Ocular and orbital blood flow in cigarette smokers

Retinal nerve fiber layer and ganglion cell complex thickness in diabetic smokers without diabetic retinopathy

PURPOSE

To compare the thickness of the retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GC-IPL) in smoker and nonsmoker diabetics without diabetic retinopathy.

MATERIALS AND METHODS

Patients with diabetes were divided into two groups according to their smoking status: Group 1 consisted of 38 smoker diabetics who had chronically smoked more than 20 cigarettes per day for more than five years; Group 2 consisted of 38 nonsmoker diabetics. After a detailed ophthalmologic examination, the mean and regional (superior, supratemporal, inferior, inferotemporal, temporal, nasal, superonasal, and inferonasal) RNFL and GC-IPL thicknesses were measured with spectral-domain optic coherence tomography (SD-OCT) and compared between groups.

RESULTS

The mean age was 54.7 ± 10.5 and 51.2 ± 9.7 years in the smoker and nonsmoker groups, respectively (p = 0.14). Gender, duration of diabetes, and the mean axial length were similar between groups (p:0.43, p:0.54, p: 0.52, respectively). Mean RNFL thickness was 89.1 ± 8.0 µm in the smoker group and 93.4 ± 7.0 µm in the nonsmoker group, and it was significantly thinner in the smoker group (p = 0.01). The temporal RNFL thickness in the smoker group was thinner than in the nonsmoker group (p = 0.02). There was no difference in superior, inferior, and nasal RNFL thicknesses between the groups (p = 0.31, p = 0.12, p = 0.39, respectively). The mean macular GC-IPL thickness of the smoker and nonsmoker groups was 78.53 ± 15.74 µm and 83.08 ± 5.85 µm, respectively (p = 0.09). Superior, superonasal, inferonasal, inferior, inferotemporal, and superotemporal quadrant GC-IPL thicknesses were similar between the groups (p = 0.07, p = 0.60, p = 0.55, p = 0.77, p = 0.71, p = 0.08, respectively). The groups showed no difference in minimum GC-IPL thickness (p = 0.43). There was a significant negative correlation between smoking exposure and mean, inferior quadrant RNFL thicknesses in the smoker group (p = 0.04, r= -0.32, and p = 0.01, r= -0.39, respectively).

CONCLUSION

Mean RNFL thickness was significantly thinner in smoker diabetics. Although not statistically significant, especially mean, superior, and superotemporal GC-IPL was thinner in smoker diabetics. The results suggest a potential association between the coexistence of diabetes and smoking with alterations in RNFL and GC-IPL thickness.

Orbital and ocular perfusion in thyroid eye disease

Thyroid eye disease (TED) is characterized by enlargement of extraocular muscles, an increase in retrobulbar fat, orbital fibrosis, and fluctuations in plasma thyroid hormone levels in most patients, often associated with raised autoantibody titers. The occurrence of orbital space conflict compromises the orbital perfusion, unchecked progression of which results in irreversible loss of visual acuity and visual fields. The quantitative assessment of orbital perfusion can be done by measurement of blood flow velocities in the superior ophthalmic vein (SOV), ophthalmic artery (OA), central retinal artery (CRA), and posterior ciliary artery by color Doppler imaging. The retinal and choroidal microvasculature is studied by optical coherence tomography and optical coherence tomography angiography. The orbital and ocular perfusion fluctuates during the course of TED. Orbital congestion is reflected by the reduction or reversal of SOV flow and an increase in subfoveal choroidal thickness. The active phase is characterized by high blood flow velocities of the OA and CRA. The onset of dysthyroid optic neuropathy is associated with reduced arterial perfusion and reduction in parafoveal and peripapillary vascular density. Orbital decompression improves the SOV flow and decreases the resistivity index of CRA. Sequential evaluation of orbital hemodynamic changes can thus supplement the clinical scoring systems for monitoring and planning intervention in TED.

Choroidal thickness in eyes of migraine patients measured using spectral domain-optical coherence tomography: A meta-analysis

Recent developments in high-resolution optical coherence tomography allow evaluation of even the slightest changes of choroidal thickness in various disorders, including migraine. In this review, we analyze the choroidal thickness measurements reported in various studies that compare results between migraineurs and healthy individuals. We searched PubMed, Scopus, and EMBASE to identify relevant literature reporting choroidal thickness in the migraineurs' different macular regions compared with healthy controls. A fixed-effects or random-effects model was applied for the meta-analysis based on the heterogeneity level. Moreover, subgroup analyses, meta-regression, publication bias, and quality assessment were also performed. We identified ten studies involving 580 migraineurs (173 with aura, 128 without aura, and 279 without specification for the presence of aura) and 407 healthy controls to be included in this meta-analysis. Results indicated that average choroidal thickness was significantly decreased in the migraine cases (SMD, -1.28; 95% CI, -2.47 to -0.08; P = 0.04) compared to healthy individuals. Furthermore, both with aura (SMD, -1.16; 95% CI, -1.39 to -0.92; P < 0.0001) and without aura migraine patients (SMD, -0.81; 95% CI, -1.28 to -0.34; P < 0.001) had significantly thinner subfoveal choroid compared to healthy controls. Moreover, subfoveal choroidal thickness in the migraineurs with aura was significantly lower than those without aura (SMD, -0.45; 95% CI, -0.84 to -0.05; P = 0.03). The alterations in choroidal thickness, suggestive of migraine's neurovascular pathophysiology, were tentatively confirmed by this study's findings. Further longitudinal studies with more diverse settings are required to derive more definitive conclusions.

Effects of Smoking on Optic Nerve Head Microvasculature Density in Glaucoma

PRCIS

Decreased superficial whole image capillary density was observed in open angle glaucoma (OAG) patients with high smoking intensity.

PURPOSE

To investigate the effects of smoking on optic nerve head capillary density measured by optical coherence tomography angiography in patients with OAG.

METHODS

In this retrospective cross-sectional study, perimetric and preperimetric glaucoma patients enrolled in the Diagnostic Innovations in Glaucoma Study (DIGS) with optical coherence tomography angiography follow-up were included. Univariable and multivariable linear mixed analysis were performed to determine the effects of different variables on the superficial whole image capillary density.

RESULTS

A total of 432 eyes of 271 glaucoma patients comprising 63 preperimetric (106 eyes) and 208 perimetric OAG (326 eyes) were included. A history of tobacco consumption was reported in 105 (38.8%). Among smokers, mean (95% confidence interval) smoking intensity was 12.8 (10.2, 15.5) pack-years. After adjusting for age, glaucoma severity and other confounders, each 10 pack-year increase in smoking intensity (95% confidence interval) was associated with -0.54 (-1.06, -0.02) % lower whole image capillary density ( P =0.041).

CONCLUSIONS

Smoking intensity is associated with reduced optic nerve vessel density in glaucoma.

Evaluation of subclinical alterations in retinal layers and microvascular structures with OCT and OCTA in healthy young short-term smokers

PURPOSE

To detect the changes that can be determined with optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) in young and short-term smokers.

METHOD

In this cross-sectional, observational, and comparative study, 45 "healthy" smokers and 45 healthy non-smoker control participants were included. Those with a smoking history between 1 year to 5 years and an average of 10-30 cigarettes per day were included in the study. OCT and OCTA measurements were made at least 60 min after smoking and at least 8 h after caffeine-containing beverages in order to end the effect of nicotine on systemic and retinal blood flow in the smoking group.

RESULTS

The mean smoking period was 2.2 ± 0.13 years. Mean macular thickness(MMT), retinal nerve fiber layer(RNFL), and choroidal thickness(Cht) were significantly lower in the smoker group, while ganglion cell-inner plexiform layer(GC-IPL) thickness was higher. Vessel density(VD) values were similar between groups, while perfusion density(PD) values were significantly higher in the smoker group. There were significant correlations between MMT and outer VD, outer PD, foveal avascular zone(FAZ) perimeter and circularity index. FAZ area and central VD and PD were inversely correlated. Also, FAZ circularity index and subfoveal, nasal, and temporal ChTs were positively correlated.

CONCLUSION

Despite the short-term smoking, ischemic effects were observed in retinochoroidal and vascular structures.

Effect of smoking on the macula and optic nerve integrity using optical coherence tomography angiography

OBJECTIVE

To investigate the effect of chronic smoking on the macula and optic nerve integrity using optical coherence tomography angiography (OCTA).

METHODS

This prospective, comparative study involved the right eyes of 160 healthy subjects (80 smokers group, and 80 control group). OCTA scanning was performed for all subjects. All macular subfields thickness, peripapillary retinal nerve fiber layer (RNFL) thickness, macular ganglion cell complex (GCC) thickness, superficial and deep macular vessel density, foveal avascular zone (FAZ) area, and the macular outer retina flow area, were measured and analyzed.

RESULTS

The thickness of some macular subfields, inferior GCC, and RNFL was statistically significantly lower in the smokers' group (p < 0.05). The FAZ area was 0.409 ± 0.048 mm² in the smokers' group and 0.327 ± 0.055 mm² in the control group (p < 0.001). The superficial foveal VD was 31.35 ± 5.79% in the smokers' group and 33.63 ± 4.78% in the control group (p = 0.06). The deep foveal VD was 39.38 ± 4.56% in the smokers' group and 34.15 ± 6.57% in the control group (p ≤ 0.001). The superficial and deep parafoveal VD was 52.09 ± 4.56% and 59.99 ± 2.25% respectively in the smokers' group, and 54.75 ± 2.30% and 55.58 ± 4.69% respectively in the control group (p < 0.05). The macular outer retina flow area was 1.29 ± 0.12 mm² in the smokers' group and 1.16 ± 0.11 mm² in the control group (p < 0.001).

CONCLUSION

Chronic smoking affected the integrity of the macula and optic nerve. It decreased the macular VD, enlarged the FAZ, and increased outer retinal flow area.

Effects of chronic methamphetamine abuse on the retinal nerve fiber layer, ganglion cell layer and Bruch's membrane opening minimum rim width

BACKGROUND

Methamphetamine (Meth) is a highly addictive and hallucinogenic agent which is used as the second most common illicit drug globally. Meth could affect the retina and optic nerve by inducing the release of vasoconstrictive agents such as endothelin 1 and induction of severe oxidative stress with accumulation of reactive oxygen species.

AIM

To evaluate the effects of chronic Meth abuse on the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL) and the Bruch's membrane opening minimum rim width (MRW).

METHOD

In this case-control study, we recruited 55 Meth abusers and 49 healthy individuals with mean age of 44.63 ± 0.97 and 43.08 ± 0.91 years, respectively. RNFL thickness, GCL thickness and MRW were evaluated using optical coherence tomography.

RESULTS

We found statistically significant decrease in RNFL, MRW thickness in Meth abusers (P: 0.002 and P: 0.006, respectively). We did not detect statistically significant difference regarding GCL thickness between the groups (P = 0.320). Our results showed a weak but statistically significant correlation of Meth dose increment and decrement of RNFL thickness ((P: 0.005, r = -0.193) and MRW (P: 0.013, r = -0.174). We found no correlation between duration of Meth consumption with RNFL and MRW thickness (P: 0.205, r= -0.124; P: 0.771, r= -0.029, respectively).

CONCLUSION

We found a statistically significant adverse association in meth abusers with RNFL thickness and MRW. These two parameters were also statistically associated with the meth dose as measured by daily dose of Meth. Although we found a decrease in the GCL thickness, it did not reach statistical significance.

Use of choroidal vascularity index for choroidal structural evaluation in smokers: an optical coherence tomography study

PURPOSE

To compare the choroidal vascularity index (CVI) and choroidal thickness (CT) in smokers and healthy non-smoking subjects using spectral-domain optical coherence tomography (SD-OCT).

METHODS

Forty-two smokers with no systemic disorders and 46 age-sex matched healthy volunteers were included in the study. SD-OCT was used to measure choroidal thickness at the fovea and 1500 µm intervals from the foveal centre in both nasal and temporal directions. Choroidal images were binarized and segmented to the luminal area (LA), stromal area (SA), and total choroidal area (TCA) using ImageJ software. The choroidal vascularity index was calculated as the ratio of LA to TCA. Smoking subjects were divided into three groups according to pack-year exposure: 10-20 pack-years, 20-30 pack-years, and >30 pack-years. Subgroup analysis was performed to evaluate the relationship between CT/CVI/LA/SA/TCA and pack-years.

RESULTS

The mean age of the smokers and non-smokers was 43.1 ± 7.26 years and 41.82 ± 9.92 years, respectively (p = 0.51). The mean subfoveal choroidal thickness was 301.57 ± 55.04 µm in smokers and 303.38 ± 53.42 µm in non-smokers (p = 0.826). No significant difference was observed between groups for CT values in the subfoveal location or at 1500 µm intervals in the nasal and temporal direction from the fovea. The CVI was significantly lower in smokers (65.4 ± 2.3%) than in non-smokers (66.3 ± 2.5%) (p = 0.021). In the subgroup analysis, subjects with >20 pack-years of smoking had a significantly lower CVI than non-smokers, but those between 10-20 pack-years did not. A negative correlation was found between the CVI and smoking, as measured by cigarette pack-years (r = -0.226, p = 0.04).

CONCLUSION

The CVI was significantly decreased in smokers compared to healthy controls. The study results suggest that the CVI could be a non-invasive tool for evaluating choroidal vascular changes in smokers.

Evaluation of Foveal Avascular Zone and Capillary Plexus in Smokers Using Optical Coherence Tomography Angiography

Purpose:

To evaluate the macular microvasculature in smokers in comparison to healthy subjects using optical coherence tomography angiography (OCTA).

Methods:

Fifty chronic, regular smokers and 50 healthy non-smokers, as a control group, were recruited for the study. Foveal avascular zone (FAZ) area (mm²) and vessel density (VD) (%) in the superficial (SCP) and deep capillary plexus (DCP) were evaluated.

Results:

FAZ area was 0.424 ± 0.100 mm² in the smoker group and 0.333 ± 0.093 mm² in the non-smoking control group (P = 0.002). The deep foveal VD was 31.76 ± 6.33% in the smoker group and 53.09 ± 5.88% in the non-smoking control group (P = 0.006). Superficial foveal and parafoveal, deep parafoveal VD were not statistically different between the groups (P = 0.120), (P = 0.337), (P = 0.287), respectively.

Conclusion:

In our study, there was an enlargement of FAZ and reduction of foveal VD at DCP in the eyes of smokers compared with non-smoking adults.

Impact of Carotid Endarterectomy on Choroidal Thickness and Volume in Enhanced Depth Optical Coherence Tomography Imaging

Purpose

Carotid endarterectomy (CEA) is considered an effective therapeutic method for improving ocular circulation. The choroid is a predominantly vascular tissue; thus, systemic and local vascular alterations may influence its morphology and function. The aim of the current study was to analyse changes in choroidal thickness and volume in patients with significant internal carotid artery stenosis (ICAS) before and after unilateral CEA.

Methods

The 42 eyes of the 21 asymptomatic patients included in the study were divided into two groups: those ipsilateral (EIE) and those contralateral (ECE) to CEA. All participants underwent a complete ophthalmologic examination, including enhanced depth imaging-optical coherence tomography (EDI-OCT). A comparative analysis of subfoveal thickness (CT) and choroidal volume (CV) measured in nine Early Treatment of Diabetic Retinopathy Study (ETDRS) subfields at baseline, on the 2nd day after CEA, and in the 3rd month after CEA was performed.

Results

In the EIE and ECE groups, no significant differences in either CT or CV values before and on the 2nd day after the CEA were observed. In the EIE group, a significant increase in CT and CV in the 3rd month after CEA compared to baseline was noted in the specific ETDRS region. Changes in CT and CV after surgery were positively correlated with the participants' physical activity status and diastolic blood pressure and negatively correlated with the participants' age and smoking status. Additionally, the analysis of changes in CV after CEA showed a positive correlation between the EIE and ECE groups.

Conclusions

CT and CV fluctuations in the central and perifoveal areas visualized with EDI-OCT enabled the observation of the processes of tissue adaptation to variable blood flow conditions.

The Effect of Smoking on Macular, Choroidal, and Retina Nerve Fiber Layer Thickness

Objectives

This study aimed to compare the thickness of the macula, choroid, and peripapillary retina nerve fiber layer (RNFL) in smokers with those of healthy, nonsmoking individuals using spectral domain optical coherence tomography (SD-OCT).

Materials and Methods

Sixty-eight healthy smokers with an average of 19.75 pack-years and 71 nonsmoker subjects (control group) were included in the study. Macular thickness, RNFL thickness, and choroidal thickness (CT) were measured by SD-OCT.

Results

The mean age of the smokers was 42.76±6.97 years and that of the control group was 41.15±11.61 years (p=0.32). Inferonasal and temporal RNFL thicknesses were 121.60±27.40 μm and 69.75±9.82 μm in the smokers group and 109.05±21.71 μm and 75.95±15.01 μm in the nonsmoker group, respectively. The differences were statistically significant (p=0.003, p=0.005, respectively). Central macular thickness (CMT) was 222.97±18.95 μm and subfoveal CT was 369.52±105.36 μm in the smoker group, while these values were 222.98±17.72 μm and 347.42±104.63 μm in the nonsmoker group, respectively. There were no significant differences in these comparisons (p=0.99, p=0.49, respectively). A significant negative correlation was found between smoking exposure and nasal and temporal CT.

Conclusion

The results of our study revealed that RNFL thickness was decreased but CMT and CT were not affected in healthy chronic smokers.

Systemic Disease and Long-term Intraocular Pressure Mean, Peak, and Variability in Nonglaucomatous Eyes

PURPOSE

Elevated intraocular pressure (IOP) is a well-known risk factor in glaucoma development and progression. As most glaucoma risk factors are not modifiable, IOP remains the sole focus of medical and surgical therapy. Identifying modifiable factors and their effects on IOP, such as systemic diseases, is therefore of interest. The objective is to assess the long-term, longitudinal relationship between systemic diseases and IOP mean, peak, and variability, including diabetes, hypertension, body mass index (BMI), and smoking status.

DESIGN

Secondary analysis of randomized clinical trial data.

METHODS

Longitudinal IOP and systemic disease data from the Age-Related Eye Disease Study (AREDS), a randomized clinical trial of high-dose antioxidants, was analyzed.

STUDY POPULATION

A total of 3909 older participants without a reported diagnosis of glaucoma or glaucoma treatment during AREDS with up to 12 years of annual IOP and systemic disease data.

MAIN OUTCOME MEASURES

Independent systemic disease risk factors associated with IOP.

RESULTS

Univariate analysis identified numerous systemic disease factors associated with IOP mean, peak, and variability. Longitudinal adjusted models identified diabetes, obesity, and systolic hypertension as significantly associated with increased IOP, while systemic beta-blocker use was inversely associated.

CONCLUSIONS

Results demonstrate a relationship between multiple systemic diseases and IOP; moreover, they demonstrate that systemic diseases influence additional parameters beyond mean IOP, such as IOP peak and variability. Although only to be taken within the context of IOP, these population-level trends reveal potentially modifiable factors in IOP control, and are particularly important in the context of increasing obesity and diabetes prevalence rates in American adults.

Clinical impact of migraine for the management of glaucoma patients

Migraine is a common and debilitating primary headache disorder that affects 10-15% of the general population, particularly people of working age. Migraine is relevant to providers of clinical eye-care because migraine attacks are associated with a range of visual sensory symptoms, and because of growing evidence that the results of standard tests of visual function necessary for the diagnosis and monitoring of glaucoma (visual fields, electrophysiology, ocular imaging) can be abnormal due to migraine. These abnormalities are measureable in-between migraine events (the interictal period), despite patients being asymptomatic and otherwise healthy. This picture is further complicated by epidemiological data that suggests an increased prevalence of migraine in patients with glaucoma, particularly in patients with normal tension glaucoma. We discuss how migraine, as a co-morbidity, can confound the results and interpretation of clinical tests that form part of contemporary glaucoma evaluation, and provide practical evidence-based recommendations for the clinical testing and management of patients with migraine who attend eye-care settings.

Ocular blood flow in polycystic ovary syndrome

AIM

The aim of this study was to evaluate whether the presence of polycystic ovary syndrome (PCOS) alters ocular blood flow parameters.

MATERIAL AND METHODS

Color Doppler imaging of the orbital vessels was performed in 41 eyes of 41 patients with PCOS. Forty-eight eyes of 48 age-matched volunteers served as controls. The ophthalmic artery (OA), the central retinal artery and the posterior ciliary artery were examined. Ocular blood flow indices of the peak systolic velocity, diastolic velocity, end-diastolic velocity, systolic/diastolic ratio, resistive index and pulsatility index were computed.

RESULTS

The peak systolic velocity, diastolic velocity and end-diastolic velocity of the OA, central retinal artery and posterior ciliary artery were significantly increased in PCOS patients in comparison to the controls (all P < 0.001). The mean systolic/diastolic ratio, resistive index and pulsatility index of the OA in PCOS patients were significantly decreased (all P < 0.05). Ocular blood flow velocity was positively correlated with serum luteinizing hormone, follicle-stimulating hormone and total cholesterol levels. There was a significant negative correlation between serum glucose and insulin levels and ocular blood flow velocity.

CONCLUSION

Ocular blood flow velocity is increased in PCOS patients and vascular resistance seems to decrease only in the OA.

Retinal nerve fibre layer, ganglion cell layer and choroid thinning in migraine with aura

BACKGROUND

The aim of this study was to investigate the thickness of the retinal nerve fiber layer (RNFL), the ganglion cell layer (GCL), and choroid thickness (CT) in patients who have migraines, with and without aura, using spectral optical coherence tomography (OCT).

METHODS

Forty-five patients who had migraines without aura (Group 1), 45 patients who had migraines with aura (Group 2), and 30 healthy participants (control group) were included in the study. Spectral OCT was used to measure the RNFL, GCL and CT values for all patients.

RESULTS

The mean age of Group 1, Group 2, and the control group was 34.6 ± 4.3, 32.8 ± 4.9, and 31.8 ± 4.6 years, respectively. The mean attack frequency was 3.6/month in Group 1 and 3.7/month in Group 2. The mean age among the groups (p = 0.27) and number of attacks in migraine patients (p = 0.73) were not significantly different. There was significant thinning in the RNFL and GCL in Group 2 (p < 0.05, p < 0.001 respectively), while there were no significant differences in RNFL and GCL measurements between Group 1 and the control group (p > 0.05). All groups were significantly different from one another with respect to CT, with the most thinning observed in Group 2 (p < 0.001). When all migraine patients (without grouping) were compared with the control group, there were significant differences on all parameters: RNFL thickness, GCC thickness and CT (p < 0.05).

CONCLUSIONS

RNFL and GCL were significantly thinner in the migraine patients with aura as compared with both the migraine patients without aura and the control subjects. In migraine, both with aura and without aura, patients' choroid thinning should be considered when evaluating ophthalmological findings.

Choroidal Thickening in Patients with Sleep Apnea Syndrome

Sleep apnoea syndrome (SAS) is characterised by repetitive episodes of cessation of breathing during sleep, resulting in hypoxaemia and hypercapnia. Ophthalmological consequences such as glaucoma, non-arteritic anterior ischaemic neuropathy and papilloedema are relevant to hypoxaemia. The choroid is a vascular structure that performs several regulatory functions for the retina. Defects in this structure contribute to degenerative, inflammatory, and neovascular changes in the retina. The authors examined the choroidal thickness (CT) in sleep apnoea patients using optical coherence tomograpy (OCT). The sleep apnoea patients were divided into subgroups according to their apnoea-hypopnoea index (AHI) scores, and statistical analysis was performed using the AHI and minimal arterial oxygen saturation (min. Spo₂) values. There was a medium-high negative correlation between CT and AHI (Spearman rho: r = -0.744, p = 0.000), and a positive correlation between CT and min. Spo₂ values (Pearson correlation: r = 0.308, p = 0.000).

A pilot study of an acupuncture protocol to improve visual function in retinitis pigmentosa patients

BACKGROUND

Patients with retinitis pigmentosa are motivated to try complementary or integrative therapies to slow disease progression. Basic science, clinical research and retinitis pigmentosa patients' self-reports support the hypothesis that acupuncture may improve visual function.

METHODS

A prospective, case series, pilot study enrolled 12 adult patients with RP treated at an academic medical centre with a standardised protocol that combined electroacupuncture to the forehead and below the eyes and acupuncture to the body, at 10 half-hour sessions over two weeks. Pre- and post-treatment tests included Early Treatment Diabetic Retinopathy Study visual acuity (VA), Pelli-Robson contrast sensitivity (CS), Goldmann visual fields, and dark-adapted full-field stimulus threshold (FST)(n = 9). Scotopic Sensitivity Tester-1 (SST-1) dark-adaptometry was performed on the last two subjects.

RESULTS

Six of 12 subjects had measurable, significant visual function improvements after treatment. Three of nine subjects tested with the FST had a significant 10.3 to 17.5 dB (that is, 13- to 53-fold) improvement in both eyes at one week after acupuncture, maintained for at least 10 to 12 months, which was well outside typical test-retest variability (95% CI: 3-3.5 dB) previously found in retinitis pigmentosa. SST-1 dark-adaptation was shortened in both subjects tested on average by 48.5 per cent at one week (range 36 to 62 per cent across 10 to 30 dB), which was outside typical coefficients of variation of less than 30 per cent previously determined in patients with retinitis pigmentosa and normals. Four of the five subjects with psychophysically measured scotopic sensitivity improvements reported subjective improvements in vision at night or in dark environments. One subject had 0.2 logMAR improvement in VA; another had 0.55 logCS improvement. Another subject developed more than 20 per cent improvement in the area of the Goldmann visual fields. The acupuncture protocol was completed and well tolerated by all, without adverse events or visual loss.

CONCLUSIONS

Acupuncture entails minimal risk, if administered by a well-trained acupuncturist and may have significant, measurable benefits on residual visual function in patients with retinitis pigmentosa, in particular scotopic sensitivity, which had not previously been studied. These preliminary findings support the need for future controlled studies of potential mechanisms.

Evaluation of retrobulbar blood flow in patients with age-related cataract; color Doppler ultrasonographic findings

Objectives

Cataracts are the most common cause of blindness worldwide, with cataract surgery being the most common ophthalmic procedure. To our best knowledge, this is the first case-control study with a large number of participants to evaluate ocular blood flow in patients with cataracts.

Materials and methods

Color Doppler and duplex sonography of the orbital vessels was performed in 224 eyes of 112 patients with known bilateral age-related cataracts and in 76 eyes of 38 healthy age- and sex-matched volunteers.

Results

The mean ± (standard deviation [SD]) of peak systolic velocity (PSV) of the ophthalmic artery in patients with cataracts (34.59 ± 22.49 cm/second) was significantly different to that in controls (52.11 ± 14.01 cm/second) (P < 0.001). The mean ± SD PSV of the central retinal artery in patients with cataracts (15.31 ± 4.93 cm/second) was significantly different to that in controls (9.61 ± 5.64 cm/second) (P < 0.001).

Conclusion

The mean PSV and resistive index (RI) of the ophthalmic and central retinal arteries were lower in cataract patients when compared with normal subjects. This suggests that ocular hypoperfusion and changes in ocular hemodynamic may have a role in the formation of age-related cataracts.

Ocular ischemia in high myopia treated with intravenous prostaglandin e1

BACKGROUND

High myopia is associated with a decreased ocular blood flow. In some cases this ocular ischemia may be the cause of severe visual loss.

METHODS

Three patients with high myopia and progressive loss of visual acuity had a diagnosis of ocular ischemia by color Doppler. Intravenous prostaglandin E1, a powerful vasodilator of the microcirculation, was used to treat the ocular ischemia in all 3 patients.

RESULTS

The visual acuity improved in all three cases with one patient improving from 20/100 to 20/30. The mean deficit of the visual fields in this patient improved from -19.08 to -9.52 after treatment. The treatment was repeated every 6 weeks to 8 weeks.

CONCLUSION

Patients with high myopia and progressive visual acuity loss should be evaluated for ocular ischemia. Intravenous prostaglandin E1 should be considered in those cases of ocular ischemia with visual loss. Unfortunately the effect does not last for more than 6 weeks to 8 weeks and needs to be repeated at this interval for extended periods.

Doppler ultrasound evaluation of facial transverse and infraorbital arteries: influence of smoking and aging process

BACKGROUND

Plastic surgeons are always concerned about integrity of facial vascularization in smokers and elderly candidates for face-lifting. Using Doppler ultrasound, this study aimed to evaluate influence of chronic smoking and aging on facial transverse and infraorbital artery blood flow.

METHODS

For this study, 40 healthy volunteer women were submitted to bilateral Doppler ultrasound of facial transverse and infraorbital arteries. Volunteers were divided into three groups: group 1 (13 nonsmoking women ages 18-33 years), group 2 (13 nonsmoking women ages 55-70 years), and group 3 (14 smoking women ages 55-70 years). Blood flow parameters measured were peak systolic velocity, end-diastolic velocity, resistivity index, and pulsatility index.

RESULTS

Chronic smoking did not cause statistically significant alterations in peak systolic velocity in any of the arteries. However, there was a significant augmentation of end-diastolic velocity and a reduction in resistivity and pulsatility index in both arteries. Aging process did not significantly alter any of the parameters evaluated. Findings in both sides of the face were similar for both arteries.

CONCLUSIONS

Chronic smoking significantly altered end-diastolic velocity, resistivity, and pulsatility index in regional arterial circulation of the face. Aging process, however, did not significantly influence any of blood flow parameters studied.

Acute effects of cigarette smoking on multifocal electroretinogram

BACKGROUND

Cigarette smoking was shown to have stimulant effects on pattern visual-evoked potentials. The aim of this study was to investigate the acute effects of cigarette smoking on multifocal electroretinogram (mfERG).

METHODS

This prospective case-control study was held in a tertiary referral centre in Turkish Armed Forces. mfERGs were investigated in a group of habitual smokers (30 right eyes of 30 subjects) in separate real smoking and sham smoking sessions. mfERG responses of the subjects were recorded after overnight abstinence. The responses were averaged over five retinal regions, the central hexagon (CH; central 6 degrees) and four concentric rings (ring 1 [R1; 7-12 degrees], ring 2 [R2; 13-18 degrees], ring 3 [R3; 19-24 degrees], ring 4 [R4; 25-30 degrees]). On each session mfERGs were recorded before (BS) and after smoking (AS) conditions.

RESULTS

Regarding P1 amplitudes (first positive deflection of the mfERG) in the real smoking sessions, the differences were significant in the CH (BS: 66.2 +/- 16.3 microV, AS: 73.3 +/- 19.6 microV, P < 0.001), in R1 (BS: 44.3 +/- 13.0, AS: 48.3 +/- 16.0, P = 0.004) and in R2 (BS: 30.1 +/- 8.3, AS: 33.7 +/- 9.7, P = 0.002). Similar results were found for N1 amplitudes and P1 and N1 (first negative deflection of the mfERG) latencies in the CH, R1 and R2. The differences in outer retinal areas (R3, R4) in the real smoking sessions and in all rings in the sham smoking sessions were not significant.

CONCLUSION

Cigarette smoking may stimulate the central retinal areas in the acute phase. This effect may be related with the stimulant effect of nicotine on neurotransmission, deleterious effects on retinal and/or choroidal circulation, carbon monoxide toxicity and nicotine withdrawal.

Postoperative complications following gingival augmentation procedures

BACKGROUND

Postoperative pain, swelling, and bleeding are the most common complications following soft tissue grafting procedures; however, detailed documentation is sparse in the literature. The aims of this prospective study were as follows: 1) to compare the frequency of complication occurrence after free soft tissue grafting (FSTG) or subepithelial connective tissue grafting (SCTG) procedures; 2) to evaluate the use of an acellular dermal matrix (ADM) as the donor tissue alternative to an FSTG or SCTG; and 3) to identify possible predictors for these complications.

METHODS

Seventy-five FSTG and 256 SCTG procedures were performed in 228 patients by a single operator. In five free soft tissue and 84 bilaminar graft procedures, an ADM was used instead of autogenous tissue. Variables such as the duration and location of procedures, smoking history, gender, and age were recorded. Patients were asked to fill out a questionnaire 1 week after the surgeries regarding postoperative pain, swelling, and bleeding. Data were analyzed using the chi2 test and logistic regression analysis. Odds ratios were calculated for moderate and severe adverse outcomes grouped together.

RESULTS

The duration of surgical procedures was highly correlated with pain or swelling post-surgically (P = 0.001). Current smokers were three times more likely to experience post-surgical swelling (P = 0.01). Patients who underwent FSTG procedures were three times more likely to develop post-surgical pain (P = 0.002) or bleeding (P = 0.03) compared to those who received SCTG procedures. When an ADM was applied instead of autogenous tissue, the probability of swelling or bleeding was significantly reduced (odds ratio [OR] = 0.46, P = 0.02 and OR = 0.3, P = 0.001, respectively).

CONCLUSIONS

Long surgical procedures and smoking may increase the severity and frequency of certain post-surgical complications after gingival augmentation procedures. FSTG procedures incur a higher likelihood for postoperative pain or bleeding than SCTG procedures, whereas the application of an ADM may significantly reduce the probability of swelling and bleeding.

Immediate Improvement in Penile Hemodynamics after Cessation of Smoking: Previous Results

OBJECTIVES

To assess the chronologic relationship between the cessation of smoking and the restoration of erectile function. Smoking is associated with an increased risk of erectile dysfunction.

METHODS

Twenty active smokers (20 to 40 cigarettes/day) affected by erectile dysfunction (International Index of Erectile Function 5-item score less than 21) were enrolled in the study. The mean age was 40 years. All the patients underwent penile color Doppler ultrasonography during the basic and dynamic phases (10 microg prostaglandin E1). A second Doppler evaluation was performed 24 to 36 hours after cessation of smoking. The peak systolic velocity (PSV) and end-diastolic velocity (EDV) were recorded. The PSV and EDV cutoff value was 30 cm/s and 5 cm/s, respectively.

RESULTS

Of the 20 patients, 10 (50%) had normal PSV values but only 5 (25%) had normal EDV values at the baseline Doppler evaluation. All the patients (100%) had normal PSV values at the second penile Doppler evaluation after smoking withdrawal, and 17 (85%) also had normal EDV values. The average PSV was 40.1 and 50.3 cm/s (P = 0.09) and the mean EDV was 6.8 and 2.4 cm/s (P <0.01) at the baseline penile Doppler examination and after smoking withdrawal, respectively.

CONCLUSIONS

Within 24 to 36 hours of the cessation of cigarette smoking, the color Doppler parameters demonstrated a significant improvement in EDV and a trend toward an increase in PSV. Additional clinical evaluation is required to further characterize the expeditious improvement in erectile function after the cessation of smoking.

Changes in cerebral and ocular hemodynamics in Behçet's disease assessed by color-coded duplex sonography

AIM

To quantify the cerebral and retrobulbar hemodynamics in Behçet's disease with and without ocular involvement and compared with that of healthy controls.

MATERIALS AND METHODS

Of 51 people studied, 17 had Behçet's disease with ocular involvement, 17 had Behçet's disease without ocular involvement, and 17 were healthy controls. A single eye was examined in each patient. Peak systolic velocity (PSV), end-diastolic velocity (EDV), time-averaged maximum velocity (Tamax), and resistance index (RI) were evaluated in the ophthalmic (OA), posterior ciliary (PCA), central retinal (CRA) and middle cerebral artery (MCA). Additionally, the average blood flow velocities in the central retinal vein (CRV), and acceleration time (AT) and pulsatility index (PI) in the MCA were calculated.

RESULTS

The mean EDV in the PCA was 25% lower and RI was higher in patients with ocular involvement of BD than in patients without involvement (p = 0.006 and p = 0.005, respectively) and in healthy controls (p = 0.003 and p = 0.004, respectively). Differences were smaller in comparisons of the CRA and absent on comparisons of the OA and MCA. The acceleration time of the MCA was significantly higher in patients with Behçet's disease than in healthy controls (p = 0.03).

CONCLUSION

This study suggests that the flow hemodynamics in retrobulbar circulation has more altered Behçet's disease with ocular involvement than without ocular involvement and healthy control. Additionally, the cerebral hemodynamic might be affected in patients with Behçet's disease compared with healthy controls.

Response of retinal blood flow to systemic hyperoxia in smokers and nonsmokers

BACKGROUND

We investigated the influence of chronic smoking on ocular vascular reactivity during breathing of 100% oxygen.

METHODS

Retinal vascular reactivity was tested during inhalation of 100% oxygen over 10 min. The observer-masked two-cohort study was performed in 24 healthy male volunteers (12 smokers and 12 nonsmokers) using the Zeiss Retinal Vessel Analyzer and laser Doppler velocimetry. From these parameters retinal blood flow was calculated.

RESULTS

Hyperoxia significantly decreased arterial (smokers: p<0.001 vs baseline; nonsmokers: p=0.003 vs baseline) and venous (smokers: p<0.001 vs baseline; nonsmokers: p<0.001 vs baseline) diameters. This decrease was significantly more pronounced in smokers (arterial diameter: p<0.001, venous diameter: p=0.003). Hyperoxia decreased venous blood flow velocity (smokers: p=0.02 vs baseline; nonsmokers: p<0.001 vs baseline) to a comparable degree (p=0.51). The two groups showed a comparable decrease in retinal blood flow during hyperoxia (smokers: p<0.001 vs baseline; nonsmokers: p<0.001 vs baseline; p=0.76 between groups). The decrease of PCO(2) during inhalation of 100% oxygen was significantly more pronounced in smokers than in nonsmokers (p=0.038).

CONCLUSION

The present study indicates an abnormal retinal vascular response to hyperoxia in smokers. Further studies are needed to identify possible neural or humoral factors involved in this shifted vasoconstrictory status in smokers.

Response of choroidal blood flow to carbogen breathing in smokers and non-smokers

AIM

To investigate a potential difference in ocular vascular reactivity during carbogen breathing in optic nerve head, choroid, and retina between healthy smokers and non-smokers.

METHODS

25 (13 smokers and 12 non-smokers) healthy male volunteers participated in this observer masked, two cohort study. During inhalation of carbogen (5% CO(2) and 95% O(2)) over 10 minutes measurements were taken using laser Doppler flowmetry to assess submacular choroidal and optic nerve head blood flow, laser interferometry to assess fundus pulsation amplitudes, and retinal vessel analyser (RVA) to assess retinal vessel diameters.

RESULTS

At baseline choroidal blood flow was higher (p = 0.018, ANOVA) in smokers than in non-smokers. During administration of carbogen the response in choroidal blood flow was significantly different between the two groups: there was an increase in non-smokers after carbogen breathing (p = 0.048) compared with relatively stable blood flow in smokers (p = 0.049 between groups, ANOVA). A similar response pattern was seen for fundus pulsation amplitude, which increased notably after carbogen breathing in non-smokers but not in smokers (p<0.001 between groups, ANOVA). Optic nerve head blood flow and retinal vessel diameters were reduced in both groups to a comparable degree during carbogen breathing.

CONCLUSION

The study indicated abnormal choroidal vascular reactivity in chronic smokers. These early haemodynamic changes may be related to the increased risk to smokers of developing ocular vascular diseases. The specific mechanisms underlying abnormal choroidal vascular reactivity in chronic smokers remain to be characterised.

Fluorophotometric Evaluation of Blood-Retinal Barrier Permeability in Patients with Essential Hypertension

<i>Aim:</i> The fluorophotometric evaluation of the blood-retinal barrier (BRB) integrity in patients with essential hypertension (EH) without signs of BRB damage. <i>Material and Methods:</i> 55 subjects participated in the study: 36 patients with EH and 19 normotensive healthy volunteers; 22 men and 33 women. The protocol included ophthalmic examination, fluorescein angiography, fluorophotometry, laboratory tests (total cholesterol, LDL and HDL cholesterol, triglycerides, fibrinogen, serum creatinine concentration, fasting glucose concentration, oral glucose test), urinary cotinine concentration measurement and cotinine-creatinine ratio (CCR) calculation. <i>Results:</i> BRB permeability (P_BRB) in patients with EH was significantly higher than in the control group (2.24 ± 0.68 vs. 1.64 ± 0.64 nm/s; p = 0.003). In hypertensive patients with CCR >50 ng/mg, the P_BRB was significantly higher than the P_BRB in healthy volunteers not exposed to smoke (2.32 vs. 1.68 nm/s; p < 0.05). <i>Conclusions:</i> The P_BRB in patients with EH is significantly higher than that in the normotensive control group, which shows the damaging effect of EH on the BRB.