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Objective: The objective of this study was to assess the Doppler parameters, associated within the central retinal artery (CRA), based on a cohort of Nigerian participants. Materials and Methods: A total of 66 participants were recruited and consented at a medical clinic in Calabar, Nigeria, and presented from August 2019 to December 2023. The diagnostic data points recorded on this cohort were their fasting blood glucose (FBG) (mmol/L), CRA peak systolic velocity (PSV), CRA end-diastolic velocity (EDV), the resistive index (RI), and pulsatility index (PI). The data analysis was completed to provide descriptive information, as well as correlations. The statistical significance was set at P <.05. Results: In this cohort, the women demonstrated a higher PSV and EDV, based on the vascular flow within the right CRA (Rt. PSV [20.8 ± 6.0 SD] and Rt. EDV [5.8 ±2.1 SD]), as well as the left CRA (Lt. PSV [20. 6 ± 4.4 SD] and Lt. EDV [6.2 ± 2.0 SD]). This was compared to the men's data taken on the vascular flow within the right CRA (Rt. PSV [19.6 ± 5.3 SD] and Rt. EDV [5.2 ± 1.8 SD]), as well as their left CRA (Lt. PSV [19.2± 4.7 SD] and Lt. EDV [5.3 ± 1.3 SD]). The participants' FBG levels did not correlate with their respective Doppler parameters. The Doppler parameters, based on the flow within the right CRA, showed moderate to weak positive correlations compared with the left CRA. The PSV recorded in the right CRA was varied across the specific participant age groups of 17 to 25 and 26 to 34 years. Conclusion: Potential sex and age-related variations in the Doppler velocities, recorded within the CRA, were specific to this cohort, and the sample size may have compromised the overall study's statistical power. A replication of this research is needed, and data from a larger cohort of participants are needed. [ABSTRACT FROM AUTHOR]

Clinical imaging provided by optical coherence tomography (OCT) and its variant, OCT-angiography (OCT-A), has revolutionised eyecare practice. The imaging techniques allow for the identification and quantification of ocular structures, supporting the diagnosis and prognosis of eye disease. In this review, an overview of the usefulness of OCT-A imaging in the diagnosis and management of a range of ocular conditions is provided when used in isolation or in combination with other imaging modalities and measures of visual function (visual field results). OCT-A imaging has the capacity to identify and quantify ocular vasculature non-invasively, thereby assisting the clinician in the diagnosis or to determine the efficacy of intervention in ocular conditions impacting retinal vasculature. Thus, additional clinically useful information can be obtained in eye diseases involving conditions such as those impacting retinal vessel occlusion, in diabetic retinopathy, inherited retinal dystrophy, age-related macular degeneration, choroidal neovascularisation and optic nerve disorders. Through a clinical case series, various ocular conditions are reviewed, and the impact of OCT-A imaging is discussed. Although OCT-A imaging has great promise and is already used in clinical management, there is a lack of set standards to characterise altered vascular features in disease and consequently for prognostication, primarily due to a lack of large-scale clinical trials and variability in OCT-A algorithms when generating quantitative parameters. [ABSTRACT FROM AUTHOR]

Rana, Vipin, Pradeep Kumar, Sandeepan Bandopadhyay, Vijay K. Sharma, Meenu Dangi, Dattakiran Joshi, Sanjay Kumar Mishra, Satyabrat Srikumar, and V.A. Arun. Central retinal artery occlusion in young adults at high altitude: thin air, high stakes. High Alt Med Biol. 00:000–000, 2024.—We present five cases of young security personnel who were posted at high altitude (HA) for a duration of at least 6 months and presented with a sudden decrease of vision in one eye. The diagnosis of central retinal artery occlusion (CRAO) was made in all patients. Fundus fluorescein angiography and optical coherence tomography of the macula supported the diagnosis. None of these cases had any preexisting comorbidities. Erythrocytosis was noticed in all patients, and two of them had hyperhomocysteinemia. Four out of five patients showed either middle cerebral artery or internal carotid artery (ICA) thrombosis on computed tomography angiography. The patients were managed by a team of ophthalmologist, hematologist, vascular surgeon, and neurologist. In cases of incomplete ICA occlusion, patients were managed surgically. However, in the case of complete ICA occlusion, management was conservative with antiplatelet drugs. This case series highlights HA-associated erythrocytosis and hyperhomocysteinemia as important risk factors for CRAO in young individuals stationed at HA. [ABSTRACT FROM AUTHOR]

PurposeTo report a rare case of a combined central retinal artery (CRA) and medial posterior ciliary artery (MPCA) occlusion due to an atherosclerotic lesion in the common trunk supplying both arteries.ObservationsA 75-year-old man presented with acute vision loss associated with elevated intraocular pressure in the right eye. Multi-modal imaging revealed a combined retinal and choroidal infarction in the distribution of the CRA and MPCA, localizing the lesion to the common trunk of the ophthalmic artery supplying both the CRA and MPCA. Neurovascular imaging provided supportive evidence for the diagnosis.Conclusions and importanceA simultaneous retinal and choroidal vascular occlusion is an uncommon presentation. Familiarity with the anatomy of the ophthalmic arteries and its branches facilitates localizing the lesion.

Aim: To compare the ocular blood flow in glaucomatous eyes and normal healthy eyes. This study compares open-angle glaucoma patients to healthy adults by measuring various parameters in the ophthalmic artery (OA), central retinal artery (CRA), and short posterior ciliary artery (SPCA). Materials and methods: A total of 50 glaucomatous eyes and 50 normal eyes were included in a prospective case-control study over 1 year. The color Doppler imaging (CDI) was conducted using a noninvasive linear multifrequency probe with a frequency range of 5-9 MHz. OA, CRA, and SPCA were measured for peak systolic velocity (PSV), end-diastolic volume (EDV), pulsatility index (PI), and resistivity index (RI). Results: When compared with controls, PSV was decreased in all three vessels, with the results being remarkable only in CRA. The EDV also showed a remarkable decrease in all three vessels. Additionally, all three vessels showed significant increases in PI and RI except OA, p-value < 0.05. Conclusion: Blood velocity is decreased, and resistive indices are increased in glaucomatous eyes compared with normal eyes. Variations in ocular blood flow could be a cause or consequence of glaucomatous optic neuropathy and are an important predictor of disease progression. [ABSTRACT FROM AUTHOR]

Purpose: The prospective study aimed to examine the central retinal artery (CRA) using computed tomography (CT). Materials and methods: Seventy adult outpatients comprising 32 men and 38 women, at a mean age of 60.6 ± 13.3 years, were enrolled in the study. The patients underwent contrast-enhanced CT. The scan timing was set to start 5.0 s after the circle of Willis began to be delineated. Results: The ophthalmic arteries (OphAs) were comfortably delineated in all. In 97% of the patients, the CRA was delineated from the original site on the OphA to a more distal segment coursing on the optic sheath. Unilateral and bilateral CRA delineations were observed in 44% and 53% of cases, respectively. The delineated CRAs demonstrated highly variable morphologies in terms of the course and length on the optic sheath. In addition, the distance between the original site of the CRA and the posterior limit of the bulb was measured. The mean distance was 18.6 ± 5.0 mm on the right and 17.8 ± 4.3 mm on the left, respectively. No significant right-to-left differences in the measurements (p > 0.05) were observed. Conclusions: If optimal scan timing is adopted, the CRA segments coursing on the optic sheath can be delineated using contrast-enhanced CT. CT may be a useful diagnostic modality for the CRAs and associated pathological conditions. [ABSTRACT FROM AUTHOR]

Purpose: To determine ocular blood flow parameters by Doppler ultrasound scanning in type 2 diabetic patients with different stages of diabetic retinopathy. Material and Methods: In this prospective study, forty-five patients (90 eyes) with type 2 diabetes mellitus were divided into three groups of 15 patients each: no diabetic retinopathy group (DR0), non-proliferative retinopathy (NPDR), and proliferative retinopathy (PDR) groups. Doppler indices such as systolic blood flow velocity (Vs), diastolic blood flow velocity (Vd), time-averaged maximum velocity (TAMXV), pulsatility index (PI) and resistivity index (RI) in the ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary arteries (SPCA) were determined. ANOVA was used for quantitative comparisons between the three groups. Results: There was a significant (р < 0.05) decrease in (a) the Vs from 71.1 ± 20.6 cm/s in the DR0 group to 59.9 ± 16.7 cm/s in the NPDR group and 47.4 ± 16.4 cm/s in the PDR group, (b) Vd from 22.1 ± 6.9 cm/s to 17.0 ± 6.6 cm/s and 12.3 ± 5.9 cm/s, respectively; and (c) TAMXV from 37.2 ± 11.3 cm/s to 31.9 ± 9.1 cm/s and 25.3 ± 9.7 cm/s, respectively, and an increase in the RI from 0.69 ± 0.06 cm/s to 0.71 ± 0.09 cm/s and 0.75 ± 0.08 cm/s, respectively, in the OA. In addition, there was a significant decrease in the Vd from 9.9 ± 5.4 cm/s in the DR0 group to 8.1 ± 3.8 cm/s in the NPDR group and 5.5 ± 3.1 cm/s in the PDR group, and an increase in the PI from 1.34 ± 0.16 cm/s to 1.46 ± 0.28 cm/s and 1.54 ± 0.24 cm/s, respectively, and in the RI from 0.71 ± 0.06 cm/s to 0.75 ± 0.07 cm/s and 0.80 ± 0.05 cm/s, respectively, in the CRA. Moreover, there was a significant decrease in the Vd from 4.3 ± 1.6 cm/s in the DR0 group to 3.2 ± 2.0 cm/s in the NPDR group and 3.1 ± 2.2 cm/s in the PDR group, and an increase in the PI from 1.32 ± 0.21 cm/s to 1.37 ± 0.24 cm/s and 1.54 ± 0.26 cm/s, respectively, and in the RI from 0.76 ± 0.04 cm/s to 0.82 ± 0.06 cm/s and 0.82 ± 0.06 cm/s, respectively, in the SPCA. Conclusion: We found that the arteries examined in patients with diabetic retinopathy tended to have decreased blood flow velocities and increased resistivity and pulsatility indices, with the greatest changes observed in patients with PDR. In addition, the difference in mean values of most Doppler indices between the PDR and NPDR groups was larger than that between the NPDR and DR0 groups.

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The endoscopic endonasal approach (EEA) offers a minimally invasive route to treat medial intraconal space (MIS) lesions. Understanding the configuration of the ophthalmic artery (OphA) and the central retinal artery (CRA) is crucial. An EEA to the MIS was performed on 30 orbits. The description of the intraorbital part of the OphA was divided into 3 segments and classified as type 1 and type 2 and the MIS was divided into three surgical zones (A, B, C). The CRA's origin, course, and point of penetration (PP) were analyzed. The relationship between the position of the CRA in the MIS and the OphA type was analyzed. The OphA type 2 was present in 20% of specimens. The site of origin of the CRA from the OphA was found on the medial surface in type 1 and on the lateral surface of type 2. The point of penetrationof the central retinal arterywas found in 87% of the specimens on the inferomedial surface, just anterior to the inferior muscular trunk, at an average distance of 9.5 mm ± 1 from the globe and 17 mm ± 1.5 from the AZ. The presence of the CRA in Zone C was associated only with OphA type 1. OphA type 2 is a common finding and can compromise the feasibility of an EEA to the MIS. A detailed preoperative analysis of the OphA and CRA should be conducted prior to approaching the MIS due to the implications of the anatomical variations that can compromise safe intraconal maneuverability during an EEA. [ABSTRACT FROM AUTHOR]

Purpose: to study the state of blood flow in the ocular arteries of patients with various forms, stages and course types of active retinopathy of prematurity (ROP). Material and methods. Colour duplex scanning was performed by colour Doppler mapping and pulsed Doppler sonography for 55 premature babies (55 eyes) with active ROP and 8 premature babies (8 eyes) without ROP signs. The children’s gestation age was 25 to 32 weeks, and the body weight at birth was 680 to1760 g. Blood flow was examined in the ophthalmic artery (OA), the central retinal artery (CRA) and the medial and lateral posterior short ciliary arteries (PSCA). Results. The ophthalmic artery revealed no significant differences between the children with ROP and without ROP, except for a significant increase in the peak systolic velocity (Vsyst) in an unfavorable course of stage III of ROP. The development of aggressive posterior ROP is accompanied by a statistically insignificant decrease in blood flow velocity of OA. Hemodynamic parameters of CRA indicate an increase in peripheral vascular resistance in children with an unfavorable course of ROP. A significant increase of Vsyst in the posterior short ciliary arteries was revealed in children with an unfavorable course of stages I–III of ROP and Vsyst, and Vdiast (diastolic blood flow velocity) in children with aggressive posterior ROP as compared with children without ROP. A pronounced impact of the ROP course (favorable or unfavorable) on the Vsyst, Vdiast, and PI indicators in the posterior short ciliary arteries was revealed. The most informative hemodynamic parameters in predicting the course of active ROP are Vsyst and Vdiast values in the ophthalmic artery and Vsyst in the posterior short ciliary arteries. The least informative were the hemodynamic parameters of the central retinal artery. Conclusion. The assessment of hemodynamic changes in eye arteries may be used as an additional diagnostic criterion in the early diagnosis of ROP.

Purpose: To determine ocular blood flow parameters by Doppler ultrasound scanning in type 2 diabetic patients with different stages of diabetic retinopathy. Material and Methods: In this prospective study, forty-five patients (90 eyes) with type 2 diabetes mellitus were divided into three groups of 15 patients each: no diabetic retinopathy group (DR0), non-proliferative retinopathy (NPDR), and proliferative retinopathy (PDR) groups. Doppler indices such as systolic blood flow velocity (Vs), diastolic blood flow velocity (Vd), time-averaged maximum velocity (TAMXV), pulsatility index (PI) and resistivity index (RI) in the ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary arteries (SPCA) were determined. ANOVA was used for quantitative comparisons between the three groups. Results: There was a significant (р < 0.05) decrease in (a) the Vs from 71.1 ± 20.6 cm/s in the DR0 group to 59.9 ± 16.7 cm/s in the NPDR group and 47.4 ± 16.4 cm/s in the PDR group, (b) Vd from 22.1 ± 6.9 cm/s to 17.0 ± 6.6 cm/s and 12.3 ± 5.9 cm/s, respectively; and (c) TAMXV from 37.2 ± 11.3 cm/s to 31.9 ± 9.1 cm/s and 25.3 ± 9.7 cm/s, respectively, and an increase in the RI from 0.69 ± 0.06 cm/s to 0.71 ± 0.09 cm/s and 0.75 ± 0.08 cm/s, respectively, in the OA. In addition, there was a significant decrease in the Vd from 9.9 ± 5.4 cm/s in the DR0 group to 8.1 ± 3.8 cm/s in the NPDR group and 5.5 ± 3.1 cm/s in the PDR group, and an increase in the PI from 1.34 ± 0.16 cm/s to 1.46 ± 0.28 cm/s and 1.54 ± 0.24 cm/s, respectively, and in the RI from 0.71 ± 0.06 cm/s to 0.75 ± 0.07 cm/s and 0.80 ± 0.05 cm/s, respectively, in the CRA. Moreover, there was a significant decrease in the Vd from 4.3 ± 1.6 cm/s in the DR0 group to 3.2 ± 2.0 cm/s in the NPDR group and 3.1 ± 2.2 cm/s in the PDR group, and an increase in the PI from 1.32 ± 0.21 cm/s to 1.37 ± 0.24 cm/s and 1.54 ± 0.26 cm/s, respectively, and in the RI from 0.76 ± 0.04 cm/s to 0.82 ± 0.06 cm/s and 0.82 ± 0.06 cm/s, respectively, in the SPCA. Conclusion: We found that the arteries examined in patients with diabetic retinopathy tended to have decreased blood flow velocities and increased resistivity and pulsatility indices, with the greatest changes observed in patients with PDR. In addition, the difference in mean values of most Doppler indices between the PDR and NPDR groups was larger than that between the NPDR and DR0 groups. [ABSTRACT FROM AUTHOR]

Introduction: Diabetic retinopathy is a vascular disorder affecting the microvasculature of retina. It is caused by changes in the blood vessels of retina. If untreated, it may lead to blindness which is usually preventable if retinopathy is diagnosed early and treated promptly. As the prevalence of diabetes is rising, the systemic complications that include retinopathy, nephropathy, neuropathy and involvement of cardiovascular system are also increasing. Diabetic retinopathy is the leading cause of blindness in the world. Prevention of retinopathy needs early diagnosis. (1) In ophthalmology, Color Doppler imaging is a new method that enables us to assess the orbital vasculature. It allows for simultaneous two dimensional anatomical and Doppler evaluations of retinal artery. Objective and Aim: Aim of the study is to evaluate the ocular blood flow in patients with diabetes mellitus with no ocular symptoms. Materials and Methods: Color Doppler evaluation of 50 diabetic patients (100 eyes) was done with SIEMENS SONOLINE G- 50 machine with High frequency probe (5-7.5 Mega Hertz). Doppler spectral analysis of ophthalmic arteries (OA) and central retinal arteries (CRA) were done. The peak systolic velocity (PSV), end diastolic velocity (EDV), resistive index (RI) and S/D ratio were calculated. PSV, EDV, RI were measured in all patients in both the eyes. Results: The PSV of CRA in diabetics was significantly reduced (p=<0.05). The EDV of CRA in diabetics was also significantly reduced (p=<0.05). The RI of CRA is significantly increased (p=<0.05) in diabetics. The 95% confidence interval is observed in PSV, EDV, RI of CRA in diabetics. Conclusion: There was statistical significant difference between the PSV, EDV and RI of CRA in diabetics. This significant difference could be due to the circulatory changes in blood vessels in diabetics. No significant difference was made in OA in diabetics. This study concludes that retinal hemodynamic changes were present even before the clinical manifestations of retinopathy in diabetics. [ABSTRACT FROM AUTHOR]

Purpose: To report a rare case of a combined central retinal artery (CRA) and medial posterior ciliary artery (MPCA) occlusion due to an atherosclerotic lesion in the common trunk supplying both arteries. Observations: A 75-year-old man presented with acute vision loss associated with elevated intraocular pressure in the right eye. Multi-modal imaging revealed a combined retinal and choroidal infarction in the distribution of the CRA and MPCA, localizing the lesion to the common trunk of the ophthalmic artery supplying both the CRA and MPCA. Neurovascular imaging provided supportive evidence for the diagnosis. Conclusions and importance: A simultaneous retinal and choroidal vascular occlusion is an uncommon presentation. Familiarity with the anatomy of the ophthalmic arteries and its branches facilitates localizing the lesion.

Abstract Background Severe intraocular hemorrhage is a rare complication of cataract surgery due to the recent generalization of minimal-incision cataract surgery. We report a case of a massive intraocular hemorrhage that probably originated from the central retinal artery after cataract surgery, in which hemostasis was difficult to achieve during vitrectomy. Case presentation An 86-year-old woman was referred to our department for intraocular lens (IOL) dislocation after undergoing cataract surgery. Massive intraocular hemorrhage was observed during the initial visit to our department. She underwent pars plana vitrectomy (PPV) and IOL repositioning under local anesthesia. However, the hemorrhage could not be removed completely because of continued massive intraoperative bleeding from the posterior fundus, and it was extremely difficult to achieve hemostasis during the initial surgery. At 7 days after the initial surgery, PPVs were performed under general anesthesia. Bleeding significantly decreased in the second surgery compared to the first. The bleeding probably originated from the central retinal artery on the optic disc; hemostasis was obtained by coagulation of the bleeding site with intraocular diathermy. After the second surgery, there was no exacerbation of bleeding and the patient’s condition was stable. However, the patient’s visual acuity showed no light perception after the second surgery. Conclusions Massive intraocular hemorrhage may occur from the central retinal artery after undergoing cataract surgery. In such cases, surgery with general anesthesia with a lower maintained blood pressure (instead of surgery under local anesthesia) should be recommended, considering the possibility of difficult hemostasis in the event of bleeding from the retinal artery.

目的 探讨超选动脉内溶栓（intra-arterial thrombolysis，IAT）治疗急性视网膜中央动脉闭塞（central retinal artery occlusion，CRAO）的疗效。 方法 回顾性纳入首都医科大学附属北京同仁医院神经外科2019年4月-2020年5月连续收治的CRAO且经超选IAT治疗的患者，记录患者的临床特点。治疗后1周进行最佳矫正视力（best-corrected visual acuity，BCVA）检查，判断视觉改善情况。根据术后视觉有无改善分为视觉改善组和视觉未改善组，比较2组的人口学信息、临床特点及病变侧颈动脉狭窄情况。根据IAT术前或术中DSA影像判断病变侧颈动脉狭窄情况，采用华法林-阿司匹林治疗症状性颅内动脉疾病（warfarin and aspirin for symptomatic intracranial disease，WASID）研究标准计算颈动脉狭窄程度，将患者分为颈动脉狭窄/闭塞（颈动脉狭窄≥50%）组和无狭窄（颈动脉狭窄

To analyze the main hemodynamic parameters in the central retinal artery, as well as their relationship with hemodynamic indicators in the central retinal vein, depending on the stage and type of active included in the study were distributed according to the stages and type of disease course. All children were at the same gestational age at the time of examination – 37–38 weeks of postmenstrual age or at 6–11 weeks of life. For all these children were performed color duplex scanning of the vessels of the eye and orbit in the modes of color Doppler mapping and pulsed Doppler. Results. The study of the hemodynamic features of the central retinal artery in premature infants with active ROP showed that the progression of the disease was accompanied by a significant increase in blood flow velocity (Vsyst and Vdiast) with each subsequent stage of ROP. A higher index of peripheral vascular resistance is recorded in comparison with the non-progressive favorable type for children with an unfavorable course of the disease.The analysis of the ratio of the maximum blood flow velocities in the central retinal artery and central retinal vein made it possible to determine in which of the vessels the hemodynamic changes are most pronounced, depending on the stage and form of active ROP. Conclusion. Thus, there are statistically significant changes in such large vessels of the retinal bed as the central retinal artery and central retinal vein during active ROP. Color duplex scanning, having a significant diagnostic potential in assessing hemodynamic parameters, made it possible to obtain reliable information about the linear blood flow velocity and the state of peripheral resistance in the central retinal artery and their relationship with the central retinal vein. This information opens up prospects for improving the accuracy of predicting the nature of the course of the disease, especially in the early stages.

Background: Severe intraocular hemorrhage is a rare complication of cataract surgery due to the recent generalization of minimal-incision cataract surgery. We report a case of a massive intraocular hemorrhage that probably originated from the central retinal artery after cataract surgery, in which hemostasis was difficult to achieve during vitrectomy. Case presentation: An 86-year-old woman was referred to our department for intraocular lens (IOL) dislocation after undergoing cataract surgery. Massive intraocular hemorrhage was observed during the initial visit to our department. She underwent pars plana vitrectomy (PPV) and IOL repositioning under local anesthesia. However, the hemorrhage could not be removed completely because of continued massive intraoperative bleeding from the posterior fundus, and it was extremely difficult to achieve hemostasis during the initial surgery. At 7 days after the initial surgery, PPVs were performed under general anesthesia. Bleeding significantly decreased in the second surgery compared to the first. The bleeding probably originated from the central retinal artery on the optic disc; hemostasis was obtained by coagulation of the bleeding site with intraocular diathermy. After the second surgery, there was no exacerbation of bleeding and the patient's condition was stable. However, the patient's visual acuity showed no light perception after the second surgery. Conclusions: Massive intraocular hemorrhage may occur from the central retinal artery after undergoing cataract surgery. In such cases, surgery with general anesthesia with a lower maintained blood pressure (instead of surgery under local anesthesia) should be recommended, considering the possibility of difficult hemostasis in the event of bleeding from the retinal artery. [ABSTRACT FROM AUTHOR]

Background: Haemodynamic alterations of the retrobulbar circulation are sequelae of untreated, longstanding hypertension. Early evaluation of the retrobulbar blood flow is very crucial to prevent irreversible ocular complications. The objective of this study was to evaluate the differences in central retinal artery (CRA) and ophthalmic artery (OA) haemodynamics in adult hypertensive and non-hypertensive subjects. Methodology: This prospective, comparative cross-sectional study was conducted among 63 hypertensives and 75 normotensive controls. Using Doppler ultrasonography, the CRA and OA Doppler velocimetry parameters among cases and controls were evaluated and analysed. Results: The CRA Peak Systolic Velocity (PSV) and End-diastolic velocity (EDV) was 7.54 ± 2.60cm/s and 2.99 ± 1.15cm/s (p<0.001) in hypertensives but 10.8 ± 2.51cm/s and 4.50 ± 1.25cm/s) p<0.001 in controls. The systolic/diastolic ratio (S/D) in cases was 2.64 ± 0.75 and 2.44 ± 0.38 p=0.045 in controls. The CRA's Pulsatility Index (PI) between cases and controls was not statistically significant, p =0.082. Furthermore, the CRA's PSV, PI, Resistivity index (RI) and S/D, were higher among subjects with stage 1 compared to stage 2 hypertension (p=0.004; p=0.027; p<0.001 and p=0.001 respectively). The OA mean EDV in hypertensives was 4.57 ± 1.97 and in controls= 5.31 ± 1.79 (p=0.022), while the OA mean RI and Peak Ratio, p=0.009 and 0.003, respectively, were higher in stage 1 hypertension. Conclusion: The Central retinal and ophthalmic artery blood flow parameters were significantly lower among hypertensive cases. Also, hypertensive stage 2 cases had significantly lower blood flow and vascular impedance parameters in the CRA and both Central retinal and ophthalmic artery, respectively. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the relationship between the mammography-detected breast arterial calcification (BAC) and orbital color Doppler ultrasonography (CDUS) results., Methods: Our single-center study, included female patients who applied to our hospital between January and May 2022 and underwent mammography and orbital CDUS examinations. Two radiologists evaluated the mammograms, grouped the patients as BAC (+) and BAC (-), and performed orbital CDUS. Continuous variables obtained from CDUS were compared according to the presence of BAC. Also, receiver operating characteristics (ROC) analysis was used to determine the orbital CDUS threshold values for the presence of BAC., Results: A total of 119 women were included with a median age of 62 years, 57 (47.90%) had BAC. Orbital CDUS examination was performed on both eyes of 119 patients (238 eyes in total). Peak systolic velocity (PSV) and end-diastolic velocity (EDV) values of the ophthalmic artery (OA) (P < .001) and EDV of the central retinal artery (CRA) (P < .001) were significantly lower in patients with BAC. Pulsatile index (PI) and resistive index (RI) values of OA (P < .001) and CRA (P < .001) were higher in patients with BAC. In ROC analysis, the cut-off values for the presence of BAC were calculated as OA PI ≥1.415 and OA RI ≥0.755 (P < .001); CRA PI ≥1.135 and CRA RI ≥0.655 (P < .001)., Conclusions: Orbital perfusion disorders may be observed in patients with vascular calcification detected on routine mammography. Therefore, a more detailed evaluation of patients with BAC detected on mammography with orbital CDUS may enable early detection and treatment of ocular vascular problems., (© 2024 American Institute of Ultrasound in Medicine.)

Aim and objectives: There has been a growth of more than 300% between 2000 and 2017 in aesthetic procedures with fillers, with an incidence of ocular complications in more than 130%, causing devastating outcomes for the patient. The use of Hyaluronidase, indications and limitations of this drug is evolving. This article will provide a guideline management of peripheral vascular occlusion based on 8215 patients and 6 peripheral vascular occlusions, following strict guidelines based on current evidence. Materials and methods: A search were made based on Beast Bet Methodology selecting the relevant articles according to the keywords. Conclusion: To date there is no guidance in the literature for the use, dosage, limitations and effect of hyaluronidase. More studies in humans are required to evaluate the real action of hyaluronidase against vascular occlusion due to filler.

Central retinal artery occlusion (CRAO), the ocular analog of a cerebral stroke, is an ophthalmic emergency. The visual prognosis for overall spontaneous visual recovery in CRAO is low. Furthermore, the risk of future ischemic heart disease and cerebral stroke is increased due to the underlying atherosclerotic risk factors. There is currently no guideline-endorsed treatment for CRAO. This review will describe the anatomy, pathophysiology, epidemiology, and clinical features of CRAO, and investigate the current and future management strategies. [ABSTRACT FROM AUTHOR]

Objectives: To relate the changes in ocular structure and hemodynamic response in primary open‐angle glaucoma (POAG). Methods: Patients with POAG (n = 46) and control subjects (n = 53) were recruited. Retinal nerve fiber layer and ganglion cell complex were evaluated using optical coherence tomography (OCT). Blood flow was characterized in ophthalmic artery (OA) and central retinal artery (CRA) using color Doppler ultrasonography (CDU), and resistivity index (RI) was calculated. Measurements from CDU and OCT were statistically correlated and the degree of the association was examined. Receiver operating characteristics was produced based on RI and optimal threshold was determined. Results: In POAG patients, OCT revealed neuronal damage and CDU indicated increased resistance to arterial flow. Flow dynamics correlated negatively with the ocular tissue dimensions, sufficiently establishing an association between the ocular structure and its hemodynamic response. Based on the possibility of indirect POAG diagnosis with CDU, threshold 0.7 for RI of OA yielded 73.9% sensitivity and 77.4% specificity in distinguishing the cases of POAG from the controls. Threshold of 0.66 for RI of CRA, had higher specificity of 83%, but lower sensitivity of 52.1%. Conclusions: Ocular flow exhibits different characteristics in individuals with POAG than normal. The changes associated with the underlying neuronal structure, suggesting the possibility of a potential new diagnostic biomarker for POAG. This justifies further studies with a larger cohort, examining the ocular flow with CDU in POAG and comparing it against OCT findings for establishing the power of CDU in differential diagnosis or glaucoma progression. [ABSTRACT FROM AUTHOR]

Purpose: Few studies have explored the central retinal artery (CRA) using neuroimaging. Our study aimed to explore this using magnetic resonance imaging (MRI). Methods: A total of 81 patients with intact orbital structures and visual function underwent thin-slice contrast MRI. Results: The identified CRAs showed highly variable morphologies on both axial and sagittal images. On the axial images, the CRAs were detected in the right orbit in 11.1% and in the left orbit in 19.8%. The distance between the site of CRA branching from the ophthalmic artery to the posterior limit of the bulb was 18.8 ± 3.9 mm (12.8–24.6 mm) on the right and 18.9 ± 3.3 mm (14.6–26.7 mm) on the left. On the sagittal images, CRAs were detected on the right in 76.5% and on the left in 85.2%. The distance between the CRA branching site and the posterior limit of the bulb was 20.4 ± 3.8 mm (14.2–28.2 mm) on the right and 19.2 ± 3.7 mm (11.3–27.1 mm) on the left. Conclusions: Thin-sliced, contrast sagittal MRI can be used to explore the proximal part of the CRA. In particular, serial sagittal imaging may be useful for detecting the CRAs and their relationship with relevant structures. [ABSTRACT FROM AUTHOR]

With the increase of cosmetic injectable hyaluronic acid (HA), there have been more cases with serious complications, including skin necrosis, blindness, and cerebral embolism. Patients who have recovered from HA filler-induced total vision loss are extremely rare. We report a case of a 27-year-old female who developed severe ocular pain on the right side and total vision loss following a 1.0 ml HA filler injection in the nasal dorsum. She arrived at our hospital 4 hours later. Her visual acuity was no light perception (NLP), and she exhibited eyelid ptosis, ophthalmoplegia, and frontal and nasal ecchymosis. She was promptly treated with subcutaneous and retrobulbar hyaluronidase injections, as well as intra-arterial 1500 IU hyaluronidase injections into the right ophthalmic artery with DSA assistance. Her vision improved from NLP to counting fingers at 1.0 meters. Unfortunately, 13 hours later, she felt an intense headache, and her vision again decreased to NLP. We immediately performed an injection of 1500 IU hyaluronidase combined with 8 mg alteplase for intra-arterial thrombolysis (IAT) into the right ophthalmic artery. Her vision improved immediately afterward. After 3 months, her visual acuity had significantly recovered from NLP (admission vision status) to 20/50 (Snellen chart with glasses). Similarly, skin, conjunctival, eye movement, and ptosis symptoms completely recovered. This case demonstrates that reversal of complete blindness due to embolism of the ophthalmic and central retinal arteries could be accomplished through multidisciplinary therapies, especially IAT using fibrinolytic agents combined with hyaluronidase followed by an anticoagulant regimen. Level of evidence VThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Giant cell arteritis (GCA) is the most important medical emergency in ophthalmology, because its most dreaded complication is visual loss, which is preventable if these patients are diagnosed early and treated immediately and aggressively. This is a brief review of GCA, its ophthalmic manifestations, and how to diagnose and manage them.

The purpose of this study is to describe a surgical technique and report the functional outcome of treating nonarteritic central retinal artery occlusion (CRAO) in 2 eyes of two consecutive male patients. Two males (A) and (B) presented 6 days and few hours, respectively, after symptom onset with the clinical features typical of CRAO, including sudden severe deterioration of vision to counting fingers and a cherry-red spot in the left and right fovea, respectively. While A had been on recent treatment for hypertension and hyperlipidemia, B had no significant medical history. Both patients underwent surgery, A, 9 days, and B,

BACKGROUND: Diabetes mellitus (DM) and hypertension (HT) have been the two major medical and public health issues for over 40 years worldwide. Colour doppler imaging (CDI) is widely used to evaluate ocular circulation. It is non-invasive, safe, and useful tool, most commonly used to investigate circulatory parameters in retrobulbar blood vessels. The aim was to study ocular blood flow (OBF) velocity in the ophthalmic artery (OA), central retinal artery (CRA) and central retinal vein (CRV) in patients with DM and HT by CDI. MATERIALS AND METHODS: A cross-sectional observational study was done for 6 months (June 2021-November 2021) on 40 patients of age 40 years and above with DM and/or HT of a minimum 6 months duration. Retrobulbar circulation was assessed in all subjects bilaterally. Subjects were further divided into groups with or without retinopathy. RESULTS: Of the total number of 40 participants, 26 (65%) were male, and 14 (35%) were female. 16 (40%) participants were diabetics, 8 (20%) were hypertensive, and 16 (40%) had both DM and HT. 57.5% were diagnosed with retinopathy changes. The mean values of the pulsatile index (PI) were: 1.23 in patients with DM, 1.30 in patients with HTN, and 1.33 in patients with DM and HTN. CONCLUSION: Our study showed reduced blood flow velocity and increased resistivity index (RI) in patients with DM and/or HT. Significant changes were noted in retrobulbar blood flow in patients with retinopathy. These results can potentially provide prognostic values in times to come regarding altered OBF even before retinopathy develops. [ABSTRACT FROM AUTHOR]

There are multiple treatment strategies proposed for the management of vision loss related to the injection of soft tissue fillers. Currently, there is no internationally accepted consensus on the immediate management of soft tissue filler induced vision loss (STFIVL). A recent systematic review of the literature concluded that there is not enough evidence to support retrobulbar hyaluronidase, and alternative treatments require exploration. The available literature demonstrates the inconsistent and unproven success of retrobulbar and peribulbar hyaluronidase in reversal of soft filler induced vision loss. Various therapeutics have been used to aid the reversal of vision loss but with mixed outcomes. The current evidence base does not support the use of retrobulbar and peribulbar hyaluronidase. The use of retrobulbar hyaluronidase for reversing soft tissue filler induced vision loss is controversial. Its efficacy remains unproven and there is mixed evidence within the literature. The current evidence suggests that there may be an increased risk of introducing severe adverse events associated with retrobulbar hyaluronidase and may even exacerbate the problem for those clinicians who are not ophthalmology trained. Therefore, we recommend two alternative treatment pathways for ophthalmology and non-ophthalmology trained practitioners. The suggested goal of this publication is to understand the pathophysiology of STFIVL, recognize signs and symptoms, and to propose algorithms to manage vision loss for both non-ophthalmology and ophthalmology trained clinicians. Clinicians must act swiftly and arrange immediate transfer to an emergency department or ophthalmology specialist setting to give the patient the best chance of vision restoration. The focus of any intervention for non-ophthalmology trained clinicians should be based around the immediate use of non-invasive techniques. [ABSTRACT FROM AUTHOR]

Purpose This study was conducted to test the hypothesis that the carotid intima-media thickness (CIMT) is higher in patients with sickle cell disease (SCD) than in the normal population, and to determine the relationships of the CIMT with central retinal artery (CRA) and renal artery Doppler indices. Methods Forty-four confirmed steady-state SCD patients aged 16 years and above were recruited consecutively. The Doppler velocimetric indices of their right renal artery and both CRAs were obtained. The CIMT was also measured on each side via B-mode ultrasonography. The subjects were categorized by age and sex. Mean and median values for each group were determined. The Spearman correlation test was used to quantify the relationships between CIMT and the Doppler parameters. Results The participants had a median age of 24.50 years (interquartile range, 12.50 to 36.50 years). Twenty-three were men (52.3%) and 21 were women (47.7%). The median CIMT was 0.70 mm (IQR, 0.50 to 0.90 mm). Significant correlations with the CIMT were found for the CRA peak systolic velocity (r=0.312, P=0.003), the renal artery resistivity index (RI) (r=0.284, P=0.007), and the renal artery pulsatility index (PI) (r=0.273, P=0.010). There was no significant relationship between the CIMT and the CRA end-diastolic velocity, CRA RI, or CRA PI. Conclusion CIMT in SCD patients was higher than in the previously reported age groups of the reference populations. In addition, the CIMT was significantly correlated with the CRA peak systolic velocity, the renal artery RI, and the renal artery PI.

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Objective: The ophthalmic artery and its branches have one of the most complex anatomy and embryology of all arteries. Although many studies have been done on its branches, different references have given different conclusions about the first branch of it. Therefore, it was aimed to investigate the first branch of the ophthalmic artery in this study. Materials and Method: Forty-one orbits of the cadavers, which belonged to the Department of Anatomy of Istanbul Faculty of Medicine, were examined. Results: It was observed that the first branch was the central retinal artery in 23 orbits (56%), the posterior ciliary arteries in 14 orbits (34%), the lacrimal artery in three orbits (7%) and the supraorbital artery in one orbit (3%). Conclusion: It was observed that the first branch of the ophthalmic artery was the central retinal artery or posterior ciliary arteries substantially. Both arteries are essential for vision and are very important to be protected in surgeries involving this area. [ABSTRACT FROM AUTHOR]

Background: We aimed to compare optic nerve elasticity and central retinal artery resistive index values in Nonproliferative diabetic retinopathy and Proliferative diabetic retinopathy. Materials and Methods: The degree of optic nerve hardness of 31 patients with nonproliferative diabetic retinopathy and proliferative diabetic retinopathy was evaluated using the Shear-Wave Elastography technique. Simultaneously, the resistive index values of the central retinal artery were measured using Color Doppler Ultrasonography and compared with the control group. Results: Optic nerve Shear-Wave Elastography values were significantly higher in patients with retinopathy compared to healthy volunteers and diabetic patients without retinopathy(p<0.05). Central retinal artery resistive index values were significantly higher in patients with retinopathy than those without retinopathy (p <0.05). RI values were measured as 0.57 ± 0.88 for those without retinopathy and as 0.67 ± 0.53 for those with retinopathy. Conclusions: The etiopathogenesis diabetic retinopathy is still controversial. Significant changes in the degree of stiffness of the optic nerve and ocular blood flow parameters in Color Doppler Ultrasonography examination can be observed in Nonproliferative diabetic retinopathy and Proliferative diabetic retinopathy with Shear Wave Elastography. [ABSTRACT FROM AUTHOR]

Purpose: The present study aimed to explore the glymphatic pathway in the intraorbital optic nerve (ON) using magnetic resonance imaging (MRI). Methods: Following conventional MRI examination, a total of 89 outpatients underwent T2-weighted imaging in thin-sliced coronal and sagittal sections. Moreover, three injected cadaver heads were dissected. Results: In the cadaver specimens, differences in appearance between the central and peripheral parts of the ON were not observed. On the axial T2-weighted MRI performed in the initial examination, the central part of the intraorbital ONs was delineated as a well-demarcated, linear hyperintense area in 19% of patients. On the thin-sliced serial coronal images, the hyperintense areas were identified on both sides in 91% of patients. They were delineated as continuous hyperintense areas in the ONs with an inconsistent appearance even in the same nerve. In 12.4% of patients, the areas were divided into the upper and lower parts by a horizontal septum, while others showed variable morphologies, lacking a septum. On thin-sliced sagittal images, hyperintense areas were identified in 46% of patients. Conclusion: Hyperintense areas in the intraorbital ON detected on T2-weighted sequences may involve a glymphatic pathway with perivascular spaces of the ON and central retinal artery. These may be collapsed and difficult to identify on surgical and cadaver specimens. [ABSTRACT FROM AUTHOR]

The purpose of this study is to describe a surgical technique and report the functional outcome of treating nonarteritic central retinal artery occlusion (CRAO) in 2 eyes of two consecutive male patients. Two males (A) and (B) presented 6 days and few hours, respectively, after symptom onset with the clinical features typical of CRAO, including sudden severe deterioration of vision to counting fingers and a cherry-red spot in the left and right fovea, respectively. While A had been on recent treatment for hypertension and hyperlipidemia, B had no significant medical history. Both patients underwent surgery, A, 9 days, and B, <15 h after symptom onset. Surgery involved a vitrectomy, lowering of intraocular pressure (<3 mmHg), and gradual increase of arterial pressure to 165/100 mmHg (through the slow injection of intravenous adrenaline). Intraoperatively, this resulted in immediate perfusion and visible dilation of the blood-filled central retinal artery (CRA) and retinal arteriolar network and dilatation of the central retinal vein. The final vision settled to 6/60 in A and 6/36+1 in B. Although preoperative macular infarction persisted in both eyes as demonstrated by optical coherence tomography angiography, both patients claim a convincing subjective visual benefit. The procedure appeared to have positively changed the natural history of the disease in both eyes. Vitrectomy with the manipulation of intraocular and arterial pressures significantly increases ocular perfusion along the entire CRA, which can dislodge CRA thrombo-emboli and has the potential to restore retinal perfusion and improve visual outcome if undertaken before irreversible retina damage. This is a relatively straightforward technique and should join the list of surgical techniques for treating CRAO. [ABSTRACT FROM AUTHOR]

Abstract Background The present study was undertaken to assess the resistive index (RI) of central retinal artery (CRA) as a bioimaging biomarker for the severity of diabetic retinopathy (DR), for the first time. Methods Eighty-one consecutive patients of type 2 diabetes mellitus between the ages of 40 and 70 years were included in a tertiary care center-based cross sectional study. Severity of retinopathy was assessed according to Early Treatment Diabetic Retinopathy Study (ETDRS) classification: diabetes mellitus with no retinopathy (No DR) (n = 26); non-proliferative diabetic retinopathy (NPDR) (n = 29); and proliferative diabetic retinopathy (PDR) (n = 26). Twenty-six healthy controls of similar age were also included. Resistive index of CRA was studied using color Doppler and gray scale sonography. Central subfield thickness (CST), cube average thickness (CAT), retinal photoreceptor ellipsoid zone (EZ) disruption, and retinal nerve fiber layer (RNFL) thickness were evaluated using spectral domain optical coherence tomography. Sensitivity and specificity were assessed by receiver operating characteristic (ROC) curve. Results Mean RI of CRA for the study groups revealed significant increase with severity of diabetic retinopathy (F = 10.24, P

INTRODUCTION[|]This study was designed to evaluate hemodynamic alterations in the retrobulbar blood flow in primary open-angle and normal-tension glaucoma patients using Doppler ultrasonography (US) and to emphasize the importance of diagnostic imaging and vascular factors in the etiology.[¤]METHODS[|]A total of 98 eyes of 50 patients were examined for the study. The control group consisted of 14 normal cases. The patient groups were comprised of 25 patients with primary open-angle and 11 patients with normal-tension glaucoma. All of the examinations were performed using a multifrequency (5-7.5-10 MHz) linear transducer and a Toshiba PowerVision 7000 SSA-380A color Doppler US device (Toshiba Corp., Tokyo, Japan). The peak systolic velocity and resistive index values of the ophthalmic artery, central retinal artery, and temporal posterior ciliary arteries were examined.[¤]RESULTS[|]There was no significant difference between the groups in terms of age and gender distribution, and no difference in peak systolic velocity or resistive index between the 2 eyes. In both glaucoma groups, the peak systolic velocity and resistive index of the ophthalmic artery and the peak systolic velocity in the central retinal artery showed no statistically significant difference with those of the control group. The resistive index of the central retinal artery was higher in the glaucoma patients compared with the control group. In the posterior ciliary arteries, the peak systolic velocity was lower and the resistive index was higher in the glaucoma group than in the control group. No statistically significant difference was found between the 2 glaucoma groups in any parameter.[¤]DISCUSSION AND CONCLUSION[|]The findings in the central retinal artery, and especially in the posterior ciliary arteries, support the theory that changes in vascular hemodynamics can play a role in the etiology of glaucoma. Color Doppler US is a safe, noninvasive, contrast-free, radiation-free, and reproducible method to evaluate retrobulbar blood flow.[¤]

Background: Giant cell arteritis (GCA) is the most common form of systemic vasculitis in persons aged 50 years and older. Medium and large vessels, like the temporal and axillary arteries, are commonly affected. Typical symptoms are headache, scalp tenderness, jaw claudication and ophthalmological symptoms as loss of visual field, diplopia or amaurosis due to optic nerve ischemia. Tongue pain due to vasculitic affection of the deep lingual artery can occur and has so far not been visualized and followed up by modern ultrasound. Case presentation: We report the case of a 78-year-old woman with typical symptoms of GCA, such as scalp tenderness, jaw claudication and loss of visual field, as well as severe tongue pain. Broad vasculitic affection of the extracranial arteries, vasculitis of the central retinal artery and the deep lingual artery could be visualized by ultrasound. Further did we observe a relevant decrease of intima-media thickness (IMT) values of all arteries assessed by ultrasound during follow-up. Especially the left common superficial temporal artery showed a relevant decrease of IMT from 0.49 mm at time of diagnosis to 0.23 mm on 6-months follow-up. This is the first GCA case described in literature, in which vasculitis of the central retinal artery and the lingual artery could be visualized at diagnosis and during follow-up using high-resolution ultrasound. Conclusion: High-resolution ultrasound can be a useful diagnostic imaging modality in diagnosis and follow-up of GCA, even in small arteries like the lingual artery or central retinal artery. Ultrasound of the central retinal artery could be an important imaging tool in identifying suspected vasculitic affection of the central retinal artery. [ABSTRACT FROM AUTHOR]

Background. Measurement of the optic nerve sheath diameter (ONSD) with point-of-care ultrasound (POCUS) is a non-invasive and radiation-free technique that can be used to assess increased intracranial pressure (ICP). Ophthalmic artery and central retinal artery Doppler indices can be used like transcranial Doppler to evaluate increased ICP. This study aims to examine the diagnostic value of ONSD measurements and central retinal artery Doppler indices in the evaluation of pediatric patients with increased ICP. Methods. This was a prospective, case-controlled single center study. The study group was comprised of a total of 38 pediatric patients with increased ICP and the control group included 19 healthy children. Ophthalmic ultrasound was performed and ONSD and central retinal artery Doppler indices were measured. Results. The mean age of the study group was 80.84 ± 65.12 months. The mean ONSD was 5.9 ± 0.8 (3.6-8.1) mm in the study group and the mean resistive index (RI) was 0.71 ± 0.08 (min:0,55-max:1) and was significantly greater than the control group (p<0.001 and p<0.001, respectively). In terms of predicting increased ICP, the ONSD measurement was the strongest parameter, with its area under the curve: 0.767 (95 percent confidence interval: 0.68-0.85). In the study group, the cut-off value for ONSD was 5.8 mm (66 percent sensitivity, 100 percent specificity) and the cut-off value for RI was 0.68 (63 percent sensitivity, 83 percent specificity). Conclusions. Point-of-care ultrasound is a noninvasive and important tool in pediatric intensive care units. Our study is significant as one of the few pediatric studies where central retinal artery Doppler indices are evaluated in addition to OSND, in patients with increased ICP. [ABSTRACT FROM AUTHOR]

Giant cell arteritis (GCA) is the most important medical emergency in ophthalmology, because its most dreaded complication is visual loss, which is preventable if these patients are diagnosed early and treated immediately and aggressively. This is a brief review of GCA, its ophthalmic manifestations, and how to diagnose and manage them. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to identify changes in Doppler flow parameters in the central retinal artery (CRA) and ophthalmic artery (OA) that could be indicative of de novo development of thyroid‐associated orbitopathy in the early period after radioiodine treatment. Methods: Eighty‐two patients with hyperthyroidism were enrolled: 44 with Graves disease and 38 with toxic nodular goiter. In both groups, blood flow parameters in the CRA and OA were analyzed before and 2 and 4 weeks after radioiodine administration. The peak systolic velocity and end‐diastolic velocity (EDV) were evaluated, and the resistive index (RI) was calculated. Results: There were no statistically significant differences in the peak systolic velocity, EDV or RI between groups at baseline and 4 weeks after radioiodine administration. Two weeks after radioiodine administration, the RI in the CRA (P =.034) and EDV in the OA (P =.026) were significantly lower, and the EDV in the CRA (P =.004) was higher in patients with Graves disease than in patients with toxic nodular goiter. There was an inverse correlation between baseline thyrotropin receptor autoantibody (TRAb) levels and the difference between the RI at weeks 4 and 2 (RI3‐RI2) in the CRA (r = −0.458; P <.05) and a positive correlation between the baseline anti‐thyroid peroxidase antibody concentration and RI3‐RI2 in the OA (r = 0.435; P <.05). Conclusions: Administration of radioiodine results in more prominent features of hyperkinetic circulation. Patients with Graves disease and high TRAb titers have a lower sensitivity to radioiodine treatment. High TRAb titers suggest higher disease activity and a weaker therapeutic effect of radioiodine. Access the CME test here and search by article title. [ABSTRACT FROM AUTHOR]

This report presents a rare case of a central retinal artery occlusion in an eight-year-old girl attributed to an undiagnosed patent ductus arteriosus (PDA). Despite intensive treatment, the patient's eyesight failed to improve. Cases of central retinal artery occlusion may occur in patients with undiagnosed, small PDA, with only symptomatic treatment being available., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Glynatsis et al.)

Aim: To compare the ocular blood flow in glaucomatous eyes and normal healthy eyes. This study compares open-angle glaucoma patients to healthy adults by measuring various parameters in the ophthalmic artery (OA), central retinal artery (CRA), and short posterior ciliary artery (SPCA)., Materials and Methods: A total of 50 glaucomatous eyes and 50 normal eyes were included in a prospective case-control study over 1 year. The color Doppler imaging (CDI) was conducted using a noninvasive linear multifrequency probe with a frequency range of 5-9 MHz. OA, CRA, and SPCA were measured for peak systolic velocity (PSV), end-diastolic volume (EDV), pulsatility index (PI), and resistivity index (RI)., Results: When compared with controls, PSV was decreased in all three vessels, with the results being remarkable only in CRA. The EDV also showed a remarkable decrease in all three vessels. Additionally, all three vessels showed significant increases in PI and RI except OA, p -value < 0.05., Conclusion: Blood velocity is decreased, and resistive indices are increased in glaucomatous eyes compared with normal eyes. Variations in ocular blood flow could be a cause or consequence of glaucomatous optic neuropathy and are an important predictor of disease progression., How to Cite This Article: Murugesan MAD, Venkat P, Basetti B. Comparison of Ocular Blood Flow in Glaucomatous Eyes and Nonglaucomatous Eyes at a Tertiary Hospital in South India: A Prospective Case-control Study. J Curr Glaucoma Pract 2024;18(2):45-50., Competing Interests: Source of support: Nil Conflict of interest: NoneConflict of interest: None, (Copyright © 2024; The Author(s).)

Objective To observe the changes of pupil diameter and ocular hemodynamics in non-proliferative diabetic retinopathy ( NPDR) patients with cataract who underwent mydriasis in the early stage after phacoemulsification and intraocular lens implantation. Methods Totally 100 patients with NPDR complicated with cataract ( 100 eyes) were treated with phacoemulsification and intraocular lens implantation. Then, they were randomly divided into the observation group and control group, with 50 cases in each group. The patients in the observation group were given compound tropicamide eye drops for mydriasis at the same time every day after operation ( the next day as the first day after operation) . In the control group, mydriasis was perlormed once at the same time on day 7 and 14 after operation. The ocular hemodynamic indexes, pupil diameter and pupillary time after mydriasis were observed in the two groups, and the pupil compliance of the two groups was calculated on the 14th day after operation. Results Compared with the control group, the mean value of end diastolic blood flow velocity ( EDY) and peak systolic velocity ( PSV) of central retinal artery and short posterior ciliary artery in the observation group increased on the 7th and 14th days after operation, and the average value of resistance index ( RI) decreased ( all P < 0. 05 ) ; the EDY and PSV of the central retinal artery and short posterior ciliary artery in the observation group increased and RI decreased on the 14th day after operation as compared with those on the 7th day, while the average values of EDV and PSV of the central retinal artery and short posterior c山ary artery in the control group decreased, and the average RI value increased (all P < 0. 05). Compared with the control group, the observation group had longer pupil diameter and shorter mydriasis time on the 7th and 14th days after operation (all P < 0. 05). Compared with the 7th day, the pupil diameter was longer and the mydriasis time was shorter in the observation group on the 14th day after operation (all P < 0. 05). Compared with the control group, the pupil compliance rate and basic compliance rate of the observation group were higher on the 14th day after operation (all P < 0. 05). Co nclusions The average EDV and PSV of central retinal artery and short posterior ciliary artery decrease in NPDR patients with cataract who receive mydriasis every day in the early stage after phacoemulsification and intraocular lens implantation, and the mean value of RI increases. Moreover, the pupil diameter is longer and the mydriasis time is shorter, the pupil of patients is close to or reaches the mydriasis diameter required for further fundus treatment. [ABSTRACT FROM AUTHOR]

We report a case of central retinal artery occlusion (CRAO) leading to unilateral blindness occurring in a moyamoya patient 30 years after successful pial synangiosis when she was 6 years old. Imaging studies at the time of the CRAO revealed total occlusion of the ipsilateral cervical and intracranial internal carotid artery, a vessel shown to be patent on MRI/MRA studies for decades previously. This case demonstrates that long-term follow-up of operated moyamoya patients may reveal late secondary complications, of which physicians, patients, and families need to be aware. [ABSTRACT FROM AUTHOR]

Measuring and monitoring of intracranial pressure is considered standard of care in patients with suspected intracranial hypertension. Sonographic assessment of the optic nerve sheath diameter (ONSD) has been promising and potentially useful for noninvasive intracranial hypertension screening. ONSD measurements are easy to perform, repeatable at bedside, fast, low cost, and radiation-free. However, they are still burdened by inter-rater variability, lack of ultrasound (US) setting standardization (e.g., US frequency, focus depth, etc.), and possible artifacts. To overcome this problem, we propose the CLOSED protocol associated with equipment specifications, as a guide to minimize the occurrence of such artifacts enabling a more reliable and accurate measurement. We suggest that color Doppler could be used as a new standard evaluation for the ONSD. [ABSTRACT FROM AUTHOR]

• Transocular sonography easily detects papilledema and enlarged ONSD in IIH. • ONSD predicts an increased intracranial pressure in IIH (cut-off: 5.8 mm). • ONSD decreases following lumbar puncture, whereas papilledema is unaffected. • Vsys of the central retinal artery can help to identify patients with IIH. • Decrease of PI reflects improved perfusion following lumbar puncture. Transorbital sonography easily detects papilledema and enlarged optic nerve sheath diameters (ONSD) in IIH (idiopathic intracranial hypertension) patients. As the central retinal artery is located within the optic nerve, its hemodynamic properties might be affected by the increased pressure. In this study we assessed the diagnostic usefulness of transorbital sonography in IIH with a special focus on color Doppler imaging of the central retinal artery. IIH patients presented papilledema and enlarged ONSD. ONSD accurately predicted an increased intracranial pressure in IIH (cut-off: 5.8 mm, 81% sensitivity, 80% specificity). 24 h following therapeutic lumbar puncture ONSD diminished significantly, whereas papilledema was not changed. PSV (peak systolic velocity) and Vmean (mean flow velocity) of the central retinal artery were increased in IIH patients compared to controls. PSV accurately predicted an increase of intracranial pressure (cut-off: 11.0 cm/s, 70% sensitivity, 69% specificity). PI (pulsatility index), PSV and Vmean decreased following lumbar puncture. PSV and Vmean decreases were statistically significant for right eyes only in which the values changed to normal. In summary, besides ONSD enlargement and papilledema transbulbar sonography demonstrated an alteration of central retinal artery blood flow in IIH patients. Especially PSV might serve as valuable surrogate marker for intracranial pressure in IIH. Furthermore, the change of intra-individual central retinal arteries PI might be a valuable parameter to demonstrate response to lumbar puncture in IIH patients. [ABSTRACT FROM AUTHOR]