Author Response: Morphometric Characteristics of Central Retinal Artery and Vein in the Optic Nerve Head of Patients with Diabetes

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.

Download Full-text

Sonographic assessment of the optic nerve and the central retinal artery in idiopathic intracranial hypertension

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2019.09.003 ◽

2020 ◽

Vol 72 ◽

pp. 292-297 ◽

Cited By ~ 1

Author(s):

Monika Jeub ◽

Elena Schlapakow ◽

Martina Ratz ◽

Christine Kindler ◽

Arndt-Hendrik Schievelkamp ◽

...

Keyword(s):

Optic Nerve ◽

Intracranial Hypertension ◽

Idiopathic Intracranial Hypertension ◽

Central Retinal Artery ◽

Sonographic Assessment ◽

Retinal Artery

Download Full-text

OCT based interpretation of the optic nerve head anatomy in young adults with retinal vascular occlusions and ischemic optic neuropathy

European Journal of Ophthalmology ◽

10.1177/1120672120957591 ◽

2020 ◽

pp. 112067212095759

Author(s):

Amy Dai ◽

Lasse Malmqvist ◽

Simon P Rothenbuehler ◽

Steffen Hamann

Keyword(s):

Young Adults ◽

Optic Nerve ◽

Optic Nerve Head ◽

Vascular Occlusion ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Ischemic Optic Neuropathy ◽

Vein Occlusion ◽

Retinal Vascular Occlusion ◽

Retinal Artery

Purpose: To examine optic nerve head (ONH) anatomy in young adults with central retinal vein occlusion (CRVO), branch retinal vein occlusion (BRVO), central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO) or nonarteritic anterior ischemic optic neuropathy (NA-AION) in order to look for associated, potentially predisposing anomalies. Methods: Cross-sectional study including 54 patients (ages 16–50 years) diagnosed from 2009 to 2018 with CRVO, BRVO, CRAO, BRAO, or NA-AION. Using Optical Coherence Tomography the presence of optic disc drusen (ODD), prelaminar hyperreflective lines and peripapillary hyperreflective ovoid mass-like structures (PHOMS), and determination of scleral canal size, retinal nerve fiber layer thickness (RNFLT) and macular ganglion cell layer thickness (GCLT) was obtained. Data for retinal vascular occlusion patients were grouped and analyzed together. Results: ODD were found in 13% of all patients, 2% of retinal vascular occlusion patients and 67% of NA-AION patients ( p < 0.0001). Prelaminar hyperreflective lines were found in 35% of all patients, 24% of retinal vascular occlusion patients and 89% of NA-AION patients ( p = 0.0005). PHOMS were found in 20% of all patients, 13% of retinal vascular occlusion patients and 56% of NA-AION patients ( p = 0.012). RNFLT was decreased in ODD patients compared to patients without ODD ( p = 0.01). Scleral canal diameter and GCLT was not correlated with ODD, prelaminar hyperreflective lines or PHOMS. Conclusion: ODD, prelaminar hyperreflective lines and PHOMS were more frequent in NA-AION patients compared to retinal vascular occlusion patients. The prevalence of ODD in retinal vascular occlusion patients was similar to the reported prevalence in the general population.

Download Full-text

Optic nerve head retinal artery macroaneurysm: Report of a case

SAGE Open Medical Case Reports ◽

10.1177/2050313x19869470 ◽

2019 ◽

Vol 7 ◽

pp. 2050313X1986947

Author(s):

Ramesh Venkatesh ◽

Prachi Gurav

Keyword(s):

Optic Nerve ◽

Fluorescein Angiography ◽

Optic Disc ◽

Optic Nerve Head ◽

Hypertensive Retinopathy ◽

Fundus Examination ◽

Elderly Male ◽

Spontaneous Involution ◽

Retinal Artery ◽

Retinal Artery Macroaneurysm

A 61-year-old elderly male, hypertensive patient presented to the retina clinic with sudden drop in vision in the left eye for 6 days. His best-corrected visual acuity at presentation was counting fingers close to face. Fundus examination of the left eye revealed the presence of subretinal and preretinal haemorrhage at the macula along with hypertensive retinopathy changes in both eyes. Fluorescein angiography was done, which showed a retinal artery macroaneurysm at the optic nerve head. Optical coherence tomogram through the optic nerve head also confirmed the presence of retinal artery macroaneurysm. The patient was treated with injection of 0.4 cc of 100% C3F8 to displace the blood off the macula. At final follow-up visit at 2 months post treatment, his vision improved to 6/12, N8. Fundus examination showed a small residual altered blood nasal to the fovea. No treatment was however done to the retinal artery macroaneurysm due to its atypical location and chance of spontaneous involution. In conclusion, retinal artery macroaneurysm at the optic disc is extremely uncommon. Identification of the retinal artery macroaneurysm lesion is more difficult in glaucoma patients due to the large and deep optic cup. Fluorescein angiography remains the main investigative modality to confirm the diagnosis. Spontaneous involution still remains the mainstay of treatment in optic disc retinal artery macroaneurysm.

Download Full-text

Author Response: Estimation of Hemoglobin Levels in the Optic Nerve Head for Glaucoma Management

Investigative Opthalmology & Visual Science ◽

10.1167/iovs.13-11885 ◽

2013 ◽

Vol 54 (3) ◽

pp. 2011 ◽

Cited By ~ 3

Author(s):

Manuel Gonzalez de la Rosa ◽

Marta Gonzalez-Hernandez ◽

Jose Sigut ◽

Silvia Alayon ◽

Nathan Radcliffe ◽

...

Keyword(s):

Optic Nerve ◽

Optic Nerve Head ◽

Author Response

Download Full-text

Standard Diffusion-weighted MRI for the Diagnosis of Central Retinal Artery Occlusion

Clinical Neuroradiology ◽

10.1007/s00062-020-00955-6 ◽

2020 ◽

Author(s):

L. A. Danyel ◽

G. Bohner ◽

F. Connolly ◽

E. Siebert

Keyword(s):

Optic Nerve ◽

Central Retinal Artery Occlusion ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Central Retinal Artery ◽

Rater Reliability ◽

Predictive Values ◽

Diffusion Weighted ◽

Retinal Artery ◽

Sensitivity Specificity

Abstract Purpose To evaluate diffusion abnormalities of the retina and optic nerve in patients with central retinal artery occlusion (CRAO) using standard stroke diffusion-weighted magnetic resonance imaging (DWI). Methods In this case-control study, DWI scans of patients with nonarteritic CRAO were retrospectively assessed for acute ischemia of the retina and optic nerve. Two neuroradiologists, blinded for patient diagnosis, randomly evaluated DWI of CRAO patients and controls (a collective of stroke and transient ischemic attack [TIA] patients) for restrictions of the retina and optic nerve. We calculated statistical quality criteria and analyzed inter-rater reliability using unweighted Kappa statistics. Results 20 CRAO patients (60,6 ± 17 years) and 20 controls (60,7 ± 17 years) were included in the study. Sensitivity, specificity, positive and negative predictive values for retinal DWI restrictions were 75%/80%/79%/76% (reader 1) and 75%/100%/100%/80% (reader 2), respectively. Unweighted Kappa was κ = 0,70 (95% CI 0,48‑0,92), indicating “substantial” interrater reliability. In comparison, sensitivity, specificity, PPV and NPV (positive and negative predictive values) for restrictions of the optic nerve in CRAO were 55%/70%/65%/61% (reader 1) and 25%/100%/100%/57% (reader 2). Inter-rater reliability was “fair” with unweighted Kappa κ = 0,32 (95% CI 0,09‑0,56). Conclusions Retinal diffusion restrictions were present in a majority of CRAO patients and detectable with reasonable sensitivity, high specificity and substantial inter-rater reliability. Further studies are necessary to study time dependency of retinal diffusion restrictions, improve image quality and investigate the reliability of retinal DWI to discern CRAO from other causes of acute loss of vision.

Download Full-text