Ophthalmodynamometric diagnosis of unilateral ischemic ophthalmopathy

doi:10.1016/S0002-9394(02)01813-5

American Journal of Ophthalmology

Volume 134, Issue 6, December 2002, Pages 911-912

https://doi.org/10.1016/S0002-9394(02)01813-5 Get rights and content

Abstract

Purpose

To describe a patient presenting with typical signs of vascular occlusive retinopathy.

Design

Observational case report.

Methods

A 65-year-old man experienced painless unilateral loss of vision to 4/20 in his left eye. Ophthalmoscopy of the left eye showed pronounced attenuation of the retinal arterioles, ischemic retinal edema, and a few intraretinal hemorrhages. Fluorescein angiography revealed a diffusely reduced retinal perfusion typical of retinal occlusive disease. Using a new ophthalmodynamometer with a pressure sensor at the mounting support of a conventional Goldmann contact lens, we additionally measured the diastolic central retinal artery collapse pressure.

Results

The diastolic central retinal artery collapse pressure was significantly lower in the left eye than in the right eye (14.7 ± 2.4 relative units vs 51.7 ± 4.3 relative units; P < .001). Both values were significantly (P = .03) lower than those in a control group (80.9 ± 6.9 relative units). Doppler sonography revealed a total occlusion of the left carotid artery and a nonrelevant stenosis of the right carotid artery.

Conclusions

A new ophthalmodynamometric device consisting of a pressure sensor at the mounting support of a Goldmann contact lens was helpful in detecting carotid artery occlusion leading to ischemic ophthalmopathy.

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To investigate the association among optic disc hemorrhage (ODH) recurrence, location, and visual field (VF) progression.
Prospective, observational study.
Patients with bilateral glaucoma or unilateral glaucoma with a fellow glaucoma suspect eye were enrolled.
Patients received optic disc photography every 3 months and VF testing every 4 months. The disc was partitioned into 8 sectors to match 8 visual field (VF) sectors. The frequency of ODH in each sector was quantified over an average of 64 months. Global VF progression rate was calculated using linear regression on mean deviation. Sectoral progression rate was calculated using linear regression on the sensitivity at each VF location over time and then selecting the largest and second largest significant (P < 0.05) negative slope within that sector. The association between ODH and VF progression rate globally and within a sector was calculated using linear mixed modeling.
Global and sectoral VF progression, ODH frequency, and ODH recurrence (globally and sectoral) and its association with VF progression rate.
A total of 151 eyes from 77 patients completed the study with mean follow-up of 64 months, 20 disc photographs, and 16 VF tests. With global VF analysis, eyes with ODH in 2 different sectors of the disc had worse progression rate than eyes with ODH in 1 sector (P = 0.012) and eyes with no ODH (P < 0.001). Regarding the largest sectoral VF progression, sectors with 1 ODH had a faster VF progression rate than those with no ODH (P < 0.017) and progressed at a similar rate to those with 2 to 8 ODH (P = 0.592). Sectors with >8 ODH had faster VF progression than all other groups (all P < 0.001).
High-frequency ODH within optic disc sectors, equivalent to detecting ODH in 45% of 3 monthly eye examination visits, was associated with significantly worse VF progression than sectors with moderate or only 1 observed ODH. In addition, ODH occurring in different sectors in the same eye was more strongly associated with greater global VF progression compared with those occurring within the same sector.
Ophthalmodynamometric pressure in eyes with proliferative diabetic retinopathy measured during pars plana vitrectomy
2011, American Journal of Ophthalmology
Citation Excerpt :
ODP in patients with giant-cell arteritis-induced anterior ischemic optic neuropathy was decreased compared with patients with nonarteritic anterior ischemic optic neuropathy.14 Jonas and Niessen reported a case in which ODP measurement was helpful to diagnose unilateral ischemic ophthalmopathy.7 Another study demonstrated that ODP in patients with ischemic central retinal vein occlusion was significantly lower than that of patients with nonischemic central retinal vein occlusion.20
To measure ophthalmodynamometric pressure (ODP) during vitrectomy in patients with proliferative diabetic retinopathy (PDR).
Prospective, interventional, consecutive case series.
This study included 75 eyes of 75 patients undergoing vitrectomy for PDR. After core vitrectomy, the intraocular pressure was gradually raised using a vented-gas forced-infusion system (VGFI), and the optic nerve head was continuously monitored through a planoconvex contact lens. When the central retinal artery or its branches on the optic nerve head showed pulsations, the pressure was recorded as ODP. Diastolic blood pressure (DBP) and systolic blood pressure (SBP) were measured at the time of ODP measurement. Multiple regression analysis was performed to investigate the relationship between ODP and various explanatory variables: DBP, SBP, age, gender, body mass index, presence of hypertension, serum hemoglobin A1c, serum total cholesterol, fasting plasma glucose, presence of rubeosis iridis, and severity of PDR.
ODP was 63.6 ± 11.5 mm Hg (range 15.5-84.4 mm Hg). The ODP significantly correlated with DBP (r = 0.570, P < .0001) and the mean arterial blood pressure (r = 0.522, P < .0001), but not with SBP (r = 0.121, P = .303). Multiple regression analysis revealed that ODP had a significant correlation with DBP (P < .0001), presence of rubeosis iridis (P < .0001), and severity of PDR (P = .046).
We measured ODP using VGFI during vitrectomy in patients with PDR. The ODP was significantly associated with DBP. The ODP was lower in patients with rubeosis iridis and severe PDR.
Ocular Ischemic Syndrome
2010, Survey of Ophthalmology
Citation Excerpt :
In OIS, the CRA perfusion pressure is low and for this reason the pressure necessary for the pulsations to appear is reduced. Diastolic are considered to be more reliable than systolic readings 220 and are decreased in OIS,122 and may improve or return to normal after carotid artery surgery.133 A recent ophthalmodynamometric device consists of a conventional Goldmann contact lens with a pressure-sensor in its mounting support.122
Ocular ischemic syndrome encompasses a spectrum of clinical findings that result from chronic ocular hypoperfusion. It is relatively uncommon, and the diagnosis may be difficult to make because of its variable presentations. The presence of an ocular ischemic syndrome always implies underlying severe carotid occlusive disease and may be its sole clinical manifestation. It may also result from other causes of reduced blood flow to the eye and the orbit such as systemic vasculitis. Besides visual loss and ocular/orbital pain, affected patients are also at risk for developing cerebral and myocardial infarction. Establishing the diagnosis is therefore essential with respect not only to visual prognosis but also to patient survival. Ophthalmologists have an important role in early diagnosis and in coordinating the systemic evaluation of patients. Referral to the neuroradiologist and the neurovascular specialist is warranted. We present the current knowledge on the ocular ischemic syndrome.
Long-term multidisciplinary follow-up of unilateral thyroid-associated orbitopathy
2008, European Journal of Internal Medicine
Citation Excerpt :
Orbital involvement is usually bilateral but may be asymmetrical in 10–15% of the cases [2,3]. Persistent unilateral involvement is rare, described as a case-report [4–14]. The natural history of unilateral TAO is unknown and the diagnosis remains challenging.
Thyroid-Associated Orbitopathy (TAO) is an autoimmune disease characterized by orbital inflammation involving both adipose tissue and extra-ocular muscles (EOM). Whereas bilateral and possibly asymmetric orbital involvement is commonly found at radiological work-up, mono-orbital involvement is poorly documented, and ascribed to an initial and/or transient stage of subsequent bilateral TAO.
From a cohort of two hundred TAO patients, we selected retrospectively fourteen patients with initial clinical unilateral TAO. Five of them were excluded because of clinical bilateralization.
The sex ratio was 0.8 (4M, 5F), and mean age 44.6 years (range: 18–63). All patients were euthyroid when the initial magnetic resonance imaging (MRI) was performed. One patient was treated with Levothyroxine, because of subclinical hypothyroidism. Eight patients (six smokers) suffered from Graves' disease, of 1–4 years duration, for which they were treated with antithyroid drugs. A thyroidectomy was performed in two patients. None of the patients ever received radioiodine. Six patients remained euthyroid after stopping of the antithyroid regimen, and two became hypothyroid. Seven patients had active, and two severe TAO. Four of nine patients exhibited bilateralization of TAO on initial MRI. Clinical status ultimately improved or normalized in all. In two patients, MRI performed after 9 years demonstrated partial shrinkage of previously enlarged EOMs, together with fatty involution of involved muscles.
Unilateral TAO is not different and just as severe as bilateral TAO. At initial work-up MRI shows signs of bi-laterality in 45% (4/9), with mild involvement of 1 or 2 extra-ocular muscles. The radiological status of affected muscles does not normalize, even in the very long term.
Ophthalmodynamometric Differences Between Ischemic vs Nonischemic Retinal Vein Occlusion
2007, American Journal of Ophthalmology
Citation Excerpt :
Studies also showed that patients with increased cerebrospinal fluid pressure such as in pseudotumor cerebri, and patients with a sinus cavernous fistula exhibited increased central retinal vein pressures.20–22 In a similar manner, eyes with an ischemic ophthalmopathy attributable to an insufficiency of the cerebroafferent blood vessels or patients with a dissection of internal carotid artery had abnormally low central retinal artery pressure measurements.6,23 With respect to retinal vein occlusions, the studies have revealed so far that the central retinal vein pressure is elevated in patients with retinal vein occlusions.
To estimate the central retinal vein pressure in patients with ischemic vs nonischemic central retinal vein occlusion (CRVO).
Prospective clinical observational comparative study.
The study included 28 patients with CRVO, either of the ischemic type (n = 7) or the nonischemic type (n = 21). The control group consisted of 38 subjects without retinal disease. A new ophthalmodynamometer consisting of a Goldmann contact lens fitted with a pressure sensor into the holding grip of the contact lens, was used to indirectly estimate the central retinal artery and vein pressure.
Central retinal vein pressure was significantly higher in the ischemic CRVO group than in the nonischemic CRVO group (91.5 ± 30.1 arbitrary units vs 52.4 ± 32.5 arbitrary units; P = .014), in which it was significantly (P < .001) higher than in the control group (4.8 ± 8.1 arbitrary units). Central retinal vein pressure was higher than the diastolic central retinal artery pressure significantly (P = .039) more frequently in the ischemic CRVO group (7/7 or 100%) than in the nonischemic CRVO group (8/21 or 38%) or the control group (0/38; P < .001). Central retinal artery pressure was significantly (P = .017) lower in the ischemic CRVO group (46.0 ± 10.6 arbitrary units) than in the nonischemic CRVO group (64.5 ± 22.8 arbitrary units), in which it was significantly (P = .016) lower than in the control group (79.9 ± 22.3 arbitrary units).
Ophthalmodynamometric estimation of the retinal vein pressure may be helpful for the differentiation between the ischemic vs nonischemic type of CRVO. In the ischemic type, vein pulsations were usually observed at supradiastolic arterial values.
Ocular ischemic syndrome, central retinal artery obstruction, and branch retinal artery obstruction
2004, Seminars in Cerebrovascular Diseases and Stroke
Ocular ischemic syndrome is a condition characterized by visual loss described mainly in males 50 years and older secondary to carotid artery stenosis or occlusion. Loss of vision results from chronic ischemic changes to the anterior and posterior segments of the eye. Pain around the eye has been reported in up to 40% of the patients. Also, these patients may report difficulty adjusting to a darker environment after light exposure. Neovascularization of the iris and retina is common. Associated systemic conditions include arterial hypertension, coronary artery disease, diabetes mellitus, cerebrovascular disease and tobacco use. Digital subtraction angiography can demonstrate carotid artery obstruction in the majority of patients, however less invasive procedures such as contrast enhanced MR angiography in combination with duplex ultrasound correlates with the degree of carotid stenosis. Carotid endarterectomy in addition to management of neovascularization of iris or retina is the treatment of choice, however, the prognosis for visual recovery is still limited. Acute retinal arterial obstruction is a dramatic and usually irreversible painless loss of vision that can involve the central retinal artery or an arterial branch, most commonly secondary to cerebrovascular and cardiovascular disease. Other associated conditions include various hematological, infectious and metabolic abnormalities. In central retinal artery occlusion a common finding includes a cherry red spot in the macula. A careful evaluation of all potential sources of emboli is essential in this condition since there is a strong association with fatal outcome due to cardiovascular disease and stroke. Other etiologies such as coagulopathies, collagen vascular diseases and viral infections have been identified in patients with retinal arterial obstructions. Despite aggressive intervention the visual prognosis of central retinal artery occlusion remains poor.

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Brief reportOphthalmodynamometric diagnosis of unilateral ischemic ophthalmopathy

Abstract

Purpose

Design

Methods

Results

Conclusions

Am J Ophthalmol

Ophthalmology

Brief report
Ophthalmodynamometric diagnosis of unilateral ischemic ophthalmopathy