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Stodtmeister R, Menzel A, Klimova A, Herber R, Pillunat KR, Pillunat LE. Measurement of the retinal venous pressure with a new instrument in patients with primary open angle glaucoma. Graefes Arch Clin Exp Ophthalmol 2024; 262:1633-1639. [PMID: 38214734 PMCID: PMC11031493 DOI: 10.1007/s00417-023-06326-4] [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: 02/04/2022] [Revised: 08/28/2023] [Accepted: 11/20/2023] [Indexed: 01/13/2024] Open
Abstract
PURPOSE To compare the results of retinal venous pressure (RVP) measurement performed with contact lens dynamometry (CLD) and with the new IOPstim. METHODS In this cross-sectional study, we included 36 patients with primary open angle glaucoma with a median age (Q25; Q75) of 74 (64; 77) years (m/f = 18/18), baseline intraocular pressure (IOP): 13.9 (12.2; 15.1) mmHg. Median mean defect: - 5.8 (- 11.9; - 2.6) db. Principle of the IOPstim: an empty balloon with a diameter of 8 mm is positioned on the eye, laterally of the limbus. Under observation of the central retinal vein (CRV), the examiner inflates the balloon. As soon as the CRV starts pulsation, the inflation is stopped and the IOP is measured, equaling the RVP at this moment. In the CLD, the pulsation of the CRV is observed with a contact lens. The RVP is calculated from the attachment force applied when pulsation appears. COURSE OF EXAMINATIONS Three single measurements of RVP in quick succession with both methods. The sequence of the two methods was randomized. The means of the three RVP measurements were compared. RESULTS Pressures in mmHg. RVP: IOPstim: 19.4 ± 5.4 (mean ± SD), CLD: 20.3 ± 5.9. Range of three single measurements: IOPstim: 2.9 ± 1.5, CLD: 2.2 ± 1.1. The differences were RVPIOPstim - RVPCLD = - 0.94 ± 1.15, and approximately normally distributed. Bland-Altman analysis: only one data point was 0.5 mmHg higher than the upper line of agreement. The confidence interval of this line was 0.65 mmHg. Concordance correlation coefficient according to Lin (CCC): 0.96. Intraclass correlation coefficient: both methods, 0.94. CONCLUSION In both methods, the range of the single measurements may be taken as a sign of good reliability, the CCC of 0.96 as a sign of a very good agreement. At the mean, the IOPstim RVP values were 1 mmHg lower than those obtained with the CLD. This difference may be due to the different directions of the prevailing force vectors induced by the instruments. The IOPstim seems applicable in glaucoma diagnostics.
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Affiliation(s)
- Richard Stodtmeister
- Department of Ophthalmology, Univ. Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Aline Menzel
- Department of Ophthalmology, Univ. Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Anna Klimova
- National Center for Tumor Diseases (NCT/UCC), German Cancer Research Center (DKFZ), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01307, Dresden, Germany
| | - Robert Herber
- Department of Ophthalmology, Univ. Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Karin R Pillunat
- Department of Ophthalmology, Univ. Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Lutz E Pillunat
- Department of Ophthalmology, Univ. Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
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Han C, Zheng XX, Zhang WF. High altitude retinopathy: An overview and new insights. Travel Med Infect Dis 2024; 58:102689. [PMID: 38295966 DOI: 10.1016/j.tmaid.2024.102689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/30/2023] [Accepted: 01/15/2024] [Indexed: 02/04/2024]
Abstract
High altitude retinopathy (HAR) is a common ocular disorder that occurs on ascent to high altitude. There are many clinical symptoms, retinal vascular dilatation, retinal edema and hemorrhage are common. These usually do not or slightly affect vision; rarely, severe cases develop serious or permanent vision loss. At present, the research progress of HAR mainly focuses on hemodynamic changes, blood-retinal barrier damage, oxidative stress and inflammatory response. Although the related studies on HAR are limited, it shows that HAR still belongs to hypoxia, and hypobaric hypoxia plays an aggravating role in promoting the development of the disease. Various studies have demonstrated the correlation of HAR with acute mountain sickness (AMS) and high-altitude cerebral edema (HACE), so a deeper understanding of HAR is important. The slow ascent rates and ascent altitude are the key to preventing any altitude sickness. Research on traditional chinese medicine (TCM) and western medicine has been gradually carried out. Further exploration of the pathogenesis and prevention strategies of HAR will provide better guidance for doctors and high-altitude travelers.
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Affiliation(s)
- Cong Han
- Department of Ophthalmology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, PR China.
| | - Xing-Xing Zheng
- Department of Ophthalmology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, PR China.
| | - Wen-Fang Zhang
- Department of Ophthalmology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, PR China.
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Wang Y, Yu X, Liu Z, Lv Z, Xia H, Wang Y, Li J, Li X. Influence of hypobaric hypoxic conditions on ocular structure and biological function at high attitudes: a narrative review. Front Neurosci 2023; 17:1149664. [PMID: 37229428 PMCID: PMC10203194 DOI: 10.3389/fnins.2023.1149664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 04/04/2023] [Indexed: 05/27/2023] Open
Abstract
Background With the development of science and technology, high-altitude environments, involving aviation, aerospace, and mountainous regions, have become the main areas for human exploration, while such complex environments can lead to rapid decreases in air and oxygen pressure. Although modern aircrafts have pressurized cabins and support equipment that allow passengers and crew to breathe normally, flight crew still face repeated exposure to hypobaric and hypoxic conditions. The eye is a sensory organ of the visual system that responds to light and oxygen plays a key role in the maintenance of normal visual function. Acute hypoxia changes ocular structure and function, such as the blood flow rate, and can cause retinal ischemia. Methods We reviewed researches, and summarized them briefly in a review. Results The acute hypobaric hypoxia affects corneal, anterior chamber angle and depth, pupils, crystal lens, vitreous body, and retina in structure; moreover, the acute hypoxia does obvious effect on visual function; for example, vision, intraocular pressure, oculometric features and dynamic visual performance, visual field, contrast sensitivity, and color perception. Conclusion We summarized the changes in the physiological structure and function of the eye in hypoxic conditions and to provide a biological basis for the response of the human eye at high-altitude.
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Affiliation(s)
- Yuchen Wang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Xinli Yu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Ziyuan Liu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Zhongsheng Lv
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Huaqin Xia
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Yiren Wang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Jiaxi Li
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Xuemin Li
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
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Retinal microvasculature is a potential biomarker for acute mountain sickness. SCIENCE CHINA. LIFE SCIENCES 2023:10.1007/s11427-022-2271-x. [PMID: 36811802 DOI: 10.1007/s11427-022-2271-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/21/2022] [Indexed: 02/24/2023]
Abstract
Increased cerebral blood flow resulting from altered capillary level autoregulation at high altitudes leads to capillary overperfusion and then vasogenic cerebral edema, which is the leading hypothesis of acute mountain sickness (AMS). However, studies on cerebral blood flow in AMS have been mostly restricted to gross cerebrovascular endpoints as opposed to the microvasculature. This study aimed to investigate ocular microcirculation alterations, the only visualized capillaries in the central neural system (CNS), during early-stage AMS using a hypobaric chamber. This study found that after high altitude simulation, the optic nerve showed retinal nerve fiber layer thickening (P=0.004-0.018) in some locations, and the area of the optic nerve subarachnoid space (P=0.004) enlarged. Optical coherence tomography angiography (OCTA) showed increased retinal radial peripapillary capillary (RPC) flow density (P=0.003-0.046), particularly on the nasal side of the nerve. The AMS-positive group had the largest increases in RPC flow density in the nasal sector (AMS-positive, Δ3.21±2.37; AMS-negative, Δ0.01±2.16, P=0.004). Among multiple ocular changes, OCTA increase in RPC flow density was associated with simulated early-stage AMS symptoms (beta=0.222, 95%CI, 0.009-0.435, P=0.042). The area under the receiver operating characteristics curve (AUC) for the changes in RPC flow density to predict early-stage AMS outcomes was 0.882 (95%CI, 0.746-0.998). The results further confirmed that overperfusion of microvascular beds is the key pathophysiologic change in early-stage AMS. RPC OCTA endpoints may serve as a rapid, noninvasive potential biomarker for CNS microvascular changes and AMS development during risk assessment of individuals at high altitudes.
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Mlinar T, Debevec T, Kapus J, Najdenov P, McDonnell AC, Ušaj A, Mekjavic IB, Jaki Mekjavic P. Retinal blood vessel diameters in children and adults exposed to a simulated altitude of 3,000 m. Front Physiol 2023; 14:1026987. [PMID: 36926190 PMCID: PMC10011172 DOI: 10.3389/fphys.2023.1026987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 02/14/2023] [Indexed: 03/08/2023] Open
Abstract
Introduction: Technological advances have made high-altitude ski slopes easily accessible to skiers of all ages. However, research on the effects of hypoxia experienced during excursions to such altitudes on physiological systems, including the ocular system, in children is scarce. Retinal vessels are embryologically of the same origin as vessels in the brain, and have similar anatomical and physiological characteristics. Thus, any hypoxia-related changes in the morphology of the former may reflect the status of the latter. Objective: To compare the effect of one-day hypoxic exposure, equivalent to the elevation of high-altitude ski resorts in North America and Europe (∼3,000 m), on retinal vessel diameter between adults and children. Methods: 11 adults (age: 40.1 ± 4.1 years) and 8 children (age: 9.3 ± 1.3 years) took part in the study. They spent 3 days at the Olympic Sports Centre Planica (Slovenia; altitude: 940 m). During days 1 and 2 they were exposed to normoxia (FiO2 = 0.209), and day 3 to normobaric hypoxia (FiO2 = 0.162 ± 0.03). Digital high-resolution retinal fundus photographs were obtained in normoxia (Day 2) and hypoxia (Day 3). Central retinal arteriolar equivalent (CRAE) and venular equivalents (CRVE) were determined using an Automated Retinal Image Analyser. Results: Central retinal arteriolar and venular equivalents increased with hypoxia in children (central retinal arteriolar equivalent: 105.32 ± 7.72 µm, hypoxia: 110.13 ± 7.16 µm, central retinal venular equivalent: normoxia: 123.39 ± 8.34 µm, hypoxia: 130.11 ± 8.54 µm) and adults (central retinal arteriolar equivalent: normoxia: 105.35 ± 10.67 µm, hypoxia: 110.77 ± 8.36 µm; central retinal venular equivalent: normoxia: 126.89 ± 7.24 µm, hypoxia: 132.03 ± 9.72 µm), with no main effect of group or group*condition interaction. A main effect of condition on central retinal arteriolar and venular equivalents was observed (central retinal arteriolar equivalent:normoxia: 105.34 ± 9.30 µm, hypoxia: 110.50 ± 7.67 µm, p < 0.001; central retinal venular equivalent: normoxia: 125.41 ± 7.70 µm, hypoxia: 131.22 ± 9.05 µm, p < 0.001). Conclusion: A 20-hour hypoxic exposure significantly increased central retinal arteriolar and venular equivalents in adults and children. These hypoxia-induced increases were not significantly different between the age groups, confirming that vasomotor sensitivity of the retinal vessels to acute hypoxia is comparable between adults and prepubertal children.
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Affiliation(s)
- Tinkara Mlinar
- Department of Automatics, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia.,Jozef Stefan International Postgraduate School, Ljubljana, Slovenia
| | - Tadej Debevec
- Department of Automatics, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia.,Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Jernej Kapus
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Peter Najdenov
- Department of Paediatrics, General Hospital Jesenice, Jesenice, Slovenia
| | - Adam C McDonnell
- Department of Automatics, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia
| | - Anton Ušaj
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Igor B Mekjavic
- Department of Automatics, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia.,Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Polona Jaki Mekjavic
- Department of Automatics, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia.,Eye Hospital, University Medical Centre, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Hanssen H, Streese L, Vilser W. Retinal vessel diameters and function in cardiovascular risk and disease. Prog Retin Eye Res 2022; 91:101095. [PMID: 35760749 DOI: 10.1016/j.preteyeres.2022.101095] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/03/2022] [Accepted: 06/13/2022] [Indexed: 12/13/2022]
Abstract
In the last two decades evidence has gradually accumulated suggesting that the eye may be a unique window for cardiovascular risk stratification based on the assessment of subclinical damage of retinal microvascular structure and function. This can be facilitated by non-invasive analysis of static retinal vessel diameters and dynamic recording of flicker light-induced and endothelial function-related dilation of both retinal arterioles and venules. Recent new findings have made retinal microvascular biomarkers strong candidates for clinical implementation as reliable risk predictors. Beyond a review of the current evidence and state of research, the article aims to discuss the methodological benefits and pitfalls and to identify research gaps and future directions. Above all, the potential use for screening and treatment monitoring of cardiovascular disease risk are highlighted. The article provides fundamental comprehension of retinal vessel imaging by explaining anatomical and physiological essentials of the retinal microcirculation leading to a detailed description of the methodological approach. This allows for better understanding of the underlying retinal microvascular pathology associated with the prevalence and development of cardiovascular disease. A body of new evidence is presented on the clinical validity and predictive value of retinal vessel diameters and function for incidence cardiovascular disease and outcome. Findings in children indicate the potential for utility in childhood cardiovascular disease prevention, and the efficacy of exercise interventions highlight the treatment sensitivity of retinal microvascular biomarkers. Finally, coming from the availability of normative data, solutions for diagnostic challenges are discussed and conceptual steps towards clinical implementation are put into perspective.
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Affiliation(s)
- Henner Hanssen
- Department of Sport, Exercise and Health, Preventive Sports Medicine and Systems Physiology, Medical Faculty, University of Basel, Switzerland.
| | - Lukas Streese
- Department of Sport, Exercise and Health, Preventive Sports Medicine and Systems Physiology, Medical Faculty, University of Basel, Switzerland
| | - Walthard Vilser
- Institute of Biomedical Engineering and Informatics, Ilmenau University of Technology, Ilmenau, Germany; Neonatology and Pediatric Intensive Care Unit, Department of Pediatrics, Jena University Hospital, Jena, Germany
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Konieczka K, Flammer J. Treatment of Glaucoma Patients with Flammer Syndrome. J Clin Med 2021; 10:4227. [PMID: 34575340 PMCID: PMC8467118 DOI: 10.3390/jcm10184227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
Flammer syndrome (FS) describes a phenotype characterized by the presence of primary vascular dysregulation along with a number of symptoms and signs. Although most people with FS are healthy, FS favors the occurrence of certain diseases, such as normal tension glaucoma. This is because disturbed autoregulation makes the eye more sensitive to intraocular pressure (IOP) spikes or blood pressure drops. Treatment of FS is generally appropriate when patients either suffer greatly from their symptoms or if we can assume that it has contributed to a disease. In glaucoma, this may be the case if the glaucoma damage progresses despite well-controlled IOP. Both the still sparse scientific studies and our long clinical experience suggest that FS-targeted therapy not only relieves the symptoms of FS but also slows the progression of glaucoma damage in selected cases. This description is intended not only to help affected patients but to also motivate clinicians and researchers to conduct therapy studies to confirm or refute our observations.
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Streese L, Vaes A, Infanger D, Roth R, Hanssen H. Quantification of Retinal Vessel Myogenic Constriction in Response to Blood Pressure Peaks: Implications for Flicker Light-Induced Dilatation. Front Physiol 2021; 12:608985. [PMID: 33679432 PMCID: PMC7929982 DOI: 10.3389/fphys.2021.608985] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/25/2021] [Indexed: 01/10/2023] Open
Abstract
Background/Aims Flicker-light induced retinal vessel dilatation (FID), a marker of microvascular endothelial function, has been shown to be blunted in sedentary cardiovascular risk patients (SR) as well as healthy physically active individuals (HA). This study aimed to quantify the retinal myogenic response to blood pressure (BP) peaks and its effects on consecutive FID for differentiation of microvascular health. Methods Ten HA and eleven SR with a previously established restriction of arteriolar FID (aFID) (<2.2%) were invited in order to assess BP-induced myogenic constriction following a standardized handgrip task and a consecutive FID. BP was measured beat-to-beat. Results The complete dataset of nine HA (3 female, mean age 65 years) and nine SR (5 female, mean age 61 years) individuals was analyzed. The central retinal arteriolar diameter equivalent (CRAE) was 183 ± 11 μm for HA and 176 ± 20 μm for SR. Initial baseline aFID was 1.6 ± 0.4% in HA and 1.6 ± 0.7% in SR. Systolic (p = 0.334) and diastolic (p = 0.245) BP increase following the handgrip task was in the range of 20–30% and comparable in both groups. BP increase was followed by a significantly higher arteriolar (−2.9 ± 1.3% vs. −1.3 ± 0.6%, p < 0.01) myogenic constriction in HA compared to SR. Moreover, in the consecutive assessment of FID directly after the BP-induced vessel constriction, aFID (4.1 ± 2.0% vs. 1.6 ± 0.9%, p < 0.01) was higher in HA compared to SR. Conclusion Initial baseline aFID was blunted in HA and SR. Retinal myogenic constriction was impaired in SR compared to HA. The consecutive aFID after BP-induced myogenic constriction recovered in HA but remained blunted in SR. Additional assessment of retinal myogenic constriction needs to be considered to improve CV risk stratification and reduce false-positive findings of endothelial dysfunction in otherwise healthy active individuals. Clinical Trial Registration ClinicalTrials.gov: NCT03986892 (https://clinicaltrials.gov/ct2/show/NCT03986892).
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Affiliation(s)
- Lukas Streese
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Anja Vaes
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Denis Infanger
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Ralf Roth
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Henner Hanssen
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Abstract
PURPOSE OF REVIEW Adequate tissue perfusion is of utmost importance to avoid organ failure in patients with cardiogenic shock. Within the recent years, the microcirculation, defined as the perfusion of the smallest vessels, has been identified to play a crucial role. Microcirculatory changes may include capillary flow disturbances as well as changes in the density of perfused vessels. Due to the availability of new technologies to assess the microcirculation, interesting new data came up and it is the purpose of this review to summarize recent studies in the field. RECENT FINDINGS Nowadays, an increasing number of studies confirm parameters of the microcirculation, derived by intravital microscopy, to represent strong outcome predictors in cardiogenic shock. In addition, microcirculation as read-out parameter in innovative clinical studies has meanwhile been accepted as serious endpoint. Treatment strategies such as mechanical assist devices, blood pressure regulating agents or fluids use tissue perfusion and microcirculatory network density as targets in addition to clinical perfusion evaluation and decreasing serum lactate levels. SUMMARY The parameter most frequently used to detect tissue malperfusion is serum lactate. Novel, noninvasive methods to quantify microvascular perfusion have the potential to guide treatment in terms of optimizing organ perfusion and oxygenation probably paving the way for an individualized therapy.
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Yang Y, Xie Y, Sun Y, Cao K, Li S, Fan S, Huang L, Wu S, Wang N. Intraocular Pressure Changes of Healthy Lowlanders at Different Altitude Levels: A Systematic Review and Meta-Analysis. Front Physiol 2019; 10:1366. [PMID: 31780951 PMCID: PMC6851261 DOI: 10.3389/fphys.2019.01366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 10/14/2019] [Indexed: 11/18/2022] Open
Abstract
Background: High altitude, characterized by hypobaric hypoxia, low temperature, and intensive ultraviolet radiation, is identifiably one of the examples of scientific enquiry into aviation and space analogs. However, little is known about the ocular physiological response, especially intraocular pressure (IOP) changes at high altitude. Objectives: This study aimed to systematically review of high altitude exposure on IOP for healthy lowlanders with unoperated eyes. Methods: A comprehensive systematic literature search was conducted in the electronic databases until September 1st, 2019. A meta-analysis was performed following the preferred reporting items for systematic review and meta-analysis statement (PRISMA). We systematically searched the studies conducted over 2,000 m above sea level (a.s.l) in healthy lowlanders with measurements of IOP. Meta-analyses (random effect model and heterogeneity tests), subgroup analyses (altitude, duration, type, and pattern of exposure), sensitivity analysis, funnel plot, Begger's and Egger's test for publication bias were performed. Quality assessment was conducted using the Newcastle-Ottawa scale. The meta-analysis was registered in the PROSPERO database (CRD42019136865). Results: Of 9595 publications searched, 20 publications (n = 745) qualified for inclusion, with non-significant decrease in overall IOP [standardized mean difference (SMD): 0.14, 95% CI: -0.12-0.40; p = 0.30] with high heterogeneity (p < 0.001, I 2 = 82%). However, subgroup analyses revealed significant decrease of IOP at high altitude of 3,000-5,500 m a.s.l (SMD: 0.57, 95% CI: 0.07-1.06; p = 0.03) whereas increase of IOP at extreme altitude of over 5,500 m a.s.l (SMD: -0.34, 95% CI: -0.61-0.06; p = 0.02). And the duration of exposure more than 72 hours (h) was likely to induce a decrease of IOP bordering on statistical significance at the 5% level (SMD: 1.29, 95% CI: 0.02-2.56; p = 0.05). Simultaneously, we also observed significant decrease of IOP for active exposure (e.g., physical activity and hiking, SMD: 0.81, 95% CI: 0.05-1.57; p = 0.04). Conclusion: Our analysis shows exposure to the altitude over 3,500 m a.s.l, duration of exposure more than 72 h and active exposure pattern may have modest, but significant effects on IOP. The higher altitude, the duration of exposure as well as physical activity seem to play crucial roles in the effects of high-altitude exposure on IOP.
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Affiliation(s)
- Yiquan Yang
- Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital of Capital Medical University, Beijing, China
| | - Yuan Xie
- Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital of Capital Medical University, Beijing, China
| | - Yunxiao Sun
- Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital of Capital Medical University, Beijing, China
| | - Kai Cao
- Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital of Capital Medical University, Beijing, China
| | - Shuning Li
- Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital of Capital Medical University, Beijing, China
| | - Sujie Fan
- Department of Ophthalmology, The Third Hospital of Handan (Handan City Eye Hospital), Handan, China
| | - Lu Huang
- Department of Neurology, The Qinghai Provincial People's Hospital, Xining, China
| | - Shizheng Wu
- Department of Neurology, The Qinghai Provincial People's Hospital, Xining, China
| | - Ningli Wang
- Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital of Capital Medical University, Beijing, China
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11
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Smith W, Kotliar KE, Lammertyn L, Ramoshaba NE, Vilser W, Huisman HW, Schutte AE. Retinal vessel caliber and caliber responses in true normotensive black and white adults: The African-PREDICT study. Microvasc Res 2019; 128:103937. [PMID: 31644892 DOI: 10.1016/j.mvr.2019.103937] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 07/20/2019] [Accepted: 10/12/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Globally, a detrimental shift in cardiovascular disease risk factors and a higher mortality level are reported in some black populations. The retinal microvasculature provides early insight into the pathogenesis of systemic vascular diseases, but it is unclear whether retinal vessel calibers and acute retinal vessel functional responses differ between young healthy black and white adults. METHODS We included 112 black and 143 white healthy normotensive adults (20-30 years). Retinal vessel calibers (central retinal artery and vein equivalent (CRAE and CRVE)) were calculated from retinal images and vessel caliber responses to flicker light induced provocation (FLIP) were determined. Additionally, ambulatory blood pressure (BP), anthropometry and blood samples were collected. RESULTS The groups displayed similar 24 h BP profiles and anthropometry (all p > .24). Black participants demonstrated a smaller CRAE (158 ± 11 vs. 164 ± 11 MU, p < .001) compared to the white group, whereas CRVE was similar (p = .57). In response to FLIP, artery maximal dilation was greater in the black vs. white group (5.6 ± 2.1 vs. 3.3 ± 1.8%; p < .001). CONCLUSIONS Already at a young age, healthy black adults showed narrower retinal arteries relative to the white population. Follow-up studies are underway to show if this will be related to increased risk for hypertension development. The reason for the larger vessel dilation responses to FLIP in the black population is unclear and warrants further investigation.
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Affiliation(s)
- Wayne Smith
- Hypertension in Africa Research Team, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa; Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
| | - Konstantin E Kotliar
- Department of Biomedical Engineering and Technomathematics, Aachen University of Applied Sciences, Juelich, Germany
| | - Leandi Lammertyn
- Hypertension in Africa Research Team, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa; Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Nthai E Ramoshaba
- Hypertension in Africa Research Team, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | | | - Hugo W Huisman
- Hypertension in Africa Research Team, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa; Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Aletta E Schutte
- Hypertension in Africa Research Team, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa; Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
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Streese L, Kotliar K, Deiseroth A, Infanger D, Vilser W, Hanssen H. Retinal Endothelial Function, Physical Fitness and Cardiovascular Risk: A Diagnostic Challenge. Front Physiol 2019; 10:831. [PMID: 31333489 PMCID: PMC6624470 DOI: 10.3389/fphys.2019.00831] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 06/17/2019] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Dynamic retinal vessel analysis (DVA) is a new non-invasive method to quantify microvascular endothelial dysfunction by flicker light-induced dilatation (FID). FID has been shown to be impaired in type 2 diabetes as well as heart failure. The aim of the study was to analyze FID in healthy active versus healthy sedentary and cardiovascular (CV) risk patients in addition to corresponding static vessel diameters. METHODS Thirty-one healthy active (HA, mean age 60 ± 8 years), 33 healthy sedentary individuals (HS, 59 ± 7 years) and 76 sedentary patients with increased CV risk (SR, 58 ± 6 years) were included in this cross-sectional study. Group differences in CV risk factors and cardiorespiratory fitness, maximal arteriolar (ADmax) and venular (VDmax) dilatation as well as the arteriolar (AFarea) and venular (VFarea) area under the flicker curve were analyzed. The central retinal arteriolar and venular diameters were used to calculate the arteriolar-to-venular diameter ratio (AVR). RESULTS HS [ADmax = 3.5 (2.1)%; AFarea = 48.2 (31.9)%∗s] showed higher FID compared to SR [ADmax = 2.7 (1.8)%, p = 0.021; AFarea = 34.5 (26.5)%∗s, p = 0.006] and HA [AFarea = 32.8 (23.1)%∗s, p = 0.029]. HA and SR did not significantly differ. HA had a higher AVR (0.87 ± 0.05) compared to HS (0.83 ± 0.04, p < 0.001) with further deterioration in SR (0.79 ± 0.05, p < 0.001). Interestingly, 28 participants had impaired FID but normal AVR and 43 participants had normal FID but impaired AVR. DISCUSSION FID can differentiate between sedentary low and high risk individuals. However, FID in healthy active persons (HA) seemed impaired with a concomitant higher AVR. We postulate that lower FID in HA may be explained by predilatated arterioles and a reduced dilatation reserve. We recommend combination of FID with analysis of retinal vessel diameters to differentiate functional non-responders from manifest microvascular endothelial dysfunction and, thereby, improve microvascular risk stratification in a personalized medicine approach. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: NCT02796976 (https://clinicaltrials.gov/ ct2/show/NCT02796976).
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Affiliation(s)
- Lukas Streese
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Konstantin Kotliar
- Department of Medical Engineering and Applied Mathematics, FH Aachen – University of Applied Sciences, Aachen, Germany
| | - Arne Deiseroth
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Denis Infanger
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Walthard Vilser
- Institute of Biomedical Engineering and Informatics, Ilmenau University of Technology, Ilmenau, Germany
| | - Henner Hanssen
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
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Yang Y, Yang D, Sun Y, Xie Y, Zhang Z, Li S, Wu S, Wang N. Retinal vessel oxygen saturation and vessel diameter in healthy individuals during high-altitude exposure. Acta Ophthalmol 2019; 97:279-286. [PMID: 30259682 DOI: 10.1111/aos.13897] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 07/20/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE To assess changes of retinal vessel oxygen saturation and vessel diameter in healthy individuals during high-altitude exposure. METHODS Retinal oxygen saturation and vessel diameter were obtained at sea level (SL, 40 m) and high altitude (HA, 3681 m) on 17 healthy individuals from Beijing (six males, 28.06 ± 8.06 years) using Oxymap T1 and then compared with 21 residents from Yushu (10 males, 28.63 ± 6.00 years). Systemic and ocular parameters were also measured before and after high-altitude exposure. Data were presented as mean ± SD and analysed using paired and independent Student t-test with significance accepted at p < 0.05. RESULTS Short-term high-altitude exposure of Beijing Group significantly affected all the systemic and ocular parameters, as well as retinal oxygen saturation and vessel diameter ranging from overall quadrant to different quadrants, other than retinal venous oxygen saturation and retinal arterial diameter. However, these changes were not evident in those permanently living at HA. Pearson's correlation analysis revealed correlations between retinal oxygen saturation and systemic and ocular parameters (all p < 0.05). The multivariate linear regression analysis indicated that retinal arterial oxygen saturation was significantly associated with arterial peripheral arterial oxygen saturation (SpO2 ) and subfoveal choroidal thickness. CONCLUSION Short-term exposure to HA induces retinal microcirculation disturbance and auto-regulatory response in healthy individuals, which is probably attributed to arterial SpO2 and endothelial dysfunction under hypoxic conditions.
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Affiliation(s)
- Yiquan Yang
- Beijing Ophthalmology and Visual Sciences Key Laboratory Beijing Tongren Eye Center Beijing Tongren Hospital Capital Medical University Beijing China
- Beijing Institute of Ophthalmology Beijing Tongren Hospital Capital Medical University Beijing China
| | - Diya Yang
- Beijing Ophthalmology and Visual Sciences Key Laboratory Beijing Tongren Eye Center Beijing Tongren Hospital Capital Medical University Beijing China
| | - Yunxiao Sun
- Beijing Ophthalmology and Visual Sciences Key Laboratory Beijing Tongren Eye Center Beijing Tongren Hospital Capital Medical University Beijing China
- Beijing Institute of Ophthalmology Beijing Tongren Hospital Capital Medical University Beijing China
| | - Yuan Xie
- Beijing Ophthalmology and Visual Sciences Key Laboratory Beijing Tongren Eye Center Beijing Tongren Hospital Capital Medical University Beijing China
- Beijing Institute of Ophthalmology Beijing Tongren Hospital Capital Medical University Beijing China
| | - Zheng Zhang
- Beijing Ophthalmology and Visual Sciences Key Laboratory Beijing Tongren Eye Center Beijing Tongren Hospital Capital Medical University Beijing China
| | - Shuning Li
- Beijing Ophthalmology and Visual Sciences Key Laboratory Beijing Tongren Eye Center Beijing Tongren Hospital Capital Medical University Beijing China
| | - Shizheng Wu
- Departments of Neurology The Qinghai Provincial People's Hospital Xining Qinghai China
| | - Ningli Wang
- Beijing Ophthalmology and Visual Sciences Key Laboratory Beijing Tongren Eye Center Beijing Tongren Hospital Capital Medical University Beijing China
- Beijing Institute of Ophthalmology Beijing Tongren Hospital Capital Medical University Beijing China
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Konieczka K, Erb C. Diseases potentially related to Flammer syndrome. EPMA J 2017; 8:327-332. [PMID: 29209435 PMCID: PMC5700007 DOI: 10.1007/s13167-017-0116-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 08/22/2017] [Indexed: 02/03/2023]
Abstract
Flammer syndrome (FS) is a prevalent and mostly benign condition. Subjects with FS seem to have a good life expectancy. Nevertheless, FS subjects are at increased risk for certain diseases, mainly when they are challenged by psychological stress or other stimuli such as coldness. FS is related to ocular diseases, such as normal-tension glaucoma, retinitis pigmentosa, central serous chorioretinopathy, optic nerve compartment syndrome, Leber’s hereditary optic neuropathy, arterial or venous occlusions in the retina, and choroid and optic nerve head, despite the absence of classical vascular risk factors. FS is also related to some non-ocular diseases, such as multiple sclerosis, breast cancer, and altitude sickness. The role of FS in other diseases such as tinnitus, sudden hearing loss, Ménière’s disease, anorexia nervosa, and thyroid dysfunction is currently under investigation. The exact relationship of FS to related diseases however still needs to be established. This may hopefully lead to more targeted diagnostics and personalized treatments.
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Affiliation(s)
- Katarzyna Konieczka
- Department of Ophthalmology, University of Basel, Mittlere Strasse 91, CH-4031 Basel, Switzerland
| | - Carl Erb
- Eye Clinic Wittenbergplatz, Berlin, Germany
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Jung C, Jung F, Kelm M. The microcirculation in hypoxia: The center of the battlefield for oxygen. Clin Hemorheol Microcirc 2017; 63:169-72. [PMID: 27567802 DOI: 10.3233/ch-1663301] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In the past years the microcirculation has gained increasing attention not only by basic scientists, but also by clinicians and translational researchers. In the clinical scenario, it has been convincingly described that the microcirculation is a key predictor of outcome and of central pathophysiological relevance. A vast body of evidence demonstrates the central role of the smallest vessels in inflammation, hyperviscosity, cell-cell-interaction, endothelial function, tissue edema, hemodynamic and blood flow regulation and its important role in the interaction with soluble factors. A central feature of different diseases and a strong regulator of different changes is hypoxia, the lack of oxygen. Also the microcirculation is on one hand a central component responding with dynamic changes to hypoxia but also the central place where hypoxia mediates its unfavorable effects. These changes and associated interactions are the topic of this special thematic issue "Hypoxia" in Clinical Hemorheology and Microcirculation and it seems logical that important and relevant findings are presented.
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Affiliation(s)
- Christian Jung
- University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Friedrich Jung
- Institute of Biomaterial Science and Berlin-Brandenburg Center for Regenerative Therapies, Helmholtz Zentrum Geesthacht, Teltow, Germany
| | - Malte Kelm
- University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
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