil' A.A., Sorokin E.L., Kolenko O.V. Macular edema after retinal vein occlusions. Macular morphometry and chorioretinal hemodynamics. Russian Journal of Clinical Ophthalmology. 2021;21(3):164–168 (in Russ.). DOI: 10.32364/2311-7729-2021-21-3- 164-168.

Arteritic bilateral anterior ischemic optical neuropathy: case report

Introduction: Arteritic anterior ischemic optic neuropathy (AAION) is infarction in anterior segment of optic nerve in which there is thrombotic occlusion of short posterior ciliary arteries due to granulomatous inflammation of giant cell arteritis (ACG). Case report: Male patient, 66 years old, complaining of loss of vision in left eye (LE) for 28 days, and in right eye (RE) for 8 days, accompanied by left hemicranial headache, pulsatile, irradiation from frontal to cervical region, of strong intensity, prevalent at night. Report of pain on chewing, chills, night sweats, neck pain and headache for 2 months. On examination, there was no light perception and bilateral non-reactive pupils. At simple retinography, LE with pale optical disc (OD), attenuation of retinal vascularization, atrophic and whitish areas; RE with OD with undefined borders, peripapillary hemorrhages and areas of retinal pallor. At fluorescent retinography; LE without arterial filling; CBC, discrete anisocytosis, thrombocytosis and microcytosis; ESR, 71mm/h in first hour; CRP, 113.6 mg/L. At, doppler USG of temporal arteries, significant increase in thickness of the myointimal layer, causing hemodynamic repercussions, with monophasic flow. Conclusion: Meeting 4 of 5 criteria of American College of Rheumatology, diagnosis of AAION was made. The condition was already irreversible at the time of examination.

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

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.

The dynamics of chorioretinal hemodynamics after courses of preventive care in women at risk for the formation of vascular retinal pathology

Objective: Clinical assessment of chorioretinal hemodynamics in women at risk for vascular retinal pathology before and after long-term courses of preventive care.Methods: 60 women having undergone preeclampsia during pregnancy were exam‑ ined. The 1st group of patients (30 people) got courses of medicamentous correction of endothelial dysfunction: sulodexide, ginkgo biloba (Tanakan), ascorbic acid. The 2nd group (30 women) did not get preventive care. The control group included 30 women having undergone physiological pregnancy (vaginal delivery, without complications). Parameters of chorioretinal hemodynamics were determined 6–8 months later and 3–4.5 years later after delivery.Results: By the end of the follow-up, in the 1st group, the blood flow velocity in the posterior short ciliary arteries statistically significantly increased; the density of the retinal vessels and subfoveolar thickness of the choroid and the area of the avascular zone of the retina decreased.Conclusions: The long-term medicamentous correction of endothelial dysfunction reduces the risk of vascular pathology development in women having undergone preeclampsia during the pregnancy.