Orbital color Doppler imaging in Behçet's disease with or without ocular involvement

Ocular blood flow and retinal, choroidal, and retinal nerve fiber layer thickness in children with familial Mediterranean fever with at least five attacks

PURPOSE

This study aimed to evaluate ocular blood flow and, retinal, choroidal and retinal nerve fiber layer thickness in children with familial Mediterranean fever (FMF) with patients who had at least five attacks.

METHODS

Fifty-six patients with FMF and 56 healthy subjects were enrolled in the study. Each participant's choroidal thickness (CT) and retinal thickness (RT) measurements were performed in the foveola and at horizontal nasal and temporal quadrants within 500-μm intervals up to 1.500 μm from the foveola using spectral-domain optical coherence tomography as well as the retinal nerve fiber layer thickness (RNFLT). Disc boundaries were determined manually by identifying seven points on the inner edge of the scleral ring. Following complete ophthalmological evaluation, peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistivity index (RI) values in the central retinal artery (CRA), ophthalmic artery (OA), and nasal posterior ciliary artery (NPCA) were measured using color Doppler ultrasonography (CDU) in the left eyes of the patients diagnosed with FMF and the controls. The results were subsequently compared.

RESULTS

No statistically significant differences were observed between the groups in terms of all RNFLT quadrant and RT measurements. All CT measurements were thinner in patients with FMF than in the controls (For Central and Temporal_1500 p = 0.01; For Temporal_500, Nasal 500 and Nasal_1000 p < 0.001; Temporal_1000 p = 0.002) except than the Nasal_1500 point. For nasal_1500 p = 0.121). The PSV and EDV values in the OA, CRA, and NPCA were significantly lower in patients with FMF compared to healthy controls (p < 0.001 for all). In contrast, the RI values of all arteries were significantly higher than in the control group (Regarding OA, CRA and NPCA RI, p = 0.003, p = 0.039, and p = 0.039, respectively).

CONCLUSIONS

The results of this study support the idea that chronic inflammation and frequent attacks in FMF may have an effect on decreased ocular blood flow and choroidal thinning.

Quantitative Evaluation of the Retinal Vascular Parameters With OCTA in Patients With Behçet Disease Without Ocular Involvement

BACKGROUND AND OBJECTIVE

To evaluate the optical coherence tomography angiography (OCTA) features of patients with Behçet disease (BD) without ocular involvement.

PATIENTS AND METHODS

Twenty-three patients with BD without ocular involvement and 29 healthy age/sex-matched control subjects were involved. The authors measured foveal avascular zone (FAZ) area, vessel density in the parafoveal region, and flow area (fovea-centered 3-mm radius area) in the superficial and deep capillary plexuses evaluated by OCTA.

RESULTS

FAZ area was significantly larger in eyes with BD in both the superficial and deep capillary plexuses (0.331 vs. 0.240 mm² [P = .004] and 0.352 vs. 0.257 mm² [P = .003], respectively). Although mean capillary vessel density in parafoveal region and mean flow area were lower in eyes with BD for both superficial and deep capillary plexuses, these findings were not statistically significant.

CONCLUSION

Microvascular changes in macular region can be identified in patients with BD without ocular manifestation. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:31-34.].

Evaluation of retrobulbar blood flow and choroidal thickness in patients with rheumatoid arthritis

PURPOSE

To evaluate whether retrobulbar blood flow and choroidal thickness (CT) are affected in patients with rheumatoid arthritis (RA), and the relationship between these values.

METHODS

We evaluated 40 eyes of 20 RA patients and 40 eyes of 20 healthy controls. The enhanced depth imaging optical coherence tomography, color Doppler imaging, was held. Statistical analysis was performed.

RESULTS

Peak systolic velocity (PSV) of ophthalmic (OA) and central retinal artery (CRA) were significantly higher in RA. No significant difference was observed when end-diastolic velocity (EDV) of OA and CRA was compared between the groups. The resistivity index (RI) of OA and CRA was higher in RA. Perifoveal/subfoveal CT was lower in RA. Negative correlation was detected between the RI of OA and the perifoveal CT, and a positive correlation was detected between RI of CRA and CT.

CONCLUSIONS

Ocular hemodynamics is effected by RA and can exaggerate ocular complications of various vascular diseases such as diabetes mellitus, hypertension, retinal vascular occlusions.

Retrobulbar magnetic resonance angiography using binomial off-resonant rectangular (BORR) pulse

PURPOSE

Applying a newly developed binomial off-resonant rectangular (BORR) pulse method for high resolution three-dimensional MR angiography (MRA) on retrobulbar ocular vessels, which has not been possible with routine MRA due to background fatty tissues.

METHODS

BORR pulse was implemented in a gradient echo sequence by replacing the original excitation pulse, and were optimized for robust orbital fat suppression. Several other MRA methods, with or without fat suppression, were also compared, including time-of-flight, contrast enhanced MRA, and hybrid of opposite-contrast MRA. Nine healthy subjects participated with written informed consents. To reduce eye motion, the subjects were instructed to casually stare at a projected cross during each MRA scan. Major vessels were evaluated by three independent radiologists using a 4-point scale.

RESULTS

The BORR method yielded the best MRA results for retrobulbar vessels without contrast enhancement, significantly superior than other MRA methods. BORR results had significantly higher visibility scores than all other methods for small vessels.

CONCLUSION

We have successfully revealed orbital vessels in retrobulbar space for the first time using MRA, by using the BORR pulse method. With a clear depiction of the vasculature without the need for contrast enhancement, our method has the potential to provide important diagnostic information for ocular vascular diseases.

Gender differences in ocular blood flow

Gender medicine has been a major focus of research in recent years. The present review focuses on gender differences in the epidemiology of the most frequent ocular diseases that have been found to be associated with impaired ocular blood flow, such as age-related macular degeneration, glaucoma and diabetic retinopathy. Data have accumulated indicating that hormones have an important role in these diseases, since there are major differences in the prevalence and incidence between men and pre- and post-menopausal women. Whether this is related to vascular factors is, however, not entirely clear. Interestingly, the current knowledge about differences in ocular vascular parameters between men and women is sparse. Although little data is available, estrogen, progesterone and testosterone are most likely important regulators of blood flow in the retina and choroid, because they are key regulators of vascular tone in other organs. Estrogen seems to play a protective role since it decreases vascular resistance in large ocular vessels. Some studies indicate that hormone therapy is beneficial for ocular vascular disease in post-menopausal women. This evidence is, however, not sufficient to give any recommendation. Generally, remarkably few data are available on the role of sex hormones on ocular blood flow regulation, a topic that requires more attention in the future.

Evaluation of vertebral artery involvement by Doppler sonography in patients with Behçet disease

OBJECTIVES

Neurologic lesions in Behçet disease are most frequently observed in areas supplied by the vertebrobasilar system. We aimed to evaluate possible vertebral artery involvement by Doppler sonography in patients with Behçet disease.

METHODS

Forty-five patients with Behçet disease and 29 healthy volunteers had Doppler sonography of the vertebral arteries. Patients were grouped according to neurologic examination and magnetic resonance imaging findings as follows: group 1, Behçet disease without neurologic involvement; group 2, neuro-Behçet disease; and group 3, control. Results were assessed with a 95% confidence interval.

RESULTS

The main findings of our study were as follows: (1) total vertebral artery volume flow was significantly lower in the patient groups than the control group (P< .05); (2) total volume flow was lower in group 2 than group 1, although the difference was not statistically significant; (3) peak systolic and end-diastolic velocity values were significantly lower in the patient groups than the control group; (4) right and left mean volume values were lower in group 2; and (5) resistive and pulsatility index values for the left vertebral artery were significantly higher in group 2, but no statistically significant differences were found in the resistive and pulsatility index values for the right vertebral artery.

CONCLUSIONS

Doppler sonography of the vertebral arteries in Behçet disease shows alterations that may aid in the diagnosis and treatment of this condition.

Color Doppler Imaging of the Orbital Vessels in Ankylosing Spondylitis

PURPOSE

To analyze the hemodynamic features of orbital blood flow velocities using Doppler ultrasonography in ankylosing spondiylitis (AS) patients, as well as to compare these results with those of healthy controls.

METHODS

33 AS patients and 32 healthy controls were consecutively included in the study groups. The same radiologist performed ocular blood flow measurements. Peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) were measured in the central retinal artery (CRA), posterior ciliary arteries (PCAs), and ophthalmic artery (OA). Resistive index was used to assess arterial resistance; it was automatically calculated as RI [(PSV-EDV)/PSV].

RESULTS

There were no significant differences in the PSV, EDV, and RI of the OA, CRA, and PCAs between AS patients and controls.

CONCLUSION

This result suggests no possible contributory role of vascular structures in formation of uveitis in AS. We believe that our preliminary results need to be complemented with further studies, particularly including AS patients with uveitis and rheumatic diseases with other ocular involvement.

Non-infectious orbital vasculitides

Non-infectious vasculitides comprise a large number of diseases. Many of these diseases can cause inflammation within the orbit and a clinical presentation, which mimics numerous other processes. Orbital disease can often be the initial presentation of a systemic process and early diagnosis can help prevent long-term, potentially fatal consequences. The evaluation and treatment of non-infectious orbital vasculitides are often complicated and require a thorough understanding of the disease and underlying systemic associations. The long-term prognosis visually and systemically must be weighed against the risks and benefits of the treatment regimen. A large variety of corticosteroid formulations currently exist and are the mainstay of initial treatment. Traditional steroid-sparing immunosuppressive agents are also an important arsenal against these vasculitides. Recently, a new class of drugs called biologics, which target the various mediators of the inflammation cascade, may potentially provide more effective and less toxic treatment. This review aims to synthesize the current literature on non-infectious orbital vasculitides.

Use of colour Doppler imaging in ocular blood flow research

The main objective of this report is to encourage consistent quality of testing and reporting within and between centres that use colour Doppler imaging (CDI) for assessment of retrobulbar blood flow. The intention of this review is to standardize methods in CDI assessment that are used widely, but not to exclude other approaches or additional tests that individual laboratories may choose or continue to use.

Doppler sonography of ocular and carotid arteries in Behçet patients

PURPOSE

To evaluate by Doppler sonography carotid and ocular hemodynamics in Behçet disease with and without ocular involvement.

METHODS

Seventy-six patients with Behçet disease (BD) were separated into three groups: with active uveitis, with inactive uveitis, and without uveitis, and compared with 23 controls. We used duplex Doppler sonography to measure peak systolic (PSV), end-diastolic (EDV), and time-averaged mean (Vmean) blood flow velocity in the ophthalmic, central retinal (CRA), temporal posterior ciliary, nasal posterior ciliary (NPCA), common carotid (CCA), internal carotid (ICA) arteries, and maximum flow velocity (Vmax) in the central retinal veins. We then calculated resistance and pulsatility indexes of all arteries. Comparisons were carried out by two-way ANOVA and Holm-Sidak method.

RESULTS

Only two patients (2.6%) had atherosclerotic plaques, without significant hemodynamic consequence. Patients with uveitis had significantly lower ICA PSV and EDV (p < 0.05), and lower CRA PSV, EDV, and Vmean (p < 0.001) than controls. Patients with active uveitis had lower NPCA PSV and EDV than patients without uveitis or controls (p < 0.01). There were no differences in temporal posterior ciliary, ophthalmic, and CCA PSV, EDV, and in Vmean between groups (p > 0.05). Patients with uveitis had lower central retinal veins Vmax than patients without uveitis and than controls (p < 0.01). Resistance index, pulsatility index of retrobulbar arteries, CCA, and ICA were similar in the four groups (p > 0.05).

CONCLUSIONS

Patients with Behçet disease and ocular involvement have lower CRA, CRV, NPCA, and ICA blood flow velocities than healthy volunteers.