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Mihály Z, István L, Czakó C, Benyó F, Borzsák S, Varga A, Magyar-Stang R, Banga PV, Élő Á, Debreczeni R, Kovács I, Sótonyi P. The Effect of Circle of Willis Morphology on Retinal Blood Flow in Patients with Carotid Stenosis Measured by Optical Coherence Tomography Angiography. J Clin Med 2023; 12:5335. [PMID: 37629376 PMCID: PMC10455622 DOI: 10.3390/jcm12165335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/11/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
The Circle of Willis (CoW) is the main collateral system, and its morphological variants are more common in patients who have severe carotid artery stenosis. Earlier data suggest that optical coherence tomography angiography (OCTA) may help to assess the changes in cerebral vascular perfusion by imaging the retinal blood flow. In this single-center prospective clinical study, patients scheduled for carotid endarterectomy (CEA) underwent preoperative computed tomography angiography (CTA) of the extra- and intracranial cerebral circulation. OCTA imaging was performed one week before surgery and postoperatively one month later. The patients were divided into two subgroups based on CTA evaluation of CoW: compromised CoW or non-compromised CoW (containing hypoplastic and normal segments). The effect of the patient's age, OCTA scan quality (SQ), CoW morphology, laterality, and surgery on superficial capillary vessel density (VD) in the macula were assessed in multivariable regression models using linear mixed models. We found that VD significantly decreased with aging (-0.12%; 95%CI: -0.07--0.15; p < 0.001) and was significantly higher in patients with non-compromised CoW morphology (by 0.87% 95%CI (0.26-1.50); p = 0.005). After CEA, retinal blood flow significantly improved by 0.71% (95%CI: 0.18-1.25; p = 0.01). These results suggest that in the case of carotid artery occlusion, patients with non-compromised CoW have more preserved ocular blood flow than subjects with compromised CoW due to remodeling of the intra-orbital blood flow. Measuring the retinal blood flow might be used as a relevant and sensitive indicator of collateral cerebrovascular circulation.
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Affiliation(s)
- Zsuzsanna Mihály
- Department of Vascular and Endovascular Surgery Heart and Vascular Centre, Semmelweis University, 1122 Budapest, Hungary; (Z.M.)
| | - Lilla István
- Department of Ophthalmology, Semmelweis University, 1085 Budapest, Hungary (Á.É.)
| | - Cecilia Czakó
- Department of Ophthalmology, Semmelweis University, 1085 Budapest, Hungary (Á.É.)
| | - Fruzsina Benyó
- Department of Ophthalmology, Semmelweis University, 1085 Budapest, Hungary (Á.É.)
| | - Sarolta Borzsák
- Department of Vascular and Endovascular Surgery Heart and Vascular Centre, Semmelweis University, 1122 Budapest, Hungary; (Z.M.)
| | - Andrea Varga
- Department of Vascular and Endovascular Surgery Heart and Vascular Centre, Semmelweis University, 1122 Budapest, Hungary; (Z.M.)
| | - Rita Magyar-Stang
- Department of Neurology, Semmelweis University, 1085 Budapest, Hungary (R.D.)
| | - Péter Vince Banga
- Department of Vascular and Endovascular Surgery Heart and Vascular Centre, Semmelweis University, 1122 Budapest, Hungary; (Z.M.)
| | - Ágnes Élő
- Department of Ophthalmology, Semmelweis University, 1085 Budapest, Hungary (Á.É.)
| | - Róbert Debreczeni
- Department of Neurology, Semmelweis University, 1085 Budapest, Hungary (R.D.)
| | - Illés Kovács
- Department of Ophthalmology, Semmelweis University, 1085 Budapest, Hungary (Á.É.)
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY 10021, USA
- Department of Clinical Ophthalmology, Faculty of Health Sciences, Semmelweis University, 1085 Budapest, Hungary
| | - Péter Sótonyi
- Department of Vascular and Endovascular Surgery Heart and Vascular Centre, Semmelweis University, 1122 Budapest, Hungary; (Z.M.)
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Fehér J, Élő Á, István L, Nagy ZZ, Radák Z, Scuderi G, Artico M, Kovács I. Microbiota mitochondria disorders as hubs for early age-related macular degeneration. GeroScience 2022; 44:2623-2653. [PMID: 35978068 PMCID: PMC9385247 DOI: 10.1007/s11357-022-00620-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 07/01/2022] [Indexed: 01/07/2023] Open
Abstract
Age-related macular degeneration (AMD) is a progressive neurodegenerative disease affecting the central area (macula lutea) of the retina. Research on the pathogenic mechanism of AMD showed complex cellular contribution governed by such risk factors as aging, genetic predisposition, diet, and lifestyle. Recent studies suggested that microbiota is a transducer and a modifier of risk factors for neurodegenerative diseases, and mitochondria may be one of the intracellular targets of microbial signaling molecules. This review explores studies supporting a new concept on the contribution of microbiota-mitochondria disorders to AMD. We discuss metabolic, vascular, immune, and neuronal mechanism in AMD as well as key alterations of photoreceptor cells, retinal pigment epithelium (RPE), Bruch's membrane, choriocapillaris endothelial, immune, and neuronal cells. Special attention was paid to alterations of mitochondria contact sites (MCSs), an organelle network of mitochondria, endoplasmic reticulum, lipid droplets (LDs), and peroxisomes being documented based on our own electron microscopic findings from surgically removed human eyes. Morphometry of Bruch's membrane lipids and proteoglycans has also been performed in early AMD and aged controls. Microbial metabolites (short-chain fatty acids, polyphenols, and secondary bile acids) and microbial compounds (lipopolysaccharide, peptidoglycan, and bacterial DNA)-now called postbiotics-in addition to local effects on resident microbiota and mucous membrane, regulate systemic metabolic, vascular, immune, and neuronal mechanisms in normal conditions and in various common diseases. We also discuss their antioxidant, anti-inflammatory, and metabolic effects as well as experimental and clinical observations on regulating the main processes of photoreceptor renewal, mitophagy, and autophagy in early AMD. These findings support an emerging concept that microbiota-mitochondria disorders may be a crucial pathogenic mechanism of early AMD; and similarly, to other age-related neurodegenerative diseases, new treatment approaches should be targeted at these disorders.
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Affiliation(s)
- János Fehér
- PRIMAVERA Program, Nutripharma Hungaria Ltd., Budapest, Hungary
| | - Ágnes Élő
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Lilla István
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Zoltán Zsolt Nagy
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Zsolt Radák
- grid.472475.70000 0000 9243 1481Research Institute of Sport Science, University of Physical Education, Budapest, Hungary
| | - Gianluca Scuderi
- grid.7841.aOphthalmology Unit, NESMOS Department, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Marco Artico
- grid.417007.5Department of Sensory Organs, “Sapienza” University of Rome, Roma, Italy
| | - Illés Kovács
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Budapest, Hungary ,grid.5386.8000000041936877XDepartment of Ophthalmology, Weill Cornell Medical College, New York City, NY USA
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István L, Czakó C, Benyó F, Élő Á, Mihály Z, Sótonyi P, Varga A, Nagy ZZ, Kovács I. The effect of systemic factors on retinal blood flow in patients with carotid stenosis: an optical coherence tomography angiography study. GeroScience 2022; 44:389-401. [PMID: 34837589 PMCID: PMC8810958 DOI: 10.1007/s11357-021-00492-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/16/2021] [Indexed: 12/17/2022] Open
Abstract
Carotid artery stenosis (CAS) is among the leading causes of mortality and permanent disabilities in the Western world. CAS is a consequence of systemic atherosclerotic disease affecting the majority of the aging population. Optical coherence tomography angiography (OCTA) is a novel imaging technique for visualizing retinal blood flow. It is a noninvasive, fast method for qualitative and quantitative assessment of the microcirculation. Cerebral and retinal circulation share similar anatomy, physiology, and embryology; thus, retinal microvasculature provides a unique opportunity to study the pathogenesis of cerebral small vessel disease in vivo. In this study, we aimed to analyze the effect of systemic risk factors on retinal blood flow in the eyes of patients with significant carotid artery stenosis using OCT angiography. A total of 112 eyes of 56 patients with significant carotid stenosis were included in the study. We found that several systemic factors, such as decreased estimated glomerular filtration rate (eGFR), hypertension, and carotid occlusion have a significant negative effect on retinal blood flow, while statin use and carotid surgery substantially improve ocular microcirculation. Neither diabetes, clopidogrel or acetylsalicylic acid use, BMI, serum lipid level, nor thrombocyte count showed a significant effect on ocular blood flow. Our results demonstrate that a systematic connection does exist between certain systemic risk factors and retinal blood flow in this patient population. OCTA could help in the assessment of cerebral circulation of patients with CAS due to its ability to detect subtle changes in retinal microcirculation that is considered to represent changes in intracranial blood flow.
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Affiliation(s)
- Lilla István
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
| | - Cecilia Czakó
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
| | - Fruzsina Benyó
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
| | - Ágnes Élő
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
| | - Zsuzsa Mihály
- Department of Vascular & Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Péter Sótonyi
- Department of Vascular & Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Andrea Varga
- Department of Vascular & Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Zoltán Zsolt Nagy
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
| | - Illés Kovács
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary.
- Department of Ophthalmology, Weill Cornell Medical College, New York, USA.
- Department of Clinical Ophthalmology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary.
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István L, Czakó C, Élő Á, Mihály Z, Sótonyi P, Varga A, Ungvári Z, Csiszár A, Yabluchanskiy A, Conley S, Csipő T, Lipecz Á, Kovács I, Nagy ZZ. Imaging retinal microvascular manifestations of carotid artery disease in older adults: from diagnosis of ocular complications to understanding microvascular contributions to cognitive impairment. GeroScience 2021; 43:1703-1723. [PMID: 34100219 PMCID: PMC8492863 DOI: 10.1007/s11357-021-00392-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023] Open
Abstract
Carotid artery stenosis (CAS) is a consequence of systemic atherosclerotic disease affecting the aging populations of the Western world. CAS is frequently associated with cognitive impairment. However, the mechanisms contributing to the development of vascular cognitive impairment (VCI) associated with CAS are multifaceted and not fully understood. In addition to embolization and decreased blood flow due to the atherosclerotic lesion in the carotid artery, microcirculatory dysfunction in the cerebral circulation also plays a critical role in CAS-related VCI. To better understand the microvascular contributions to cognitive decline associated with CAS and evaluate microvascular protective effects of therapeutic interventions, it is essential to examine the structural and functional changes of the microvessels in the central nervous system (CNS). However, there are some limitations of in vivo brain vascular imaging modalities. The retinal microvasculature provides a unique opportunity to study pathogenesis of cerebral small vessel disease and VCI, because the cerebral circulation and the retinal circulation share similar anatomy, physiology and embryology. Similar microvascular pathologies may manifest in the brain and the retina, thus ocular examination can be used as a noninvasive screening tool to investigate pathological changes in the CNS associated with CAS. In this review, ocular signs of CAS and the retinal manifestations of CAS-associated microvascular dysfunction are discussed. The advantages and limitation of methods that are capable of imaging the ocular circulation (including funduscopy, fluorescein angiography, Doppler sonography, optical coherence tomography [OCT] and optical coherence tomography angiography [OCTA]) are discussed. The potential use of dynamic retinal vessel analysis (DVA), which allows for direct visualization of neurovascular coupling responses in the CNS, for understanding microvascular contributions to cognitive decline in CAS patients is also considered.
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Affiliation(s)
- Lilla István
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
| | - Cecilia Czakó
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
| | - Ágnes Élő
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
| | - Zsuzsanna Mihály
- Department of Vascular & Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Péter Sótonyi
- Department of Vascular & Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Andrea Varga
- Department of Vascular & Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Zoltán Ungvári
- Department of Biochemistry and Molecular Biology, Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Theoretical Medicine Doctoral School/Departments of Medical Physics and Informatics & Cell Biology and Molecular Medicine, University of Szeged, Szeged, Hungary
| | - Anna Csiszár
- Department of Biochemistry and Molecular Biology, Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Theoretical Medicine Doctoral School/Departments of Medical Physics and Informatics & Cell Biology and Molecular Medicine, University of Szeged, Szeged, Hungary
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Andriy Yabluchanskiy
- Department of Biochemistry and Molecular Biology, Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shannon Conley
- Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Tamás Csipő
- Department of Biochemistry and Molecular Biology, Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Ágnes Lipecz
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
- Department of Biochemistry and Molecular Biology, Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Department of Ophthalmology, Josa Andras Hospital, Nyiregyhaza, Hungary
| | - Illés Kovács
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary.
- Department of Ophthalmology, Weill Cornell Medical College, New York City, NY, USA.
- Department of Clinical Ophtalmology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary.
| | - Zoltán Zsolt Nagy
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
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Élő Á, Czakó C, István L, Benyó F, Nagy ZZ, Kovács I. Retinalis biomarkerek szerepe a vascularis dementia és az Alzheimer-kór korai formáinak diagnosztikájában. Orv Hetil 2020; 161:1744-1752. [DOI: 10.1556/650.2020.31841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/02/2020] [Indexed: 11/19/2022]
Abstract
Absztrakt:
A dementiák társadalmunkban egyre nagyobb problémát jelentenek, folyamatosan nő a
megbetegedések száma. A dementia leggyakoribb előfordulási formája az
Alzheimer-kór, mely az esetek 60–80%-áért felelős. Kórlefolyása hosszú, a
preklinikai stádiumtól a súlyos Alzheimer-kórig több év, évtized is eltelik. Az
Alzheimer-kór egy olyan progresszív neurodegeneratív betegség, amely súlyos
szellemi leépüléshez vezet. A diagnózishoz számos, kognitív funkciót mérő teszt
és képalkotó vizsgálat áll rendelkezésre, a korai diagnózis azonban nagyobb
kihívást jelent, így a betegség gyakran későn kerül felismerésre. Mivel az agyi
és a retinalis keringés között bizonyítottan kapcsolat van, felmerül annak
lehetősége, hogy a retina vizsgálata az Alzheimer-kór és a vascularis dementiák
korai diagnózisában és progressziójának követéséhez is segítséget nyújthat. Az
utóbbi években a retina képalkotó vizsgálataiban bekövetkezett fejlődésnek
köszönhetően lehetővé vált a retina strukturális és vérkeringési elváltozásainak
vizsgálata a dementiák különböző típusaiban. Ezek alkalmazása nemcsak a korai
diagnózisban, hanem a progresszió megítélésében és a terápia nyomon követésében
is segítséget nyújthat a jövőben. Orv Hetil. 2020; 161(41): 1744–1752.
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Affiliation(s)
- Ágnes Élő
- Általános Orvostudományi Kar, Szemészeti Klinika, Semmelweis Egyetem, Budapest, Üllői út 26., 1085
| | - Cecília Czakó
- Általános Orvostudományi Kar, Szemészeti Klinika, Semmelweis Egyetem, Budapest, Üllői út 26., 1085
| | - Lilla István
- Általános Orvostudományi Kar, Szemészeti Klinika, Semmelweis Egyetem, Budapest, Üllői út 26., 1085
| | - Fruzsina Benyó
- Általános Orvostudományi Kar, Szemészeti Klinika, Semmelweis Egyetem, Budapest, Üllői út 26., 1085
| | - Zoltán Zsolt Nagy
- Általános Orvostudományi Kar, Szemészeti Klinika, Semmelweis Egyetem, Budapest, Üllői út 26., 1085
| | - Illés Kovács
- Általános Orvostudományi Kar, Szemészeti Klinika, Semmelweis Egyetem, Budapest, Üllői út 26., 1085
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Czakó C, István L, Benyó F, Élő Á, Erdei G, Horváth H, Nagy ZZ, Kovács I. The Impact of Deterministic Signal Loss on OCT Angiography Measurements. Transl Vis Sci Technol 2020; 9:10. [PMID: 32821482 PMCID: PMC7401964 DOI: 10.1167/tvst.9.5.10] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/19/2020] [Indexed: 01/09/2023] Open
Abstract
Purpose In this study, we aimed at investigating the impact of deterministic signal loss on image quality and, thus, on optical coherence tomography angiography (OCTA) measurements performed by the RTVue-XR Avanti System. Methods Absorptive filters with different optical densities (ODs) were used to simulate signal loss in a controlled way in 30 eyes from 15 healthy subjects. Scan Quality (SQ), provided by the AngioVue software, was applied as a measure of image quality. Results Assessing the effect of decreased light transmittance on SQ values as well as that of attenuated image quality on OCTA parameters revealed a strong systematic dependence between these quantities. Attenuated image quality was associated with significantly decreased macular and peripapillary vessel density (VD) values, and we calculated a correction factor of 2.27% to 3.97% for a one-unit change in SQ for the different VD parameters. Conclusions Our findings suggest that the influence of systematic changes in image quality on OCTA parameters needs to be considered during patient follow-up in order to make valid assessment of progression. Translational Relevance For accurate evaluation of longitudinal changes in OCTA parameters, equal scan quality or using a correction factor is suggested.
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Affiliation(s)
- Cecilia Czakó
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Lilla István
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Fruzsina Benyó
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Ágnes Élő
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Gábor Erdei
- Department of Atomic Physics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Hajnalka Horváth
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Zoltán Zsolt Nagy
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Illés Kovács
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
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