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Vein Occlusion (vein + occlusion)

Distribution by Scientific Domains

Medical Sciences	100%

Kinds of Vein Occlusion

central retinal vein occlusion

retinal vein occlusion

Selected Abstracts

Cryoballoon Pulmonary Vein Isolation Guided by Transesophageal Echocardiography: Novel Aspects on an Emerging Ablation Technique

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 11 2009
CLAUDIA HERRERA SIKLÓDY M.D.
Background: Pulmonary vein (PV) isolation using a balloon-mounted cryoablation system is a new technology for the percutaneous treatment of atrial fibrillation (AF). Transesophageal echocardiography (TEE) allows real-time visualization of cryoballoon positioning and successful vein occlusion via color Doppler. We hypothesized that PV mechanical occlusion monitored with TEE could predict effective electrical isolation. Methods: We studied 124 PVs in 30 patients. Under continuous TEE assessment, a cryoballoon was placed in the antrum of each PV aiming for complete PV occlusion as documented by color Doppler. At the end of the procedure, PV electrical isolation was evaluated using a circumferential mapping catheter. Results: Of the 124 PVs studied, 123 (99.2%) could be visualized by TEE: the antrum was completely visualized in 80 of them (64.5%), partially in 36 (29.0%), and only disappearance of proximal flow could be observed in the remaining 7 PVs (5.7%). Vein occlusion could be achieved in 111 of the 123 (90.2%) visualized PVs. Postinterventional mapping demonstrated electrical isolation in 109 of 111 occluded PVs (positive predictive value 98.2%) and only in 1 of 12 nonoccluded PVs (negative predictive value 91.7%, P < 0.001). After a mean follow-up of 7.4 ± 3.7 months, 73.3% of patients remained in sinus rhythm without antiarrhythmic drugs. Conclusion: Color Doppler documented PV occlusion during cryoballoon ablation can predict effective electrical isolation. [source]

Lobectomy for Pulmonary Vein Occlusion Secondary to Radiofrequency Ablation

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 9 2010
MATTHEW A. STELIGA M.D.
Pulmonary Vein Occlusion After RF Ablation., Pulmonary vein stenosis, a recognized complication of transcatheter radiofrequency ablation in the left atrium, is often asymptomatic. Significant stenosis is commonly treated with percutaneous balloon dilation with or without stenting. We encountered a case of complete pulmonary vein occlusion that caused lobar thrombosis, pleuritic pain, and persistent cough. Imaging studies revealed virtually no perfusion to the affected lobe. A lobectomy was performed, resolving the persistent cough and pain. Pulmonary vein occlusion should be suspected in patients who present with pulmonary symptoms after having undergone ablative procedures for atrial fibrillation. This condition may necessitate surgical intervention if interventions such as balloon dilation or stenting are not possible or are ineffective.,(J Cardiovasc Electrophysiol, Vol. 21, pp. 1055-1058, September 2010) [source]

Cryoballoon Pulmonary Vein Isolation Guided by Transesophageal Echocardiography: Novel Aspects on an Emerging Ablation Technique

Increased heat-shock protein 90 expression contributes to impaired adaptive cytoprotection in the gastric mucosa of portal hypertensive rats

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 6 2009
Masayuki Tominaga
Abstract Background and Aims:, Portal hypertensive (PHT) gastropathy results in an increased susceptibility to damage. Adaptive cytoprotection against ethanol-induced damage is impaired in the gastric mucosa of rats with portal hypertension. Excessive nitric oxide (NO) production occurs in portal hypertension and is mediated in part via heat-shock protein (Hsp)90 production. The aim of this study was to investigate the relation between adaptive cytoprotection after exposure to ethanol and gastric expression of Hsp90 in PHT rats. Methods:, Portal hypertension was induced in rats by staged portal vein occlusion. Adaptive cytoprotection to 70% ethanol was evaluated by assessing the injury index of the gastric mucosa with or without pretreatment with 10% ethanol. Expression of Hsp90 mRNA was evaluated by real-time polymerase chain reaction, and expression of Hsp90 protein was evaluated by western blotting. The effect of Hsp90 inhibition in PHT rats was evaluated by administration of geldanamycin. Results:, Gastric Hsp90 mRNA expression in PHT rats was significantly less than that in sham-operated (SO) controls. However, after 10% ethanol pretreatment, Hsp90 mRNA expression was significantly greater in PHT rats than in SO controls. In PHT rats, gastric Hsp90 protein expression after 10% ethanol pretreatment was significantly greater than that without the pretreatment. However, the pretreatment had no effect on the injury index compared to SO rats. Administration of geldanamycin prior to 10% ethanol pretreatment significantly decreased the injury index in response to 70% ethanol in the PHT rats. Conclusions:, These results show that 10% ethanol pretreatment markedly increases gastric Hsp90 expression in PHT rats. Excessive production of Hsp90 may contribute impaired adaptive cytoprotection. [source]

Biventricular Pacing Using Two Pacemakers and the Triggered VVT Mode

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2001
BRENDAN O'COCHLAIN
O'COCHLAIN, B., et al.: Biventricular Pacing Using Two Pacemakers and the Triggered VVT Mode. Pacemaker dependent patients exhibit interventricular conduction delay due to right ventricular lead placement. The addition of a transvenous coronary sinus lead for biventricular pacing has been shown to be effective. Venous stenosis and thrombosis postpacemaker implantation can occur in up to 35% of patients. This report describes a patient with a preexisting left-sided dual chamber pacemaker and chronic left subclavian vein occlusion that was upgraded to a biventricular system by placing a coronary sinus lead and single chamber ventricular triggered pacemaker on the opposite side. [source]

Transvenous Pacemaker Insertion Ipsilateral to Chronic Subclavian Vein Obstruction: An Operative Technique for Children and Adults

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 11 2000
MARC OVADIA
OVADIA, M., et al.: Transvenous Pacemaker Insertion Ipsilateral to Chronic Subclavian Vein Obstruction: An Operative Technique for Children and Adults. Subclavian vein occlusion limits insertion of pacing electrodes in children and adults. The concern is greatest in children with a long-term need for pacing systems necessitating use of the contralateral vein and potential bilateral loss of access in the future. We describe an operative technique to provide ipsilateral access in chronic subclavian vein occlusion in five consecutive pediatric (n = 4, mean age 6.5 years) and adult (n = 1, age 70 with bilateral subclavian vein occlusion) patients in whom this condition was noted at the time of pacemaker or ICD implant. Occlusion was documented by venography. Pediatric cardiac diagnoses included complete heart block in all patients, tetralogy of Fallot in three, and L-transposition of the great vessels in one. Percutaneous brachiocephalic (innominate) or deep subclavian venous access was achieved by a supraclavicular approach using an 18-gauge Deseret angiocath, a Terumo Glidewire, and dilation to permit one or two 9,11 Fr sheaths. Electrode(s) were positioned in the heart and tunneled (pre, or retroclavicularly) to a pre, or retropectoral pocket. Pacemaker and ICD implants were successful in all without any complication of pneumothorax, arterial or nerve injury, or need for transfusion. Inadvertent arterial access did not occur as compared with prior infraclavicular attempts. One preclavicularly tunneled electrode dislodged with extreme exertion and was revised. Ipsilateral transvenous access for pacemaker or ICD is possible via a deep supraclavicular percutaneous approach when the subclavian venous obstruction is discovered at the time of implant. In children, it avoids the use of the contralateral vein that may be needed for future pacing systems in adulthood. This venous approach provides access large enough to allow even dual chamber pacing in children and can be accomplished safely. [source]

Central retinal vein occlusion heralding the relapse of haematodermic neoplasm

BRITISH JOURNAL OF HAEMATOLOGY, Issue 3 2008
James Tee
No abstract is available for this article. [source]

In vivo evaluation of an implantable portal pump system for augmenting liver perfusion

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 8 2000
L. R. Jiao
Background Increasing portal inflow in cirrhosis using a mechanical pump reduces portal venous pressure and improves liver function. A pump has been developed for portal vein implantation in human cirrhosis. This study describes the initial in vivo evaluation in a porcine model. Methods Five Large White pigs underwent laparotomy and exposure of the liver. Flow in the hepatic artery, portal vein and hepatic microcirculation was monitored continuously. Hepatic tissue oxygenation was measured by near-infrared spectroscopy. After baseline measurements the pump was inserted into the portal vein. Pump flow rate was then increased stepwise to 50 per cent over the baseline value for a period of 2 h. The pump was then stopped for 20 min and left in situ while continuing to collect systemic and hepatic haemodynamic data. The animal was killed and biopsies for histological examination were taken from the liver, small intestine and spleen. Results The baseline total hepatic blood flow was 626(39) ml/min; the hepatic artery supplied 18·4(2·1) per cent and the portal vein 81·6(2·1) per cent. The pump was inserted successfully in all animals without surgical complications. During surgical insertion of the pump, the temporary portal vein occlusion resulted in a significant rise in hepatic artery blood flow (22(3) per cent; P < 0·01 versus baseline). Portal vein flow was augmented by pumping; there was a significant correlation between the pump motor speed and portal vein flow (P < 0·0001). This inflow correlated directly with flow in the hepatic microcirculation and hepatic tissue oxygenation (P < 0·001). The pump ran satisfactorily throughout the study. Histological examination revealed no evidence of structural damage to the liver or ischaemic changes in the small intestine or spleen. Conclusion It is technically possible and safe to insert an implantable pump in the portal vein. Portal venous blood flow can be increased up to 50 per cent with a resultant increase in flow in the hepatic microcirculation and hepatic oxygenation and without adverse effects on either hepatic or systemic haemodynamics. © 2000 British Journal of Surgery Society Ltd [source]

Increase of vascular endothelial growth factor and interleukin-6 in the aqueous humour of patients with macular oedema and central retinal vein occlusion

ACTA OPHTHALMOLOGICA, Issue 6 2010
Hidetaka Noma
Acta Ophthalmol. 2010: 88: 646,651 Abstract. Purpose:, This study aimed to investigate whether vascular endothelial growth factor (VEGF) or interleukin-6 (IL-6) influence macular oedema in patients with central retinal vein occlusion (CRVO). Methods:, Sixteen consecutive patients with unilateral CRVO and macular oedema were studied, along with eight age- and sex-matched patients without ischaemic ocular disease. Retinal ischaemia was evaluated from capillary non-perfusion on fluorescein angiography. Macular oedema was examined by optical coherence tomography. Aqueous humour (AH) samples were obtained during combined pars plana vitrectomy and cataract surgery, and were examined by enzyme-linked immunosorbent assay. Results:, Aqueous levels of VEGF and IL-6 were significantly elevated in patients compared with controls (p = 0.0142 and p < 0.0001, respectively). Aqueous levels of both molecules were significantly higher in patients with ischaemia than in those without ischaemia (p = 0.0026 and p = 0.0487, respectively). Furthermore, AH levels of VEGF and IL-6 were correlated with the severity of macular oedema (, = 0.7265, p = 0.0049, , = 0.5324, and p = 0.0392, respectively). Conclusions:, Both VEGF and IL-6 were elevated in the AH of patients with macular oedema and ischaemic CRVO, suggesting that these molecules may be related to the increase in vascular permeability in such patients. [source]

4413: Analysis of gene expression in acute ischemic neuroretinas : a genome-wide screen discriminating occlusion (BRVO) versus laser effects in rats

ACTA OPHTHALMOLOGICA, Issue 2010
C OROPESA
Purpose Identification of genes differentially regulated in rat neuroretinas submitted to an experimental acute branch retinal vein occlusion (BRVO), to a laser treatment, or to no treatment at all. Methods We have developed an in vivo experimental model of venous occlusion by photodynamic thrombosis in rat retinas. After anaesthesia, a sodium fluorescein solution was injected in rat tail 15 minutes before laser treatments. To induce ischemia in tested retina, venous sites adjacent to the optic nerve head were photocoagulated with an argon laser. In one group of tested animals, the retina was exposed to laser treatment at sites located between major vessels. As this treatment may have an effect upon choroidal blood flow, control eyes were not subjected to laser treatment. RNAs were isolated from the neuroretina 30 minutes post treatments, and processed for Affymetrix gene-chip analysis. Results Genome-wide screen enabled us to identify 308 and 348 genes which were up- or down-regulated, respectively, by BRVO and laser treatment only. When we compared the transcriptomes of retinas subjected to vessel occlusion or laser treatment to the control one, we found that the expression profiles of, respectively, 116 and 126 genes were specifically modified. The majority of the up- and down-regulated genes encode proteins involved in different aspects of early stress response, neuroprotection, inflammation and apoptosis. Conclusion Our microarray analysis revealed changes in gene expression bearing similarities to gene expression results from other ischemia models. Furthermore, it revealed that laser treatment may have an unreported impact on retina's metabolism. [source]

3412: Anti-VEGF and corticosteroids therapy in macular edema secondary to venous occlusions

ACTA OPHTHALMOLOGICA, Issue 2010
JAC POURNARAS
Purpose To assess the evidence on interventions to improve visual acuity (VA) and to treat macular edema (ME) secondary to central (CRVO) and branch retinal vein occlusion (BRVO) Methods Recent randomized studies have evaluated the safety and efficacy of corticosteroids (triamcinolone, dexamethasone) and anti-VEGF therapies (ranibizumab). Score study evaluates preservative-free intravitreal triamcinolone with standard care in BRVO and CRVO. In Geneva study, dexamethasone (DEX) intravitreal implant is compared with sham in BRVO and CRVO. BRAVO and Cruise studies evaluate intraocular injections of ranibizumab in patients with ME following BRVO and CRVO, respectively. Results In SCORE study, there was no difference identified in visual acuity at 12 months for the standard care group compared with the triamcinolone groups in BRVO patients. Intravitreal triamcinolone is superior to observation for treating vision loss associated with ME secondary to CRVO. Improvements in BCVA with DEX implant were seen in patients with BRVO and CRVO, although the patterns of response differed. Intraocular injections of 0.3 mg or 0.5 mg ranibizumab provided rapid, effective treatment for ME following BRVO and CRVO Conclusion Grid photocoagulation remains the standard care for patients with vision loss associated with ME secondary to BRVO. Intravitreal triamcinolone is superior to observation for treating vision loss associated with ME secondary to CRVO. Dexamethasone intravitreal implant can both reduce the risk of vision loss and improve the speed and incidence of visual improvement in eyes with ME secondary to BRVO or CRVO. Anti-VEGF therapies represent new therapeutical option in the treatment of ME secondary to BRVO and CRVO. Further randomized studies are needed [source]

3416: Surgical therapy of macular edema

ACTA OPHTHALMOLOGICA, Issue 2010
CJ POURNARAS
Purpose Persistent macular oedema (ME) is the main cause of poor visual outcome during the evolution of retinal ischemic microangiopathies and traction related macular distortion. Among multiples treatment approaches, vitreoretinal surgery is applied with the goal to achieve the release of a traction related component of macular oedema . Methods Vitrectomy with peeling of the posterior hyaloid, epiretinal membranes, vitreoretinal tractions and/or internal limiting membrane removal, were studied in numerous nonrandomized cases series. Results Pars plana vitrectomy has been shown to reduce macular oedema with significant change in best corrected visual acuity, in epiretinal membranes, vitreoretinal traction syndrome and ischemic microangiopathies related macular thickening central, hemiretinal, branch retinal vein occlusion and diabetic macular edema). Evidence to date does not support any therapeutic benefit from radial optic neurotomy and arteriovenous crossing sheathotomy for BRVO and CRVO related macular oedema. Conclusion In the era of intravitreal injection of steroids and anti VEGF substances, vitrectomy seems to have a beneficial effect in traction related, selected pathologies associated to chronic macular edema. [source]

2112: AO imaging of acute macular diseases

ACTA OPHTHALMOLOGICA, Issue 2010
M PAQUES
Purpose To show clinical cases of acute macular diseases and their follow-up by adaptive optics flood imaging. Methods Cases of acute retinal ischemia, of acute macular neuroretinopathy, of photic injury and of poppers-related retinopathy have been observed by a prototypic adaptive optics flood imaging (ImagineEye corporation). Images from follow-up examinations have been registered in order to obtain retinal monitoring at the single photoreceptor level. Iamges were compared to high resolution OCT scans. Results Precise extension and progression/regression of lesions could be documented in all cases. Acute macular neuroretinopathy showed residual cones persisting within an area devoid of any detectable cone. Minute progression and regression of lesions could be documented. Acute ischemia of the inner retina due to central retinal vein occlusion resulted in focal masking of the cone mosaic. The cone mosaic reappeared during follow-up. Photic injury showed no changes over a 1 year follow-up. Images of poppers-related retinopathy showed partial improvement over time. Conclusion Adaptive optics flood imaging allows documentation of the extension and progression of acute maculopathies of various origins. [source]

2412: Laser and oxygen

ACTA OPHTHALMOLOGICA, Issue 2010
CJ POURNARAS
Purpose To evaluate the changes in the retinal oxygen partial pressure (PO2) following photocoagulation as well as the resulting effect of the laser induced improved oxygenation, on the retinal vessels hemodynamics. Methods Measurements of the partial pressure of oxygen (PO2) distribution within the retina in various animal species using oxygen sensitive microelectrodes and evaluation of changes on the retinal vessels reactivity, following laser treatment, gave additional insights concerning photocoagulation mechanisms. Results Preretinal intervascular PO2 , far away from vessels, remain constant in all retinal areas. Intervascular intraretinal PO2 gradually decreases from both the vitreo-retinal interface and the choroid towards the mid-retina. Close to the pigment epithelium, it is significantly higher than at the vitreoretinal interface due to the much higher O2 supply provided by choroidal compaires to retinal circulation. Laser photocoagulation reduces the outer retina O2 consumption and allows O2 diffusion into the inner retina from the choroid raising the PO2 in the inner healthy retinal layers and in the preretinal intervascular normal areas. In this way, laser treatment relieves retinal hypoxia in experimental branch vein occlusion (BRVO). In patients with diabetic retinopathy (DR), the retinal PO2 is also higher in areas previously treated with laser. Following photocoagulation, the resulting reversal of hypoxia, the down-regulation of the VEGF expression, the retinal vasculature constriction and the improvement of the auto-regulatory response to physiological stimuli, all affect favorably both the retinal neovascularisation and macular edema. Conclusion Photocoagulation induces an increase of the inner retinal oxygenation resulting to an improvement of the autoregulatory retinal vessels response. [source]

Central retinal vein occlusion following trabeculectomy with OloGen in patients with advanced glaucoma: a possible side-effect?

ACTA OPHTHALMOLOGICA, Issue 5 2010
Paris Tranos
No abstract is available for this article. [source]

Long-term study of vascular perfusion effects following arteriovenous sheathotomy for branch retinal vein occlusion

ACTA OPHTHALMOLOGICA, Issue 3 2010
Mahiul M. K. Muqit
Abstract. Purpose:, To evaluate the perfusion effects and long-term visual outcome of pars plana vitrectomy (PPV) combined with arteriovenous sheathotomy (AVS) with or without triamcinolone for nonischaemic branch retinal vein occlusion (NI-BRVO). Methods:, Prospective, interventional case series of eight patients with NI-BRVO and haemorrhagic macular oedema. Patients underwent PPV and AVS (n = 5), or PPV, AVS and intravitreal triamcinolone (IVT, n = 3). A masked grading technique assessed fundus photographs and fluorescein angiography (FFA) following surgery. Scanning laser ophthalmoscopy/optical coherence tomography (SLO/OCT) evaluated macular oedema and outer retinal architecture. Main outcomes examined included visual acuity (VA), retinal reperfusion, collateral vessel regression, vascular dilatation, cystoid macular oedema (CMO), and ocular neovascularization. Results:, Seven of eight patients underwent uncomplicated surgery, with increased intraretinal perfusion and reduced engorgement of distal retinal veins. The mean pre-logMAR VA was 0.8 (SD 0.17) and did not improve significantly after surgery (post-logMAR 0.6, SD 0.38; p = 0.11, paired t -test). SLO/OCT showed persistent CMO in four patients, and subfoveal thinning of the photoreceptor layer. Collateral vessels disappeared at the blockage site post-AVS in 7/8 eyes, and this was associated with improved retinal perfusion. Six of eight patients developed epiretinal membrane. No patients developed ocular neovascularization. The average follow-up was 34.5 months. Conclusions:, PPV with AVS is a safe procedure, and adjunctive IVT had no additional effects on vascular perfusion. Successful decompressive surgery was followed by disappearance of collateral vessels at the BRVO blockage site and was a clinical marker for intravascular reperfusion. Long-term epiretinal gliosis and subfoveal photoreceptor atrophy limited functional and visual recovery. [source]

Three-dimensional angiographic imaging of leakage in branch retinal vein occlusion

ACTA OPHTHALMOLOGICA, Issue 2 2010
Ursula Margarethe Schmidt-Erfurth
Abstract. Purpose:, Optical coherence tomography (OCT) is used to image branch retinal vein occlusion (BRVO) but lacks information about leakage dynamics and perfusion status. Topographical angiography (TAG) is capable of providing this information and has been described previously in age-related macular degeneration. This study evaluates TAG in BRVO. Methods:, We included 56 eyes of 40 consecutive patients with BRVO and a reduction in central vision. Two groups were established based on whether argon laser coagulation was performed or not. A standardized follow-up was performed. The chorioretinal fluorescence pattern was reconstructed following TAG. Quantitative measurements were also performed. Results:, TAG performed from indocyanine green angiography (ICGA) showed smaller lesion size (LS) compared to fluorescein angiography (FA) (mean difference: early phase = ,1.6 mm2, late phase = ,1.8 mm2). The extent of mean LS from early to late phase increased by 0.8 mm2 in FA and by 0.6 mm2 in ICGA. TAG could visualize different degrees of leakage topographically. Conclusion:, TAG gives new insights into the pathophysiology of BRVO: it enables the visualization of dynamics of leakage and the demonstration of the effects of intravasal stasis. Furthermore, TAG is less impaired by masking phenomena than FA. Functional retinal imaging shows distinct advantages over OCT: quantification of leakage activity is possible using TAG. [source]

Retinal artery occlusion following intravitreal anti-VEGF therapy

ACTA OPHTHALMOLOGICA, Issue 2 2010
Therese Von Hanno
Abstract. Purpose:, Anti-vascular endothelial growth factor (anti-VEGF) therapy effectively inhibits angiogenesis and is now enjoying widespread use in the treatment of age-related macular degeneration (AMD). It may also have a role in the treatment of macular oedema secondary to other conditions. VEGF is a signalling molecule that has a variety of roles, including vasoregulation and effects on the coagulation homeostasis. Anti-VEGF therapy may therefore have adverse effects on ocular blood flow. Methods:, Two cases of retinal artery occlusion after intravitreal injection of anti-VEGF are presented. Both patients were given the treatment to reduce macular oedema secondary to central retinal vein occlusion. Possible mechanisms are discussed. Results:, Patient 1 developed a central retinal artery occlusion within 1 month of an intravitreal injection of ranibizumab (Lucentis®). The macular oedema was totally resolved at 1 month; final visual acuity (VA) was light perception. Patient 2 developed a branch retinal artery occlusion in the macula 2 days after an intravitreal injection of bevacizumab (Avastin®). The macular oedema was almost resolved within 1 week and did not recur; final VA was 0.6. Conclusions:, Anti-VEGF therapy may have a role in the treatment of macular oedema caused by central retinal vein occlusions. However, our report indicates that the therapeutic principle may be associated with an increased risk of retinal arterial occlusions. [source]

Electrophysiological evaluation and visual outcome in patients with central retinal vein occlusion, primary open-angle glaucoma and neovascular glaucoma

ACTA OPHTHALMOLOGICA, Issue 1 2010
Elisabeth Wittström
Abstract. Purpose:, To evaluate patients with central retinal vein occlusion (CRVO) and neovascular glaucoma (NVG) using electrophysiology in order to gain better understanding of visual outcome and risk factors, such as previously diagnosed primary open-angle glaucoma (POAG). Methods:, Eighty-three patients (83 eyes) initially presenting with CRVO and examined with full-field electroretinography (ERG) within 3 months of the thrombotic event were analysed retrospectively regarding treatment, risk factors and visual outcome. In addition, 30 patients initially presenting with NVG caused by CRVO were also investigated regarding risk factors using electrophysiology in order to determine the cause of their visual impairment. Results:, Nineteen (23%) of the 83 patients initially presenting with CRVO had been diagnosed previously with POAG. Ninety-five per cent (18/19) of all the patients with previously diagnosed glaucoma developed ischaemic CRVO. Thirty-four per cent of the patients initially presenting with CRVO (28/83) developed NVG. Sixty-eight per cent (13/19) of the patients with previous glaucoma developed NVG, compared to 23% (15/64) of the patients without previous POAG. In the patients who initially presented with NVG, full-field ERG demonstrated a remaining retinal function of both cones and rods, indicating that the main cause of visual impairment is ischaemia of the ganglion cell layer. Conclusion:, Glaucoma is a significant risk factor for developing ischaemic CRVO and subsequent NVG. The presence of POAG in CRVO worsens visual outcome. NVG is associated with preserved photoreceptor function, thus indicating ischaemia of the ganglion cell layer as the primary cause of visual impairment. This emphasizes the importance of prompt treatment of ischaemia and elevated intraocular pressure in these patients. [source]

Association of exfoliation syndrome and central retinal vein occlusion: an ultrastructural analysis

ACTA OPHTHALMOLOGICA, Issue 1 2010
Robert Ritch
Abstract. Purpose:, To evaluate prospectively the frequency with which exfoliation syndrome (XFS) occurs in patients with central retinal vein occlusion (CRVO) by clinical examination and ultrastructural examination of conjunctival biopsy specimens. Methods:, Prospective observational case series. Thirty-six eyes of 36 consecutive patients with CRVO were investigated for XFS by slit-lamp examination and conjunctival biopsy when XFS was not clinically visible on examination. Results:, A clinical diagnosis of XFS or a positive biopsy result for exfoliation material (XFM) was present in 22 of the 36 patients (61%; 95% confidence interval 45,75%). Twelve of these 22 patients (54%) had a clinical diagnosis of XFS. Aggregates of XFM were identified ultrastructurally in the biopsy specimens in 10 of 24 patients with no clinical signs of XFS (42%). Patients with and without XFS had similar distribution of age, gender, race and prevalence of systemic disorders. Twelve of the 22 (54%) XFS patients had neither glaucoma nor ocular hypertension prior to the CRVO. Conclusion:, In accordance with previous retrospective and histological studies, this prospective, in vivo study suggests that CRVO is commonly associated with XFS. [source]

Bevacizumab as adjuvant for neovascular glaucoma

ACTA OPHTHALMOLOGICA, Issue 1 2010
Julia Beutel
Abstract. Purpose:, We aimed to evaluate the longterm effects of intraocular bevacizumab (Avastin®) injections as adjuvant treatment in patients with neovascular glaucoma. Methods:, Twenty eyes of 18 consecutive patients with secondary neovascular glaucoma caused by proliferative diabetic retinopathy (n = 7), ischaemic central retinal vein occlusion (n = 7), ischaemic ophthalmopathy (n = 2) and retinal ischaemia resulting from persistent detachment (n = 2) were treated with intraocular bevacizumab injections (1.25 mg/0.05 ml) in addition to other treatments. The main outcome measure was the change in degree of iris rubeosis. Secondary outcomes included intraocular pressure (IOP), best corrected visual acuity (BCVA) and numbers of additional interventions or antiglaucoma medications administered after injection. Results:, Mean (± standard deviation) follow-up was 67.7 ± 13.8 weeks (range 50,93 weeks). At the last follow-up, complete regression of rubeosis was detectable in five (20%) eyes, incomplete regression in seven (35%), stabilization in six (30%), and an increase in two (10%) eyes. Mean IOP was 26.0 ± 8.9 mmHg at baseline and significantly decreased to 14.75 ± 5.3 mmHg at the last follow-up visit (p = 0.000005). Mean baseline BCVA (logMAR [logarithm of the minimum angle of resolution] 1.43 ± 0.89) was stabilized during the follow-up period (logMAR 1.5 ± 0.98). Patients received an average of 2.75 injections. Additional treatments were laser photocoagulation in 13 (65%) eyes, cyclodestructive procedure in 14 (70%), cryopexy in six (30%), drainage procedures in two (10%), and vitrectomy in five (25%) eyes. Conclusions:, Bevacizumab may be beneficial as adjuvant treatment in neovascular glaucoma because of its anti-angiogenic properties and its ability to prevent establishment or progression of angular obstruction. The causative disease inducing the angiogenic process requires treatment in all cases. Antiglaucoma treatment is needed in cases of persistent elevated IOP. [source]

Long-term outcome of transpupillary thermotherapy as primary treatment of selected choroidal melanoma

ACTA OPHTHALMOLOGICA, Issue 7 2009
Raffaele Parrozzani
Abstract. Purpose:, To evaluate prospectively, on a long-term range, the clinical outcomes of transpupillary thermotherapy (TTT) as primary treatment of selected choroidal melanoma. Methods:, Seventy-seven eyes of 77 patients affected by small posterior choroidal melanoma were treated with TTT as a sole treatment, using an infrared diode laser at 810 nm according to a standard procedure. Follow-up was longer than 36 months. Results:, Seventeen tumours (22%) were parapapillary (PP) and 60 tumours (78%) were non-parapapillary (NPP) in location. Mean follow-up was 55.2 ± 17.9 months in PP tumours and 44.3 ± 23.7 months in NPP tumours. Thirteen (76%) PP tumours and 55 (92%) NPP tumours regressed (P > 0.05). Nine tumours recurred: seven were retreated using Iodine-125 brachytherapy and two were enucleated (both parapapillary). Four patients (5%) developed liver metastasis and died during follow-up. Tumour thickness was found to be predictive of recurrence (odds ratio: 4.3). Complications were found in 20 eyes (26%): macular pucker in 11 (14%), macular oedema in three (4%), retinal vein occlusion in six (8%), vitreous and subretinal haemorrhage in two (3%) and neovascular glaucoma in three (4%). PP tumours had more local complications (but this was not statistically significant; P > 0.05). Complications appeared more frequently in tumours treated with more than one TTT session (P = 0.01), and time-risk to develop intraocular complications seems longer in the PP group, without reaching statistical significance (P = 0.07). Conclusion:, TTT may be a clinically effective method for conservative treatment of selected, non-parapapillary, small posterior choroidal melanoma. [source]

Macular microcirculation in hypertensive patients with and without branch retinal vein occlusion

ACTA OPHTHALMOLOGICA, Issue 6 2009
Hidetaka Noma
Abstract. Purpose:, Our purpose was to determine whether a reduction in blood flow velocity (BFV) in the perifoveal capillaries is involved in the pathogenesis of branch retinal vein occlusion (BRVO) in patients with hypertension. Methods:, Subjects included hypertensive patients with (n = 12) and without (n = 16) BRVO and healthy volunteers (n = 16). Perifoveal BFV was measured by the tracing method using fluorescein angiography and a scanning laser ophthalmoscope. Logistic regression analysis was performed to assess factors that influenced the presence or absence of BRVO. Results:, Mean BFV showed a significant decrease across the three groups (healthy controls: 1.49 ± 0.11 mm/second; hypertensive patients without BRVO: 1.36 ± 0.12 mm/second; hypertensive patients with BRVO: 1.16 ± 0.24 mm/second; ptrend < 0.001). Multivariate logistic regression analysis showed that BFV was a significant risk factor for the presence of BRVO. Conclusions:, Perifoveal capillary BFV is reduced in hypertensive patients with and without BRVO. It is possible that a decrease in BFV may be involved in the occurrence of BRVO. Measurement of perifoveal capillary BFV may be useful for investigating the pathogenesis and progression of BRVO. [source]

Retinal photocoagulation and oxygenation

ACTA OPHTHALMOLOGICA, Issue 2009
CJ POURNARAS
Purpose The clinical role of photocoagulation for the treatment of hypoxia related complications of retinal ischemic microangiopathies is well established. Methods Measurements of the partial pressure of oxygen (PO2) distribution within the the retina in various animal species using oxygen sensitive microelectrodes and evaluation of the retinal vessels reactivity by laser doppler velocimetry gave additional insights concerning photocoagulation mechanisms. Results The PO2 within the vitreo-retinal interface is heterogeneous. Preretinal and trans-retinal PO2 profiles indicate that the preretinal PO2 far away from vessels remain constant in all retinal areas. Intervascular intraretinal PO2 gradually decreases from both the vitreo-retinal interface and the choroid towards the mid-retina. Close to the pigment epithelium, it is significantly higher than at the vitreoretinal interface due to the much higher O2 supply provided by choroidal compaires to retinal circulation. Laser photocoagulation reduces the outer retina O2 consumption and allows O2 diffusion into the inner retina from the choroid raising the PO2 in the inner healthy retinal layers and in the preretinal intervascular normal areas. In this way laser treatment relieves retinal hypoxia in experimental branch vein occlusion (BRVO). In patients with diabetic retinopathy (DR), the retinal PO2 is higher in areas previously treated with laser. Following photocoagulation, the resulting reversal of hypoxia, the retinal vasculature constriction and the improvement of the regulatory response to hyperoxia all affect favorably both the retinal neovascularisation and macular edema. Conclusion Photocoagulation induces an increase of the inner retinal oxygenation reversing the retinal hypoxia and improving the regulatory response of the retinal vessels [source]

Retinal and optic nerve oxygenation and carbonic anhydrase inhibition

ACTA OPHTHALMOLOGICA, Issue 2009
M LA COUR
Purpose To study the effects of carbonic anhydrase inhibition on porcine retinal and optic nerve oxygenation under physiological conditions and in experimental models of ischemia. Methods Polarographic oxygen electrodes were used to measure the oxygen tension in the vitreous 500 microns in front of the optic nerve and retina. Retinal ischemia was produced by diathermia of the superior arcade vein, producing a branch retinal vein occlusion, BRVO. Optic nerve ischemia was produced by intravenous administration of 100 mg Indomethacin intravenously. Results One week after induction of BRVO, the oxygen tension over BRVO affected retina was significantly decreased by 29%. Administration of the carbonic anhydrase inhibitor dorzolamide (500 mg) caused a significant increase in the oxygen tension over BRVO affected retina, and in effect restored this tension to normal values (n=5). Intravenous administration of 300 mg Indomethacin caused a decrease of optic nerve oxygen tension by 41%. Subsequent administration of 500 mg dorzolamide increased the optic nerve oxygen tension, albeit not to normal levels (n=6). Conclusion Carbonic anhydrase inhibition increases the oxygen tension in the retina and optic nerve. In BRVO affected retina, carbonic anhydrase inhibition restores oxygen tension to normal levels. [source]

Retinal vessel oximetry using sequential and 'snapshot' hyperspectral imaging

ACTA OPHTHALMOLOGICA, Issue 2009
A MCNAUGHT
Purpose Use of sequential, and 'snapshot' hyperspectral imagers to measure oxygen saturation in retinal vessels in normals, and examples of eye disease, eg glaucoma, and retinovascular diseases. Validation of estimated oximetry values using a model eye. Methods A sequential hyperspectral imager was constructed using a fundus camera with built-in liquid-crystal tuneable filter. Images of normals,and ocular disease are presented. A novel 'snapshot' hyperspectral imager is also described: this produces images in a single exposure. Validation of both devices using an artificial eye with capillary tubes containing human blood of known oxygen saturation, placed in front of an 'artificial retina' is described. The image analysis used to detect retinal vessels, and generate oximetric values is detailed. Results Both the sequential, and 'snapshot' retinal imagers produced accurate estimations of retinal vessel oxygen saturation, when compared with the model eye. Imaging of a small group of glaucoma eyes showed abnormally elevated venous oxygen saturation. In proliferative diabetic retinopathy, abnormally elevated venular saturation was found in areas of capillary loss on FFA. In vein occlusion, elevated venous saturation was found in eyes with ischaemic FFAs. Conclusion Both the sequential and 'snapshot' hyperspectral imagers deliver useful oximetric maps of the retina. The 'snapshot' device allows more rapid imaging. The elevated venular oxygen saturation seen in both glaucoma, and retinovascular disease, is perhaps evidence of reduced oxygen consumption in damaged inner retina in glaucoma, and/or vascular 'shunting' in retinovascular disease. [source]

Protein screening in vitreous samples of patients with retinal vein occlusion

ACTA OPHTHALMOLOGICA, Issue 2009
HT AGOSTINI
Purpose The aim of the study was to identify proteins involved in the pathogenesis of retinopathy after retinal vein occlusion. In retinal vein occlusion, proteins penetrate from leaky vessels into the vitreous. Alternatively, retinal cells produce protein factors and release them into the vitreous. Methods Vitreous and plasma samples of patients with retinal vein occlusion or macular pucker / macular hole were analyzed by antibody microarrays and ELISA. Results An antibody based microarray with more than 500 target for screening vitreous samples initially was less enlightening than antibody arrays providing the possibility to quantify up to 30 proteins in an ELISA-like microassay. Standard curves of antibody microarrays are as linear as those of ELISAs. VEGF values were similar to values measured by ELISA. Conclusion In our screen, we found some candidate factors which are currently investigated for their potential of influencing retinopathy after retinal vein occlusion. The use of microarrays to identify protein factors involved in retinal disease in the vitreous will be discussed. [source]

Role of inflammation-related gene polymorphisms in branch retinal vein occlusion

ACTA OPHTHALMOLOGICA, Issue 2009
M WEGER
Purpose Branch retinal vein occlusion (BRVO) is a common vision-threatening disease. Some cytokines have previously been shown to exert proatherogenic as well as prothrombotic effects. Gene polymorphisms affecting the expression of these cytokines are thus plausible candidates as risk factors for BRVO. The purpose of the present study was to investigate hypothesized associations between cytokine gene polymorphisms and the presence of BRVO. Methods The present case-control study comprised 398 patients with BRVO and 355 control subjects. Using 5`exonuclease assays (TaqMan), genotypes of the following single nucleotide polymorphisms were determined: interleukin 1 beta (IL1B) -511C>T, interleukin 1 receptor antagonist (IL1RN) 1018T>C, interleukin 4 (IL4) -584C>T, interleukin 6 (IL6) -174G>C, interleukin 10 (IL10) -592C>A, interleukin 18 (IL18) 183A>G, tumor necrosis factor (TNF) -308G>A, monocyte chemoattractant protein 1 (CCL2) -2518A>G, interleukin 8 (IL8) -251A>T and RANTES (CCL5) -403G>A. Results Neither genotype distributions nor allele frequencies of any of the investigated polymorphisms differed significantly between BRVO patients and control subjects (IL1B -511TT: 7.8% vs. 9.6%, p=0.68; IL1RN 1018CC: 12.1% vs. 13.5%, p=0.15, IL4 -584TT: 1.3% vs. 2.3%, p=0.58; IL6 -174CC: 17.8% vs.18.6%, p=0.97; IL10 -592AA: 5.3% vs. 9.0, p=0.14; IL18 183GG: 3.0 vs. 6.2%, p=0.11; TNF -308AA: 1.5% vs. 1.4%, p=0.95; CCL2 -2518GG: 6.5% vs. 4.5%, p=0.48; IL8 -251TT: 26.9% vs. 28.7%, p=0.23; CCL5 -403AA: 3.3% vs. 4.5%, p=0.63). Conclusion Our data suggest that none of the investigated cytokine gene polymorphisms is likely a major risk factor for BRVO. [source]

Major eye diseases and risk factors associated with systemic hypertension in an adult chinese population: the Beijing Eye Study

ACTA OPHTHALMOLOGICA, Issue 2009
T LIBONDI
Purpose To assess the relationship of hypertension with major eye diseases and other ocular parameters. Methods The Beijing Eye Study is a population-based study. Examination at baseline in 2001; follow-up examination in 2006; 3222 subjects had blood pressure measurements. All participants underwent a thourough ophthalmic examination and blood pressure measurement. Hypertension was defined as a systolic blood pressure ,140 mm Hg and/or a diastolic blood pressure ,90 mm Hg, and/or self-reported current treatment for hypertension with antihypertensive medication. Results Mean age of participants in the present study was 60.4±10.0 years. Hypertension was present in 1500 (46.6%) of the 3222 subjects who had their blood pressure measured. In multiple regression analysis, hypertension was associated with higher intraocular pressure (P = 0.005), arterio-venous nicking (P = 0.009),retinal vein occlusions (P = 0.02), and diabetic retinopathy (P = 0.02). Hypertension was not significantly associated with the prevalence of open-angle glaucoma (P = 0.19) or angle-closure glaucoma (P = 0.15), age-related macular degeneration (P = 0.73), nuclear cataract (P = 0.88), posterior subcapsular cataract (P = 0.30), cortical cataract (P = 0.10), or area of alpha zone (P=0.05) or beta zone of parapapillary atrophy (P = 0.95). Conclusion In Chinese persons, while controlling for other systemic parameters, hypertension was associated with increased intraocular pressure, retinal microvascular abnormalities, and prevalence of retinal vein occlusion and diabetic retinopathy. Hypertension was not associated significantly with age-related macular degeneration, age-related cataract, or glaucoma [source]

Central retinal vein occlusion after liver transplantation

ACTA OPHTHALMOLOGICA, Issue 5 2009
Hyewon Chung
No abstract is available for this article. [source]