Article Text

Systolodiastolic variations of blood flow during central retinal vein occlusion: exploration by dynamic angiography
Free
  1. M Paques1,
  2. O Baillart2,
  3. O Genevois1,
  4. A Gaudric3,
  5. B I Lévy2,
  6. J Sahel1
  1. 1Department of Ophthalmology of the Fondation Ophtalmologique Rothschild, Paris, France
  2. 2Departments of Physiology, Paris, France
  3. 3Ophthalmology of the Hôpital Lariboisière, Paris, France
  1. Correspondence to: Michel Paques MD, PhD, Department of Ophthalmology, Fondation Ophtalmologique Rothschild, 25 rue Manin, 75019 Paris, France; michel.paqueslaposte.net

Abstract

Background/aim: In patients with acute central retinal vein occlusion (CRVO), dynamic angiography may reveal the presence of pulsatile flow (termed here pulsatile venular outflow, PVO) within first order veins (that is, the large veins). The main goal of this study was to investigate the mechanism underlying PVO.

Methods: 10 patients with CRVO and PVO were included. Quantitative and qualitative analysis of venous flow on dynamic angiograms allowed the correlation, temporally, of second and first order vein flow on the one hand, and venous flow and systolic cycle on the other.

Results: Analysis of the time-velocity curve showed that (1) the onset of arterial systole preceded the onset of PVO by less than 0.08 seconds (n = 5); (2) PVO onset was simultaneous to the time of onset of minimal flow (Vmin) in first order veins (n = 10); (3) the time of onset of maximal flow (Vmax) in first order veins occurred 0.20–0.44 seconds after the onset of PVO (n = 6).

Conclusions: During CRVO with severe reduction in blood flow, the presence of PVO is the result of the existence of a distinct haemodynamic regimen in first and second order veins. These data support the hypothesis that second order veins flow is synchronous with the arterial flow, while the delayed peak flow in first order veins may reflect the consequences of the delayed IOP curve and/or of intermittent venous compression.

  • AVFT, arteriovenous filling time
  • CRVO, central retinal vein occlusion
  • ICG, indocyanine green
  • PVO, pulsatile venular outflow
  • SLO, scanning laser ophthalmoscope
  • central retinal vein occlusion
  • retinal circulation
  • dynamic angiography
  • venous flow
  • cardiac cycle
  • AVFT, arteriovenous filling time
  • CRVO, central retinal vein occlusion
  • ICG, indocyanine green
  • PVO, pulsatile venular outflow
  • SLO, scanning laser ophthalmoscope
  • central retinal vein occlusion
  • retinal circulation
  • dynamic angiography
  • venous flow
  • cardiac cycle
View Full Text

Statistics from Altmetric.com

Supplementary materials

  • Video Footage

    A video sequence accompanies this article.

    Files in this Data Supplement:

    • [view video] - On dynamic angiograms, all patients had severe impairment of blood flow, with AVFT ranging from 19.8 to 58.3 seconds, the mean (SD) for AVFT in normal subjects being 12.5 (2.3) seconds. PVO appeared as discrete boli of dye in first order veins at the beginning of the venous phase, progressing towards the disc with a pulsatile motion (see video).

Footnotes

  • The authors have no proprietary interest in this study.

  • Ethical approval: The protocol of this study was approved by the ethics committee of the Hopital Saint-Louis.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.