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Youngblood H, Schoenlein PV, Pasquale LR, Stamer WD, Liu Y. Estrogen dysregulation, intraocular pressure, and glaucoma risk. Exp Eye Res 2023; 237:109725. [PMID: 37956940 PMCID: PMC10842791 DOI: 10.1016/j.exer.2023.109725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/20/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
Characterized by optic nerve atrophy due to retinal ganglion cell (RGC) death, glaucoma is the leading cause of irreversible blindness worldwide. Of the major risk factors for glaucoma (age, ocular hypertension, and genetics), only elevated intraocular pressure (IOP) is modifiable, which is largely regulated by aqueous humor outflow through the trabecular meshwork. Glucocorticoids such as dexamethasone have long been known to elevate IOP and lead to glaucoma. However, several recent studies have reported that steroid hormone estrogen levels inversely correlate with glaucoma risk, and that variants in estrogen signaling genes have been associated with glaucoma. As a result, estrogen dysregulation may contribute to glaucoma pathogenesis, and estrogen signaling may protect against glaucoma. The mechanism for estrogen-related protection against glaucoma is not completely understood but likely involves both regulation of IOP homeostasis and neuroprotection of RGCs. Based upon its known activities, estrogen signaling may promote IOP homeostasis by affecting extracellular matrix turnover, focal adhesion assembly, actin stress fiber formation, mechanosensation, and nitric oxide production. In addition, estrogen receptors in the RGCs may mediate neuroprotective functions. As a result, the estrogen signaling pathway may offer a therapeutic target for both IOP control and neuroprotection. This review examines the evidence for a relationship between estrogen and IOP and explores the possible mechanisms by which estrogen maintains IOP homeostasis.
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Affiliation(s)
- Hannah Youngblood
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA, USA
| | - Patricia V Schoenlein
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA, USA; Department of Radiology and Georgia Cancer Center, Augusta University, Augusta, GA, USA; Department of Surgery, Augusta University, Augusta, GA, USA
| | - Louis R Pasquale
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - W Daniel Stamer
- Department of Ophthalmology and Biomedical Engineering, Duke University, Durham, NC, USA
| | - Yutao Liu
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA, USA; James and Jean Culver Vision Discovery Institute, Medical College of Georgia, Augusta University, Augusta, GA, USA; Center for Biotechnology and Genomic Medicine, Augusta University, Augusta, GA, USA.
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Alizadeh Y, Moravvej Z, Soltani-Moghadam R, Dourandeesh M, Akbari M, Azaripour E, Medghalchi A, Sorouri ZZ, Motaghinia Z. Evaluation of Choroidal Thickness during Pregnancy and Postpartum: A Longitudinal Study. J Curr Ophthalmol 2022; 34:312-317. [PMID: 36644463 PMCID: PMC9832460 DOI: 10.4103/joco.joco_42_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 05/22/2022] [Accepted: 06/12/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose To assess the longitudinal changes of choroidal thickness using enhanced depth imaging optical coherence tomography (EDI-OCT) during pregnancy and postpartum. Methods The study included 23 eyes of 23 healthy pregnant women and 23 eyes of 23 healthy nonpregnant women. Choroidal thickness was measured manually with EDI-OCT at seven locations: The fovea, 500, 1000, and 1500 μm temporal (T) from the fovea and 500, 1000, and 1500 μm nasal (N) from the fovea. Measurements were obtained at each pregnancy trimester and 6 weeks postpartum and in the follicular phase of the menstrual cycle for the control group. Results The mean subfoveal choroidal thickness was 410.2 ± 82.4 μm, 434.8 ± 79.6 μm, 433.5 ± 80.3 μm, and 395.0 ± 71.1 μm in the first, second, and third trimesters and 6 weeks postpartum, respectively. In all seven measured locations, statistically significant changes were noted during pregnancy and postpartum in the choroidal thickness (P < 0.001). Choroidal thickness increased from the first trimester to the second and third trimester, after which it decreased at postpartum. Choroidal thickness was greater in the pregnant group during pregnancy and postpartum compared to the control group (P < 0.001). Conclusions This study indicated significant change in choroidal thickness at seven locations measured with EDI-OCT throughout pregnancy and 6 weeks after delivery. We showed that 6 weeks after delivery, choroidal thickness remains significantly higher than nonpregnant subjects.
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Affiliation(s)
- Yousef Alizadeh
- Department of Eye, Eye Research Center, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Moravvej
- Department of Eye, Eye Research Center, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran,Department of Ophthalmology, Hakim Hospital, Neyshabour University of Medical Sciences, Neyshabour, Iran,Address for correspondence: Zahra Motaghinia, Department of Ophthalmology, School of Medicine, Arak University of Medical Sciences, Arak, Iran. E-mail:
| | - Reza Soltani-Moghadam
- Department of Eye, Eye Research Center, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Maryam Dourandeesh
- Department of Eye, Eye Research Center, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mitra Akbari
- Department of Eye, Eye Research Center, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ebrahim Azaripour
- Department of Eye, Eye Research Center, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Abdolreza Medghalchi
- Department of Eye, Eye Research Center, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ziba Zahiri Sorouri
- Department of Obstetrics and Gynecology, Reproductive Health Research Center, Alzahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Motaghinia
- Department of Ophthalmology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
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The effect of postmenopausal hormonal drop on optic nerve head and peripapillary perfusion using optical coherence tomography angiography (OCTA). Sci Rep 2022; 12:18185. [PMID: 36307438 PMCID: PMC9616838 DOI: 10.1038/s41598-022-22844-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 10/20/2022] [Indexed: 12/31/2022] Open
Abstract
We studied the effect of menopause with subsequent estrogen drop on optic nerve head structure and peripapillary vasculature. This cross-sectional analytic study was carried out on 100 eyes of 100 patients; patients were divided into a premenopausal group (50 eyes) and a postmenopausal group (50 eyes). Optical coherence tomography was done to evaluate retinal nerve fiber layer thickness (RNFLT) and optical coherence tomography angiography (OCTA) to assess the peripapillary capillary vessel density. RNFLT as well as the peripapillary vessel density (VD) were significantly lower in the postmenopausal group (P value < 0.001) with increasing age, hormonal drop, and higher intraocular pressure (IOP), specifically in the inferior quadrant. However, the negative correlation between IOP and VD (r = - 0.541) was stronger than its negative correlation with RNFLT (r = - 0.318). Postmenopausal hormonal changes lead to a significant rise in IOP-although still not glaucomatous- and a decrease in the RNFLT and perfusion of the optic nerve. This confirms the relation between hormonal drop and glaucoma in postmenopausal women. Changes in peripapillary vascular density were more evident than RNFL in correlation with IOP and age changes. So, OCTA can be used to detect early optic nerve affection.
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Sochurek JAM, Gembicki M, Grisanti S, Ranjbar M. Vascular Choroidal Alterations in Uncomplicated Third-Trimester Pregnancy. Tomography 2022; 8:2609-2617. [PMID: 36287817 PMCID: PMC9608635 DOI: 10.3390/tomography8050218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/14/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022] Open
Abstract
(1) Purpose: To evaluate the anatomy and perfusion of choroidal substructures in third-trimester pregnant women using optical coherence tomography (OCT) and OCT angiography (OCTA) imaging. (2) Methods: In this cross-sectional study, women in their third trimester of uncomplicated pregnancy and non-pregnant age-matched women were recruited. Participants underwent enhanced depth imaging (EDI) OCT and OCTA. Subfoveal choroidal thickness (SFCT), as well as choroidal sublayer perfusion, were compared between groups. (3) Results: In total, 26 eyes of 26 pregnant and 26 eyes of 26 non-pregnant women were included. The median age in both groups was 29 years. The median SFCT was 332 (211–469) µm in the pregnant group and 371.5 (224–466) µm in the non-pregnant cohort (p = 0.018). The median choriocapillaris perfusion (CCP) was significantly lower in the pregnant group (46% vs. 48%, p = 0.039). Moreover, Haller’s layer perfusion correlated significantly with mean arterial pressure in non-pregnant women (CC = 0.430, p = 0.028) but not in pregnant ones (CC = 0.054, p = 0.792). (4) Conclusions: SFCT was found to be thinner and CCP was lower in third-trimester pregnant women. Hormonal changes during pregnancy and consecutive impacts on autoregulation of small choroidal vessels might play an important role. Therefore, altered choroidal measurements during third-trimester pregnancy should be carefully evaluated as, to some extent, it could be a normal physiological change.
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Affiliation(s)
- Jan A. M. Sochurek
- Laboratory for Angiogenesis and Ocular Cell Transplantation, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Michael Gembicki
- Department of Gynecology and Obstetrics, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Salvatore Grisanti
- Department of Ophthalmology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Mahdy Ranjbar
- Laboratory for Angiogenesis and Ocular Cell Transplantation, Ratzeburger Allee 160, 23538 Lübeck, Germany
- Department of Ophthalmology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
- Correspondence:
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Liu C, Wei P, Li J. The thickness changes of retina in high myopia patients during the third trimester of pregnancy: a pilot study. BMC Ophthalmol 2021; 21:382. [PMID: 34706696 PMCID: PMC8549153 DOI: 10.1186/s12886-021-02137-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/28/2021] [Indexed: 12/04/2022] Open
Abstract
Objectives To observe and compare the difference in retinal thickness using optical coherence tomography (OCT) between patients with high myopia (HM) during the third trimester of pregnancy and age-matched HM non-pregnant women. Methods A case-control study. A total of 39 eyes from 39 HM women in the third trimester (study group) and 50 eyes of 50 age-matched non-pregnant women with HM (control group) were included. All subjects underwent SD-OCT examination. The built-in software was used to measure the retinal thickness in macular region. The data from two groups were compared using independent-samples t test. Results Among the 89 subjects in this study, the mean gestational age of the study group was 35.09 ± 2.44 weeks, and the average age was 32.24 ± 3.75 years. The average age of the control group was 34.04 ± 7.19 years old. Compared with the control group, the average thickness of parafoveal area, and the average thickness of parafoveal superior, inferior, temporal quadrants of the superficial retina and the average thickness of the foveal and parafoveal of the superficial retina were significantly decreased in the study group (P < 0.05). Compared with the control group, the average thickness of all quadrants of the retina in the parafoveal area except the nasal quadrant were significantly decreased in the study group (P < 0.05). Conclusions In this observational study, the retinal thickness of patients with high myopia during the third trimester of pregnancy was thinner than that of non-pregnant women with age-matched high myopia.
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Affiliation(s)
- Chenchen Liu
- Department of Ophthalmology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Puying Wei
- Department of Ophthalmology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Jun Li
- Department of Ophthalmology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China.
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Identification of Estrogen Signaling in a Prioritization Study of Intraocular Pressure-Associated Genes. Int J Mol Sci 2021; 22:ijms221910288. [PMID: 34638643 PMCID: PMC8508848 DOI: 10.3390/ijms221910288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 12/12/2022] Open
Abstract
Elevated intraocular pressure (IOP) is the only modifiable risk factor for primary open-angle glaucoma (POAG). Herein we sought to prioritize a set of previously identified IOP-associated genes using novel and previously published datasets. We identified several genes for future study, including several involved in cytoskeletal/extracellular matrix reorganization, cell adhesion, angiogenesis, and TGF-β signaling. Our differential correlation analysis of IOP-associated genes identified 295 pairs of 201 genes with differential correlation. Pathway analysis identified β-estradiol as the top upstream regulator of these genes with ESR1 mediating 25 interactions. Several genes (i.e., EFEMP1, FOXC1, and SPTBN1) regulated by β-estradiol/ESR1 were highly expressed in non-glaucomatous human trabecular meshwork (TM) or Schlemm’s canal (SC) cells and specifically expressed in TM/SC cell clusters defined by single-cell RNA-sequencing. We confirmed ESR1 gene and protein expression in human TM cells and TM/SC tissue with quantitative real-time PCR and immunofluorescence, respectively. 17β-estradiol was identified in bovine, porcine, and human aqueous humor (AH) using ELISA. In conclusion, we have identified estrogen receptor signaling as a key modulator of several IOP-associated genes. The expression of ESR1 and these IOP-associated genes in TM/SC tissue and the presence of 17β-estradiol in AH supports a role for estrogen signaling in IOP regulation.
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Case Report: Focal Choroidal Excavation: Conversion from Conforming to Nonconforming in a Pregnant Female. Optom Vis Sci 2021; 98:199-205. [PMID: 33633017 DOI: 10.1097/opx.0000000000001648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Although rarely seen, clinicians should closely monitor patients, especially pregnant patients with focal choroidal excavation (FCE), as it can convert between subtypes and has been linked to pachychoroidal disease and potential for vision loss. PURPOSE This study aimed to report a case of the conversion of conforming FCE to nonconforming FCE with spontaneous resolution in a pregnant female. CASE REPORT A 35-year-old Indian woman presented with a slightly decreased vision in the right eye. The patient was 3 months pregnant at this visit. Her ocular history included stable conforming FCE in both eyes that was diagnosed 1 year earlier. Retinal pigmentary changes were noted in both eyes and consistent with previous examinations as being conforming FCEs in both eyes. Optical coherence tomography through the pigmented changes revealed FCE in the right eye with overlying serous fluid, with the left eye showing stable conforming FCE. She was diagnosed with a nonconforming FCE in the right eye secondary to her pregnancy. She was monitored with subsequent visits showing spontaneous resolution of the fluid and conversion back to a conforming FCE. CONCLUSIONS This case highlights the conversion of a conforming FCE to a nonconforming FCE with spontaneous resolution in a pregnant female. Similarities are seen in terms of pathophysiology with central serous chorioretinopathy, a fellow pachychoroidal disease, which also has pregnancy as a risk factor. Risk factors in pregnant patients such as increased cortisol and increased ocular blood flow may play an important part in the pathophysiology of the conditions, as they both result in choroidal hyperpermeability. Frequent monitoring and follow-up times are suggested for the patients. Lifelong monitoring is also indicated, as reoccurrences have been reported. Further research is needed at this time to elucidate the exact etiology of FCE and conversions between conforming and nonconforming FCE.
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Hepokur M, Gönen B, Hamzaoğlu K, Tüten A, Sarici AM. Investigation of Retinal Vascular Changes during Pregnancy Using Optical Coherence Tomography Angiography. Semin Ophthalmol 2021; 36:19-27. [PMID: 33566739 DOI: 10.1080/08820538.2021.1884268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To investigate retinal vascular changes in pregnant women using optical coherence tomography angiography (OCTA).Materials and Methods: This prospective, cross-sectional study included 97 pregnant women and age-matched 34 healthy control subjects. The OCTA parameters of one eye (left) of pregnancy group and control group were compared. Besides, the OCTA parameters of three trimesters were compared between themselves and the control group. The foveal avascular zone (FAZ) area and the vessel density percentages of the superficial capillary plexus (SCP), deep capillary plexus (DCP), and radial peripapillary capillary (RPC) of all the groups were evaluated by OCTA.Results: In the pregnancy group, the vessel density of DCP was higher in all regions than the control group except the foveal region, but this difference could not reach statistical significance. On the other hand, the vessel density of SCP in the pregnancy group did not show a manifest change in all regions except the foveal region as in DCP. Although the FAZ area was wider in pregnancy group, this difference was not statistically significant (p:0.661). There was no statistically significant difference observed in vessel density of SCP, DCP, and RPC between the different trimesters and the control group, and none of these data correlated with the gestational week.Conclusion: This study showed retinal vascular changes secondary to pregnancy, especially in the vessel density of DCP. These results can provide information that should be taken into account in the evaluation and investigation of pregnancy-specific retinal vascular pathologies.
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Affiliation(s)
- Mustafa Hepokur
- Department of Ophthalmology, Istanbul Medeniyet University Göztepe Training and Research Hospital, Istanbul, Turkey
| | - Busenur Gönen
- Department of Ophthalmology, Istanbul University-Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Kübra Hamzaoğlu
- Department of Obstetrics and Gynecology, Istanbul University-Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Abdullah Tüten
- Department of Obstetrics and Gynecology, Istanbul University-Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Ahmet Murat Sarici
- Department of Ophthalmology, Istanbul University-Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
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Shalaby HS, ElSebaay ME, Samy MM. Comparison Between Central Choroidal Thickness in Pregnant Diabetic Females and Pregnant Non-Diabetic Females. Clin Ophthalmol 2021; 15:105-111. [PMID: 33469256 PMCID: PMC7811481 DOI: 10.2147/opth.s289514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/31/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To compare choroidal thickness in pregnant women with and without diabetes mellitus (DM). Methods Sixty pregnant females (60 eyes) were enrolled in this cross-sectional controlled study. They were divided into two groups: Group A (30 patients; 30 eyes) were pregestational diabetic pregnant females, while Group B (30 patients; 30 eyes) were non-diabetic pregnant females. Exclusion criteria were high-risk pregnancy, diabetic retinopathy in Group A subjects, systemic or ophthalmological pathology, drug intake other than vitamin supplements and diabetic medications, and large errors of refraction. All patients underwent full ophthalmological examination and enhanced depth imaging optical coherence tomography (EDI-OCT) to measure the choroidal thickness in the nine zones of the Early Treatment Diabetic Retinopathy Study (ETDRS) map. Results Our results show that Group A eyes (of pregnant diabetic females) had a highly significant greater choroidal thickness than Group B eyes (of pregnant non-diabetic females) in all nine zones of the ETDRS map (p-value <0.01). Moreover, we found a positive linear correlation between the duration of DM and the degree of choroidal thickening. Conclusion Pregnant diabetic females have a thicker choroid than that of pregnant non-diabetic females.
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Affiliation(s)
- Hisham Samy Shalaby
- Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Mohamed Mahmoud Samy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Evaluation of choroidal thickness and choroidal vascularity index during pregnancy. CANADIAN JOURNAL OF OPHTHALMOLOGY 2021; 56:237-243. [PMID: 33421377 DOI: 10.1016/j.jcjo.2020.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 11/01/2020] [Accepted: 12/04/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess the choroidal structural characteristics in the first and third trimesters in pregnant women using enhanced depth imaging optical coherence tomography and binarization method. DESIGN Prospective study. PARTICIPANTS Twenty-five eyes of 25 pregnant women in the first trimester (group 1) and 25 eyes of 25 pregnant women in the third trimester (group 2) were examined. Healthy age-matched 25 participants were enrolled as a control group (group 3). METHODS The choroidal thickness (CT) was measured at 3 points; subfoveal, 1500 μm nasal to the fovea, and 1500 μm temporal to the fovea. Total choroidal area, luminal area, stromal area, stroma/lumen ratio, and choroidal vascularity index (CVI) were measured by Image-J software. RESULTS The mean subfoveal and nasal CT were statistically significantly increased in group 1 compared with controls (p = 0.005 and p = 0.004, respectively). The mean temporal CT was statistically significantly increased in group 1 compared with groups 2 and 3 (group 1 vs group 2, p = 0.043; group 1 vs group 3, p = 0.011). The mean total choroidal area, stromal area, and luminal area were significantly increased in groups 1 and 2 compared with control group (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, p = 0.002, p = 0.002, respectively). There were no statistically significant differences among groups in terms of mean stroma/lumen ratio and CVI (p = 0.148 and p = 0.312, respectively). CONCLUSIONS There was a significant increase in subfoveal, temporal, and nasal CT in the first trimester. Total choroidal, stromal, and luminal areas were significantly increased in the first and third trimesters.
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Kızıltunç PB, Varlı B, Büyüktepe TÇ, Atilla H. Ocular vascular changes during pregnancy: an optical coherence tomography angiography study. Graefes Arch Clin Exp Ophthalmol 2019; 258:395-401. [PMID: 31754828 DOI: 10.1007/s00417-019-04541-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/29/2019] [Accepted: 11/07/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Pregnancy is a period presenting with many physiological adaptation mechanisms. One of the structures in which these mechanisms are observed is ocular tissues. The cornea, lacrimal and meibomian glands, and chorioretinal complex are all among the structures affected by changes during pregnancy. In this study we aimed to evaluate the macular and optic disc vessel density (VD) changes by Optical Coherence Tomography Angiography (OCTA) imaging in pregnancy. METHODS A total of 248 eyes from 124 pregnant women and 80 eyes from 40 healthy control women were involved. Vessel densities of macula were evaluated for superficial capillary plexus (SCP) and deep capillary plexus (DCP) in whole macula, foveal, parafoveal and perifoveal region. Peripapillary and whole optic disc VDs were also evaluated. Vessel densities of macula and optic disc were compared between control individuals and pregnant women. Vessel densities in different trimesters were also evaluated. RESULTS Modest but significant differences in VDs of whole macula of SCP and DCP were observed in pregnancy group. Additionally, perifoveal and parafoveal region of SCP, whole disc and radial peripapillary capillary VD were significantly higher in pregnancy group. There was no correlation between VD ratios of macula and optic disc and pregnancy weeks and trimesters. CONCLUSIONS This is the first study focusing on the OCTA parameters in pregnant individuals. These findings suggest that physiological changes during pregnancy are not limited to the cornea, eyelids and the choroid but also to the retinal and optic disc vasculature.
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Affiliation(s)
- Pınar Bingöl Kızıltunç
- Department of Ophthalmology, Ankara University School of Medicine, Vehbi Koç Eye Bank, Mamak, Ankara, Turkey.
| | - Bulut Varlı
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Tuna Çelik Büyüktepe
- Department of Ophthalmology, Ankara University School of Medicine, Vehbi Koç Eye Bank, Mamak, Ankara, Turkey
| | - Huban Atilla
- Department of Ophthalmology, Ankara University School of Medicine, Vehbi Koç Eye Bank, Mamak, Ankara, Turkey
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Chen W, Li L, Zhang H, Li Y, Chen X, Zhang Y. Macular choroidal thickness in highly myopic women during pregnancy and postpartum: a longitudinal study. BMC Pregnancy Childbirth 2018; 18:220. [PMID: 29884130 PMCID: PMC5994060 DOI: 10.1186/s12884-018-1865-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 05/29/2018] [Indexed: 12/05/2022] Open
Abstract
Background High myopia, a cause of serious visual impairment, is a significant global public health concern. We investigate longitudinal changes in macular choroidal thickness (CT) during pregnancy and 6-months postpartum in women with high myopia (HM). Methods A prospective longitudinal study was conducted in HM-pregnant women during the course of pregnancy (n = 42 eyes, 42 patients) and 6 months postpartum (n = 40 eyes, 40 patients, two cases lost).Macular CT was measured via enhanced-depth imaging (EDI)-optical coherence tomography (OCT) (EDI-OCT). Intraocular pressure (IOP), axial length (AL), refractive error, mean arterial pressure (MAP), mean ocular perfusion pressure (MOPP), and body mass index (BMI) were also measured. Results Macular CTs of HM pregnant women (214.3 ± 52.3 μm) had increased significantly during the third trimester of pregnancy compared with postpartum women (192.7 ± 51.9 μm, p = 0.014). No significant differences in AL, refractive error, or MAP were found between pregnant and postpartum groups (p > 0.05 for all parameters).During pregnancy, macular CT was negatively correlated with AL (first trimester: p = 0.010; second trimester: p = 0.013; and third trimester: p = 0.008) and positively correlated with refractive error (first trimester: p = 0.038; second trimester: p = 0.024; and third trimester: p = 0.010). No correlations between macular CT and age, IOP, MOPP, MAP, or BMI were found. Conclusions Our study revealed the presence of a significantly thicker choroid during the third trimester of pregnancy compared with 6-mo postpartum in HM women. Macular CT positively correlated with refractive error and negatively correlated with AL during pregnancy, but did not correlate with gestational age, MOPP, IOP, MAP, or BMI.
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Affiliation(s)
- Wei Chen
- Clinical College of Ophthalmology, Tianjin Medical University, No.4, Gansu Road, Tianjin City, People's Republic of China
| | - Li Li
- Clinical College of Ophthalmology, Tianjin Medical University, No.4, Gansu Road, Tianjin City, People's Republic of China
| | - Hongyuan Zhang
- Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, China
| | - Yan Li
- Clinical College of Ophthalmology, Tianjin Medical University, No.4, Gansu Road, Tianjin City, People's Republic of China
| | - Xu Chen
- Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, China
| | - Yue Zhang
- Clinical College of Ophthalmology, Tianjin Medical University, No.4, Gansu Road, Tianjin City, People's Republic of China.
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Siesky B, Harris A, Patel C, Klaas C, Harris M, McCranor L, Lauer J, Kaplan B. Comparison of Visual Function and Ocular Hemodynamics between Pre- and Post-Menopausal Women. Eur J Ophthalmol 2018; 18:320-3. [DOI: 10.1177/112067210801800228] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The incidence of eye disease increases with age and can often be linked to worsening cardiovascular function and increasing intraocular pressure. Estrogen is known to have vasodilatory effects in the systemic circulation. Decreased estrogen levels during menopause may therefore complicate or contribute to ocular pathologies as estrogen receptors are found in both retinal and choroidal tissue. The purpose of this investigation was to determine the effects of menopause on visual function and cardiovascular and ocular hemodynamics. Methods Twelve premenopausal and 24 postmenopausal women were evaluated at the Indiana University School of Medicine during a single study visit. Vision screening and ocular blood flow evaluations were performed, including blood pressure, heart rate, visual acuity, contrast sensitivity, intraocular pressure, and retinal capillary and retrobulbar blood flow imaging. Vision and ocular hemodynamics were compared using unpaired Student t-tests with pp<0.05 regarded as statistically significant. Results The premenopausal group had significantly lower heart rate (-16.1 b/m, p=0.0001) and systolic blood pressure (-17.7 mmHg, p=0.003) than postmenopausal subjects. Contrast sensitivity was significantly higher (measured in log units) in premenopausal women in both the right (0.25, p=0.039; 0.16, p=0.039) and left (0.45, p=0.001; 0.27, p=0.032) eyes at 9 and 18 cycles per degree, respectively. Premenopausal women also had significantly lower intraocular pressure in both the right (-2.19 mmHg, p=0.024) and left (-1.74 mmHg, p=0.035) eyes. Total ocular perfusion was not significantly different between groups. Conclusions This pilot work suggests that postmenopausal women have lower contrast sensitivity detection and elevated intraocular pressures compared to premenopausal women. Premenopausal women have lower cardiovascular risk factors, while total ocular circulation was similar to post-menopausal women.
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Affiliation(s)
- B.A. Siesky
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis - USA
| | - A. Harris
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis - USA
| | - C. Patel
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis - USA
| | - C.L. Klaas
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis - USA
| | - M. Harris
- Department of Gynecology, Rabin Medical Center, Petah-Tikva - Israel
| | - L.J. McCranor
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis - USA
| | - J. Lauer
- Department of Ophthalmology, Medical University of Gdansk, Gdansk - Poland
| | - B. Kaplan
- Department of Gynecology, Rabin Medical Center, Petah-Tikva - Israel
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Choroidal Thickness in Women with Uncomplicated Pregnancy: Literature Review. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5694235. [PMID: 29250544 PMCID: PMC5700513 DOI: 10.1155/2017/5694235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/09/2017] [Indexed: 11/24/2022]
Abstract
Pregnancy is a time when many changes occur in a woman's body. The goal of these changes is the provision of optimum conditions for the development of the foetus. Pregnancy also affects eye physiology. Well recognized physiological changes include a reduced corneal sensitivity, an increase in its central thickness and curvature, and a decrease in intraocular pressure. The association between choroidal thickness and pregnancy is not clear. Haemodynamic and hormonal changes taking place during pregnancy and the question of whether these changes are reflected by choroidal thickness are especially important. It is assumed that the choroid, which is one of the most highly vascularized tissues characterized by the highest blood flow to tissue volume ratio in the whole body, should respond by an increase in its thickness to an increase in blood flow and drop in the value of peripheral resistance. Measurement of choroidal thickness using enhanced depth imaging optical coherence tomography (EDI-OCT) in women with uncomplicated pregnancy provides important information concerning the effects of physiological changes in the eye.
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Wang C, Li AL, Pang Y, Lei YQ, Yu L. Changes in intraocular pressure and central corneal thickness during pregnancy: a systematic review and Meta-analysis. Int J Ophthalmol 2017; 10:1573-1579. [PMID: 29062778 DOI: 10.18240/ijo.2017.10.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 08/10/2017] [Indexed: 01/29/2023] Open
Abstract
AIM To conduct a Meta-analysis for investigating the variations in intraocular pressure (IOP) and central corneal thickness (CCT) during normal pregnancy. METHODS We searched for clinical trials published up to November 2015 without language or region restrictions in PubMed, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials, Ovid, EBSCO, Elsevier, the Chinese Biomedicine Database, WanFang, CNKI, CQVIP and Google Scholar. Studies of the ocular changes observed in pregnant women were selected. The main outcomes were assessed by changes in IOP and CCT. RESULTS Fifteen studies were included. In subgroup analyses, IOP was significantly decreased during the second MD=-1.53, 95%CI (-2.19, -0.87); P<0.00001, and third MD=-2.91, 95%CI (-3.74, -2.08); P<0.00001 trimesters of pregnancy. CCT was increased during the second MD=10.12, 95%CI (2.01, 18.22); P=0.01, trimester of pregnancy; moreover, during the third trimester of pregnancy, the CCT displayed an increasing trend, but the difference was not significant MD=5.98, 95%CI (-1.11, 13.07); P=0.1. CONCLUSION A decrease in IOP is accompanied by an increase in CCT in the second and third trimesters of a normal pregnancy in women.
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Affiliation(s)
- Chao Wang
- Department of Ophthalmology, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Ai-Ling Li
- Department of the School of Public Health of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Yu Pang
- Department of Ophthalmology, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Ying-Qing Lei
- Department of Ophthalmology, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Ling Yu
- Department of Ophthalmology, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
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Takahashi J, Kado M, Mizumoto K, Igarashi S, Kojo T. Changes in Subfoveal Choroidal Thickness During Pregnancy and After Delivery. Ophthalmic Surg Lasers Imaging Retina 2017; 48:816-821. [PMID: 29020425 DOI: 10.3928/23258160-20170928-06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 05/30/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE This study was performed to investigate longitudinal changes in the subfoveal choroidal thickness (SFCT) during pregnancy and after delivery. PATIENTS AND METHODS The SFCT was measured in the first and third trimesters, shortly after delivery, and 1 month after delivery in 25 eyes of 25 women. Enhanced depth imaging optical coherence tomography was used for measurement. RESULTS The mean SFCT was 347 μm ± 86 μm, 329 μm ± 81 μm, 333 μm ± 81 μm, and 330 μm ± 87 μm in the first and third trimesters, shortly after delivery, and 1 month after delivery, respectively. The SFCT in the first trimester was significantly greater than that in the third trimester, shortly after delivery, and 1 month after delivery. CONCLUSIONS This study indicates that the SFCT is greater in the first trimester and decreases in the third trimester of pregnancy. The SFCT does not subsequently change until 1 month after delivery. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:816-821.].
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Abstract
BACKGROUND Transient monocular vision loss (TMVL) is an alarming symptom owing to potentially serious etiologies such as thromboembolism or giant cell arteritis. Our objective is to describe the phenomenon of TMVL present on awakening, which may represent a distinct and benign entity. METHODS We performed a retrospective observational case series of 29 patients who experienced TMVL on awakening. Patients who described monocular dimming or blackout of vision were included, and those with blurred vision, concurrent eye pain, and binocular vision loss were excluded. Descriptive statistics were used to summarize the study population. RESULTS Of the 29 patients we studied, 90% (n = 26) were female and 48% had crowded discs (cup-to-disc ratio ≤0.2). The mean age was 45.4 years, although women were significantly younger than men (mean ages 43.4 and 62.7 years, respectively, P = 0.017). Brain magnetic resonance imaging and vascular imaging (magnetic resonance angiography, computed tomographic angiography, or carotid Doppler) were performed in 69% and 55% of cases, respectively, and were uniformly negative. In 14 patients for whom clear follow-up data could be obtained, no medically or visually significant sequelae of this syndrome were found, and 50% experienced resolution of symptoms. CONCLUSIONS Evaluation was uniformly negative when patients described waking with isolated vision loss in 1 eye with subsequent resolution, usually in less than 15 minutes. The natural history seems benign with symptoms frequently remitting spontaneously. This visual phenomenon may represent an autoregulatory failure resulting in a supply/demand mismatch during low-light conditions.
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Comparison of subfoveal choroidal thickness in healthy pregnancy and pre-eclampsia. Eye (Lond) 2015; 30:349-54. [PMID: 26541086 DOI: 10.1038/eye.2015.215] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 09/12/2015] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Pregnancy is a known predisposing factor for central serous chorioretinopathy (CSC). Choroidal thickness (CT) increases in patients with CSC. This study was designed to evaluate CT in pregnant women.Patients and methodsThis was a prospective study. Fourteen healthy pregnant women and seven patients with pre-eclampsia were included. Twenty-one normal subjects were also recruited. CT was measured using enhanced-depth imaging optical coherence tomography. RESULTS The mean CT of normal subjects, healthy pregnant women and patients with pre-eclampsia were 264.95±21.03, 274.23±29.30 and 389.79±25.13 μm, respectively (normal subjects vs healthy gravidas: P>0.05; normal subjects vs pre-eclampsia: P<0.001; healthy gravidas vs pre-eclampsia: P<0.001). CT decreased from 381.05±22.96 μm to 335.17±9.97 μm 1 week after delivery in patients with pre-eclampsia. CONCLUSIONS Pregnancy itself did not increase CT, whereas pre-eclampsia did appear to result in increased CT. This suggests that additional unknown factors induce hyperpermeability in pregnant women.
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Ulusoy DM, Duru N, Ataş M, Altınkaynak H, Duru Z, Açmaz G. Measurement of choroidal thickness and macular thickness during and after pregnancy. Int J Ophthalmol 2015; 8:321-5. [PMID: 25938049 DOI: 10.3980/j.issn.2222-3959.2015.02.19] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 07/15/2014] [Indexed: 01/10/2023] Open
Abstract
AIM To investigate the effect of pregnancy on subfoveal choroidal thickness (SFCT) and macular thickness in both pregnant and not pregnant healthy women. METHODS Twenty-nine healthy pregnant women in their third trimester and 36 age-matched healthy women were enrolled in a prospective, cross-sectional study. Foveal and parafoveal thickness in the four quadrants and SFCT were measured by optical coherence tomography (OCT) in the healthy pregnant women (i.e. study group) and healthy women (i.e. control group). OCT measurements were again measured 3mo after delivery in the study group. RESULTS Mean SFCT measurements in the control group, pregnant women of the study group, and after delivery of the study group were 320.86±59.18 µm, 387.97±59.91 µm, and 332.40±26.03 µm, respectively. There was a statistically significant difference in the mean SFCT values between pregnant women of the study group and the control group (P=0.000). Foveal and parafoveal thickness values were not statistically significant in either the study or control group. CONCLUSION SFCT increases during pregnancy and returns to normal range in the three months after delivery. Macular thickness does not show any change during pregnancy.
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Affiliation(s)
- Döndü Melek Ulusoy
- Department of Ophthalmology, Kayseri Education and Research Hospital, Kayseri 38010, Turkey
| | - Necati Duru
- Department of Ophthalmology, Ankara Atatürk Education and Research Hospital, Ankara 06400, Turkey
| | - Mustafa Ataş
- Department of Ophthalmology, Kayseri Education and Research Hospital, Kayseri 38010, Turkey
| | - Hasan Altınkaynak
- Department of Ophthalmology, Ankara Atatürk Education and Research Hospital, Ankara 06400, Turkey
| | - Zeynep Duru
- Department of Ophthalmology, Ankara Numune Education and Research Hospital, Ankara 06400, Turkey
| | - Gökhan Açmaz
- Department of Obstetrics and Gynecology, Kayseri Education and Research Hospital, Kayseri 38010, Turkey
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Kim YH, Lee MV, Ahn JH. Comparison of Ocular Pulse Amplitude Measured Using Dynamic Contour Tonometry and Ocular Blood Flow Analyzer. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.12.1906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yong Hyun Kim
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
| | - Mar Vin Lee
- Department of Ophthalmology, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Jae Hong Ahn
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
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Kara N, Sayin N, Pirhan D, Vural AD, Araz-Ersan HB, Tekirdag AI, Yildirim GY, Gulac B, Yilmaz G. Evaluation of Subfoveal Choroidal Thickness in Pregnant Women Using Enhanced Depth Imaging Optical Coherence Tomography. Curr Eye Res 2014; 39:642-7. [DOI: 10.3109/02713683.2013.855236] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Sayin N, Kara N, Pirhan D, Vural A, Araz Ersan HB, Tekirdag AI, Polat I, Gulac B, Yilmaz G. Subfoveal Choroidal Thickness in Preeclampsia: Comparison with Normal Pregnant and Nonpregnant Women. Semin Ophthalmol 2013; 29:11-7. [DOI: 10.3109/08820538.2013.839813] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Takahashi J, Kado M, Mizumoto K, Igarashi S, Kojo T. Choroidal thickness in pregnant women measured by enhanced depth imaging optical coherence tomography. Jpn J Ophthalmol 2013; 57:435-9. [PMID: 23864270 DOI: 10.1007/s10384-013-0265-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 06/21/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE To measure choroidal thickness in healthy pregnant women using enhanced depth imaging optical coherence tomography (EDI-OCT) and compare the measurements with those of healthy non-pregnant women. METHODS Choroidal thickness was measured at the fovea and at 3 mm superior, inferior, temporal, and nasal to the fovea using EDI-OCT in both healthy pregnant and non-pregnant women. RESULTS The mean choroidal thickness in pregnant women was 275 ± 84 μm at the subfoveal and 307 ± 89, 277 ± 89, 274 ± 74, and 159 ± 60 μm at 3 mm superior, inferior, temporal, and nasal to the fovea, respectively. In comparison, the mean choroidal thickness in non-pregnant women was 273 ± 92 μm at the subfoveal and 301 ± 73, 290 ± 76, 293 ± 77, and 149 ± 55 μm at 3 mm superior, inferior, temporal, and nasal to the fovea, respectively. No significant statistical differences were found for choroidal thickness between the pregnant and non-pregnant women at any of the measurement points. CONCLUSIONS The results of this study demonstrate that the choroidal thickness was not significantly different between healthy pregnant and non-pregnant women.
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Affiliation(s)
- Junichi Takahashi
- Department of Ophthalmology, Sapporo Kosei General Hospital, Kita 3 Higashi 8, Chuo-ku, Sapporo, 060-0033, Japan,
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24
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Pregnancy and Glaucoma. Surv Ophthalmol 2011; 56:324-35. [DOI: 10.1016/j.survophthal.2010.11.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 11/25/2010] [Accepted: 11/30/2010] [Indexed: 11/18/2022]
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25
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Nagaoka T, Sato E, Takahashi A, Sogawa K, Yokota H, Yoshida A. Effect of aging on retinal circulation in normotensive healthy subjects. Exp Eye Res 2009; 89:887-91. [PMID: 19664620 DOI: 10.1016/j.exer.2009.07.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Revised: 07/12/2009] [Accepted: 07/20/2009] [Indexed: 10/20/2022]
Abstract
Although it is important to investigate the effects of normal aging on the ocular circulation, few studies have examined the effects of aging on the retinal microcirculation in healthy subjects. The purpose of this study was to evaluate the effects of aging on the retinal microcirculation in healthy men. Forty-five healthy men were divided into three groups based on age (young, middle-aged, elderly). We measured vessel diameter and blood velocity and calculated the retinal blood flow (RBF) and wall shear rate (WSR) in the retinal arteries. We performed pulse wave analysis obtained from the retinal blood velocity measurements. We also divided the subjects into two groups based on the presence or absence of prehypertension defined as 120-139/80-89 mmHg. No significant differences in vessel diameter, blood velocity, RBF, and WSR were seen among the groups. Pulse wave analysis showed significant increases in upstroke time (UT) in elderly men compared with young men (P < 0.05). Multiple regression analysis showed that the UT was correlated with age in all subjects. A significant difference was seen only in the UT between subjects with and without prehypertension. The UT calculated from the retinal blood velocity profile is associated significantly with aging, suggesting that measurement of the UT may detect the changes in the retinal and the systemic vessels with increasing age. The UT is the only parameter that increased significantly in subjects with prehypertension compared with those without prehypertension, suggesting that the UT may indicate the effects of prehypertension on the retinal arterioles.
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Affiliation(s)
- Taiji Nagaoka
- Department of Ophthalmology, Asahikawa Medical College, 2-1-1-1 Midorigaoka Higashi, Asahikawa 078-8502, Japan.
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Sex steroid and tropic hormone levels may be associated with postoperative prognosis of vitrectomy in Korean postmenopausal women: a pilot study. Menopause 2009; 17:161-5. [PMID: 19602989 DOI: 10.1097/gme.0b013e3181aa2734] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the postoperative prognostic value of sex hormones and related biochemical markers for vitrectomy in postmenopausal Korean women. METHODS Twenty-three postmenopausal women undergoing vitrectomy who had not received hormone therapy were recruited. Before vitrectomy, hormonal profile such as follicle-stimulating hormone, estradiol, testosterone, tumor markers, and biochemical markers including homocysteine, glycosylated hemoglobin, protein, albumin, and lipid panel was measured. These parameters were correlated with ophthalmologic outcomes such as intraocular pressure, preoperative and postoperative visual acuity, and the visual improvement after surgery. RESULTS Follicle-stimulating hormone showed a positive correlation with the logarithm of the minimal angle of resolution value of postoperative visual acuity (Pearson's correlation, 0.583; P = 0.009). This significance was maintained after age or preoperative visual acuity was adjusted (P = 0.006 and P = 0.013, respectively). Testosterone also showed a positive correlation with intraocular pressure before and after adjustment for age (P = 0.027 and P = 0.033, respectively). CONCLUSIONS Sex steroid and tropic hormones may be associated with postoperative ophthalmologic outcomes in the postmenopausal women undergoing vitrectomy. Further larger scale studies will be necessary to confirm these preliminary results.
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Affiliation(s)
- Christoph Kniestedt
- Department of Ophthalmology, University Hospital Zurich (USZ), Zurich, Switzerland
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The effects of raloxifene hydrochloride on ocular hemodynamics and visual function. Int Ophthalmol 2008; 29:225-30. [PMID: 18427730 DOI: 10.1007/s10792-008-9224-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Accepted: 03/25/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the comprehensive effects of raloxifene hydrochloride on retinal, choroidal and retrobulbar hemodynamics and on visual function in post-menopausal women. DESIGN Twenty-four post-menopausal women (age 55 +/- 3.8 years) were recruited for this cross-sectional study: 12 received placebo and 12 received raloxifene hydrochloride 60 mg once a day for 3 months. Baseline measurements of both groups included heart rate (HR), blood pressure (BP), visual acuity, contrast sensitivity and intraocular pressure (IOP) for both eyes. A comprehensive ocular blood flow (OBF) assessment was obtained for each patient in a randomly chosen study eye. Retinal blood flow data was obtained using confocal scanning laser Doppler flowmetry [Heidelberg Retinal Flowmeter (HRF)]. Color Doppler imaging (CDI) was used to assess retrobulbar hemodynamics in the ophthalmic, central retinal, short nasal and temporal posterior ciliary arteries. Baseline vision and hemodynamics in post-menopausal subjects were compared using paired Student's t tests, and the percentage change in baseline versus 3-month parameters was analyzed. RESULTS There were no statistically significant differences between 3 months of raloxifene therapy and placebo in terms of age, HR, arterial or mean BP, visual acuity, contrast sensitivity, IOP or retinal or retrobulbar blood flow. CONCLUSION Raloxifene therapy at 60 mg/day had no clinically significant impact on BP, IOP or OBF in post-menopausal women.
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Abramov Y, Borik S, Yahalom C, Fatum M, Avgil G, Brzezinski A, Banin E. Does Postmenopausal Hormone Replacement Therapy Affect Intraocular Pressure? J Glaucoma 2005; 14:271-5. [PMID: 15990606 DOI: 10.1097/01.ijg.0000169390.17427.b7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the effects of postmenopausal hormone replacement therapy (HRT) on intraocular pressure (IOP). PATIENTS AND METHODS This was a cross-sectional controlled study, including 107 women aged 60 to 80 years receiving HRT and 107 controls who have never received HRT. All subjects underwent IOP assessment and funduscopic photography for cup-to-disc (C/D) ratios, and completed questionnaires regarding personal and family history of glaucoma, hormone replacement therapy, lifetime estrogen and progesterone exposure, and cardiovascular risk factors. Main Outcome Measures included IOP, prevalence of increased IOP, and C/D ratios. RESULTS The groups did not differ in mean IOP (15.3 versus 15.3 mm Hg), mean vertical (0.18 versus 0.21) and horizontal (0.17 versus 0.14) C/D ratios, and in prevalence of increased IOP (15% versus 14%), C/D ratio (7% versus 7%), or glaucoma (9% versus 11%). A personal history of ischemic heart disease was the only risk factor associated with increased IOP (O.R. = 4.63, P = 0.003). Lifetime estrogen and progesterone exposure, including pregnancies, deliveries, menstruation years, and the use of oral contraceptives did not significantly affect the risk for increased IOP. CONCLUSION Hormone replacement therapy and lifetime estrogen and progesterone exposure do not seem to affect IOP or the risk for increased IOP. A personal history of ischemic heart disease may be associated with a higher risk for this disorder.
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Affiliation(s)
- Yoram Abramov
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Ein-Kerem, Jerusalem, Israel.
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Akar ME, Yucel I, Erdem U, Taskin O, Ozel A, Akar Y. Effect of the menstrual cycle on the optic nerve head in diabetes: analysis by confocal scanning laser ophthalmoscopy. Can J Ophthalmol 2005; 40:175-82. [PMID: 16049531 DOI: 10.1016/s0008-4182(05)80029-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The purpose of this study was to examine and compare menstrual-cycle-dependent topographic changes in the optic nerve head of normally menstruating women with different grades of type 2 diabetes mellitus. METHODS We studied the right eyes of 123 normally menstruating women (36 with severe nonproliferative diabetic retinopathy [NPDR], 42 with mild NPDR and 45 healthy subjects). All subjects underwent a complete ocular examination at baseline. At 4 hormonally distinct phases of the menstrual cycle (early follicular, late follicular, mid-luteal and late luteal), we analysed the topography of the optic nerve head, using a confocal scanning laser ophthalmoscope, and measured the serum levels of estradiol, progesterone and luteinizing hormone. RESULTS We excluded from analysis the data for 8 patients with severe NPDR, 10 patients with mild NPDR and 15 control subjects who were lost to follow-up examinations during the menstrual cycle. The mean age and optic disc area did not differ significantly among the 3 groups. The duration of diabetes was significantly longer in the patients with severe NPDR than in those with mild NPDR (p < 0.05). The women with severe NPDR had a significantly increased neuroretinal rim area and a significantly decreased cup-shape measure, linear cup/disc ratio, cup/disc area ratio and cup area in the late luteal phase compared with the other phases of the menstrual cycle (p < 0.05). Those with mild NPDR or a normal retina had no significant topographic changes in the optic nerve head during the menstrual cycle. INTERPRETATION Severe NPDR is associated with significant topographic changes in the rim and cup of the optic nerve head during the menstrual cycle. This must be considered in the evaluation of women with both diabetes and glaucoma. The normal fluctuations in serum sex hormone levels during the menstrual cycle of diabetic women seem to affect the optic nerve head more when the disease is advanced.
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Affiliation(s)
- Munire Erman Akar
- Department of Obstetrics and Gynecology, Akdeniz University School of Medicine, Antalya, Turkey
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Küçükerdönmez C, Yilmaz G, Akova YA. Branch retinal arterial occlusion associated with toxoplasmic chorioretinitis. Ocul Immunol Inflamm 2004; 12:227-31. [PMID: 15385198 DOI: 10.1080/092739490500246] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Ocular toxoplasmosis can cause a variety of retinal vascular changes including branch retinal arterial occlusion, which is a rare complication of the disease. PATIENT AND METHODS We report a case of toxoplasmic chorioretinitis in a pregnant woman, who developed branch retinal arterial obstruction adjacent to the active chorioretinitis lesion. RESULTS The patient received an appropriate steroid and antibiotic treatment and the retinitis lesion resolved over a six-week period. At two months after diagnosis, visual acuity in her right eye was 20/30 and there was a hyperpigmented scar at the site where active retinitis had been observed. CONCLUSION Especially in young patients with branch retinal vascular occlusion associated with posterior uveitis, the diagnosis of ocular toxoplasmosis should be kept in mind and serologic test results should be obtained.
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Affiliation(s)
- Cem Küçükerdönmez
- Department of Ophthalmology, Başkent University School of Medicine, Ankara, Turkey.
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Toker E, Yenice O, Akpinar I, Aribal E, Kazokoglu H. The influence of sex hormones on ocular blood flow in women. ACTA ACUST UNITED AC 2004; 81:617-24. [PMID: 14641265 DOI: 10.1111/j.1395-3907.2003.00160.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the influence of sex hormones on ocular haemodynamics, blood flow velocities in the ophthalmic and central retinal arteries and serum levels of sex hormones were measured in pre- and postmenopausal women. METHODS Colour Doppler imaging (CDI) was used to determine the flow velocities (peak systolic velocity [PSV] and end-diastolic velocity [EDV]) and the resistive index (RI) in the ophthalmic and central retinal arteries in 22 premenopausal and 32 postmenopausal women, who had never received hormone replacement therapy. Serum levels were measured for oestradiol, free testosterone and follicle-stimulating hormone. The CDI parameters were compared between the two groups and the influence of serum levels of oestradiol and testosterone on blood flow velocities and the resistive indices were analysed. RESULTS After correcting for age and mean arterial blood pressure, an analysis of covariance disclosed a significantly lower EDV (p=0.02) and a significantly higher RI (p=0.01) in the central retinal artery of postmenopausal women compared with premenopausal women. Partial correlation analysis, controlling for age, revealed significant correlations between the CDI parameters and serum levels of oestradiol and testosterone. For premenopausal women, PSV (r=0.58, p=0.04) and EDV (r=0.73, p=0.006) in the ophthalmic artery correlated positively with serum oestradiol levels. The RI in the central retinal artery decreased with increasing oestradiol levels in both groups (premenopausal r= -0.40, p=0.04; postmenopausal r= -0.32, p=0.05). Peak systolic velocity in the central retinal artery correlated negatively (r= -0.49, p=0.04), whereas the RI correlated positively (r=0.53, p=0.02) with testosterone levels in the premenopausal group. Postmenopausal women with higher testosterone levels had lower EDV (r= -0.53, p=0.007) in the central retinal artery and higher RI in both vessels (ophthalmic artery r=0.48, p=0.01; central retinal artery r=0.61, p=0.002). CONCLUSION Our data provide evidence of a relationship between serum sex hormone levels and blood flow velocities and resistive indices in retrobulbar arteries. Oestradiol appears to have beneficial effects on ocular haemodynamics, whereas testosterone may act as an antagonistic to the effects of oestrogen.
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Affiliation(s)
- Ebru Toker
- Department of Ophthalmology, Marmara University Medical School, Istanbul, Turkey.
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Aydin A, Wollstein G, Price LL, Schuman JS. Evaluating pulsatile ocular blood flow analysis in normal and treated glaucomatous eyes. Am J Ophthalmol 2003; 136:448-53. [PMID: 12967797 DOI: 10.1016/s0002-9394(03)00237-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate pulsatile ocular blood flow (POBF) analysis in normal subjects and glaucoma patients by comparison of POBF measurements with functional (as determined by visual field [VF]) and structural (as determined by optical coherence tomography [OCT]) measures. DESIGN Prospective, cross-sectional study. METHODS Forty-one eyes of 24 consecutive glaucoma patients and 20 eyes of 10 healthy subjects were studied; POBF analysis was performed on all subjects at the same visit as VF testing and OCT retinal nerve fiber layer (NFL) thickness measurement. The mean results of normal and glaucomatous eyes were compared for each method. Correlation between measurements obtained with each modality and the discriminating power using receiver operator characteristic curves was tested. RESULTS The mean POBF (standard deviation [SD]) in the normal group was 1,010.4 (292.8) microl/min and 989.3 (305.5) microl/min in the glaucoma group (P =.90). Significant differences between groups were found for VF mean deviation and pattern standard deviation (P =.02, P =.004, respectively) and OCT mean NFL thickness (P <.0001). No correlation was found between POBF parameters and intraocular pressure, VF, or OCT variables except for intraocular pressure in glaucoma group (r = -.43, P =.003). The area under the receiver operator characteristic curves was higher for VF indexes and OCT mean NFL thickness than POBF parameters for distinguishing between normal and glaucomatous eyes. CONCLUSIONS The wide range of normal values and the low discriminating power of POBF between normal and glaucomatous eyes limits the clinical use of the device for glaucoma patients.
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Affiliation(s)
- Ali Aydin
- New England Eye Center, Tufts-New England Medical Center, Tufts School of Medicine, Boston, Massachusetts 02111, USA
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Abstract
UNLABELLED Visual changes in pregnancy are common, and many are specifically associated with the pregnancy itself. Serous retinal detachments and blindness occur more frequently during preeclampsia and often subside postpartum. Pregnant women are at increased risk for the progression of preexisting proliferative diabetic retinopathy, and diabetic women should see an ophthalmologist before pregnancy or early in the first trimester. The results of refractive eye surgery before, during, or immediately after pregnancy are unpredictable, and refractive surgery should be postponed until there is a stable postpartum refraction. A decreased tolerance to contact lenses also is common during pregnancy; therefore, it is advisable to fit contact lenses postpartum. Furthermore, pregnancy is associated with a decreased intraocular pressure in healthy eyes, and the effects of glaucoma medications on the fetus and breast-fed infant are largely unknown. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES After completion of this article, the reader will be able to list the various ocular changes that occur during pregnancy, summarize the ocular disturbances that occur with preeclampsia and diabetes, and describe the management of some ocular problems during pregnancy.
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Affiliation(s)
- Robert B Dinn
- Indiana University School of Medicine, Indianapolis 46202, USA
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