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INTRODUCTION: Visual loss secondary to a vascular loop or atherosclerotic carotid has been a controversial topic for many years with contemporary data supporting its existence. The role of surgery in the management of this entity is not well defined. We performed a systematic review describing the different surgical techniques and outcomes. METHOD: A search strategy was devised in accordance with the 2020 Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) statement. An electronic search was performed from the databases Pubmed, Google scholar, Scopus and Web of Science databases. The search was performed from inception until the 10th of December 2023. RESULTS: A total of 2469 articles were screened with 15 articles describing 18 patients being included. Of these cases, eleven involved compression due to unilateral or bilateral dolichoectatic internal carotid artery (ICA), three for a dolichoectatic anterior cerebral artery (ACA), two for a combination of a dolichoectatic ICA with a dorsolateral ophthalmic artery and two for a combination of a dolichoectatic ICA and ACA. CONCLUSION: Two distinct compressive entities can be differentiated. Compressive optic neuropathy at the entrance of the optic canal due to pinching between an ectatic carotid and the falciform ligament. A second entity is due to compression of the cisternal optic nerve or chiasm secondary tot a vascular loop. A variety of surgical techniques have been described and include: unroofing of the optic canal with sectioning of the falciform ligament; microvascular decompression with a Teflon® pellet, a muscle patch or, rerouting of the offending vessel with a sling. Larger and prospective studies are needed to better define the role of surgery in this, probably, underreported pathology.
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Arteria Carótida Interna , Vías Visuales , Humanos , Vías Visuales/cirugía , Arteria Carótida Interna/cirugía , Arteria Oftálmica/cirugía , Arteria Cerebral Anterior/cirugía , Síndromes de Compresión Nerviosa/cirugía , Procedimientos Neuroquirúrgicos/métodos , Descompresión Quirúrgica/métodos , Enfermedades del Nervio Óptico/cirugíaRESUMEN
A boy in his mid-teens presented with progressively increasing bleeding from the right eye and nostril intermittently over a period of 6 weeks. A complete ophthalmic examination revealed nothing significant. His otorhinological examination and haematological investigations were within normal limits. The patient came a month later with frank bleeding from the right eye. Ophthalmic examination revealed hyperaemia and maceration of the right lower palpebral conjunctiva. A histopathological examination of conjunctival scrapings from the site showed abnormal dilated blood vessels suggestive of a vascular malformation. Digital subtraction angiography confirmed the presence of a conjunctival micro arteriovenous malformation supplied by the external carotid and ophthalmic artery branches. He underwent successful transarterial Onyx embolisation resulting in complete resolution of the haemolacria.
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Conjuntiva , Embolización Terapéutica , Humanos , Masculino , Embolización Terapéutica/métodos , Conjuntiva/irrigación sanguínea , Hemorragia del Ojo/terapia , Hemorragia del Ojo/etiología , Angiografía de Substracción Digital , Malformaciones Arteriovenosas/terapia , Malformaciones Arteriovenosas/complicaciones , Malformaciones Arteriovenosas/diagnóstico por imagen , Adolescente , Arteria Oftálmica/diagnóstico por imagen , Arteria Oftálmica/anomalías , Malformaciones Vasculares/terapia , Malformaciones Vasculares/complicaciones , Malformaciones Vasculares/diagnóstico , Polivinilos/uso terapéutico , Enfermedades de la Conjuntiva/terapia , Resultado del Tratamiento , Hemobilia/terapia , Hemobilia/etiologíaRESUMEN
Purpose: To investigate morphological and hemodynamic characteristics of the ophthalmic artery (OA) in patients with white matter hyperintensity (WMH), and the association of the presence and severity of WMH with OA characteristics. Methods: This cross-sectional study included 44 eyes of 25 patients with WMH and 38 eyes of 19 controls. The Fazekas scale was adopted as criteria for evaluating the severity of white matter hyperintensities. The morphological characteristics of the OA were measured on the basis of three-dimensional reconstruction. The hemodynamic parameters of the OA were calculated using computational fluid dynamics simulations. Results: Compared with the control group, the diameter (16.0±0.27 mm vs. 1.71±0.18 mm, P=0.029), median blood flow velocity (0.12 m/s vs. 0.22 m/s, P<0.001), mass flow ratio (2.16% vs. 3.94%, P=0.012) and wall shear stress (2.65 Pa vs. 9.31 Pa, P<0.001) of the OA in patients with WMH were significantly decreased. After adjusting for confounding factors, the diameter, blood flow velocity, wall shear stress, and mass flow ratio of the OA were significantly associated with the presence of WMH. Male sex and high low-density protein level were associated with moderate-to-severe total WMH, and smoking was associated with the moderate-to-severe periventricular WMH. Conclusions: The diameter, blood flow velocity, mass flow ratio, and wall shear stress of the OA were independently associated with the presence of WMH. Atherosclerosis might be involved in the common mechanism of the occurrence of WMH and the OA changes.
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Hemodinámica , Arteria Oftálmica , Sustancia Blanca , Humanos , Masculino , Femenino , Arteria Oftálmica/diagnóstico por imagen , Arteria Oftálmica/fisiopatología , Sustancia Blanca/diagnóstico por imagen , Sustancia Blanca/fisiopatología , Sustancia Blanca/irrigación sanguínea , Sustancia Blanca/patología , Estudios Transversales , Hemodinámica/fisiología , Persona de Mediana Edad , Anciano , Velocidad del Flujo Sanguíneo , Imagen por Resonancia Magnética , AdultoRESUMEN
PURPOSE: To evaluate the effectiveness and safety of selective ophthalmic arterial injection (SOAI) for retinoblastoma utilizing a microballoon catheter system with an M chamber. STUDY DESIGN: Retrospective analysis. METHODS AND PATIENTS: This study was sanctioned by theNational Cancer Center Hospital' Independent Ethics Committee. The surgeon was a general interventional radiologist. After confirming that the distal internal carotid artery was not delineated by balloon occlusion and the ophthalmic artery was visualized using digital subtraction angiography, melphalan was manually administered. Notably, in cases presenting bilateral retinoblastoma, both eyes received treatment in a singular, low-dose procedure. Between July 2015 and December 2021, 125 patients with retinoblastoma (68 boys and 57 girls) underwent SOAI at our facility. The average age at initial treatment was 19.3 months. The study covered 250 procedures, with patients undergoing an average of 3.7 procedures. RESULTS: The success rate of the procedure was 99.2%, with a mean procedure duration of 18.3 min. Two distinct technical failures were recorded: one attributed to an internal carotid artery having a wide lumen and the other due to the ophthalmic artery remaining undetected on angiography post-balloon occlusion of the internal carotid artery. Adverse events were minimal but included bronchospasm post-procedure and severe orbital inflammation in 0.8% and 0.4% of cases, respectively. CONCLUSION: SOAI using the microballoon catheter with the M chamber is a feasible and safe procedure for the treatment of retinoblastoma. The success rate was 99.2%. This system can be recommended as intra-arterial chemotherapy for retinoblastoma.
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Inyecciones Intraarteriales , Melfalán , Arteria Oftálmica , Neoplasias de la Retina , Retinoblastoma , Humanos , Retinoblastoma/terapia , Retinoblastoma/diagnóstico , Retinoblastoma/tratamiento farmacológico , Arteria Oftálmica/diagnóstico por imagen , Neoplasias de la Retina/terapia , Neoplasias de la Retina/tratamiento farmacológico , Neoplasias de la Retina/diagnóstico , Estudios Retrospectivos , Femenino , Masculino , Lactante , Preescolar , Melfalán/administración & dosificación , Angiografía de Substracción Digital , Resultado del Tratamiento , Estudios de Seguimiento , Antineoplásicos Alquilantes/administración & dosificación , NiñoRESUMEN
BACKGROUND: Duplex sonographic visualization of a retrogradely perfused ophthalmic artery (AO) as an expression of an existing collateral supply in high-grade stenosis of the internal carotid artery (ACI) is a widely used and validated tool. After revascularization there may be another reversal of flow. Recently, the question of whether knowledge of the flow direction of the AO before and after implantation of a stent can be used as an outcome predictor has been posed more frequently. METHODS AND RESULTS: In this article, the method of duplex sonographic assessment of the AO is explained more elaborately and we present a case of a patient with 75% restenosis of the left ACI with contralateral chronic occlusion of the right ACI. We focus on the special aspect that the ipsilateral AO was initially perfused retrogradely and that postinterventionally there was a flow reversal to a physiological anterograde flow. The case report is used to illustrate the value of duplex sonographic visualization of the AO. CONCLUSION: Our case report is able to illustrate two aspects: On the one hand, the AO can be perfused retrogradely in the specific case of chronic ACI occlusion of the opposite side, even when the ACI stenosis of the considered side is less than 80%. On the other hand, the AO can offer added diagnostic value as a follow-up parameter for re- or in-stent stenoses.
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Arteria Carótida Interna , Estenosis Carotídea , Arteria Oftálmica , Ultrasonografía Doppler Dúplex , Humanos , Arteria Carótida Interna/diagnóstico por imagen , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/cirugía , Arteria Oftálmica/diagnóstico por imagen , Stents , Ultrasonografía Doppler Dúplex/métodosRESUMEN
INTRODUCTION: The aim of the study was to investigate the clinical efficacy of superselective ophthalmic artery thrombolysis for central retinal artery occlusion (CRAO). METHODS: Retrospective study of CRAO patients who attended the Department of Ophthalmology of Affiliated Hospital of Weifang Medical University from January 2022 to July 2023, 138 CRAO patients with onset time of 1-3 days were selected for the study. Among them, 86 patients refused thrombolytic treatment and chose to adopt traditional treatment, which was categorized as the control group; 52 patients adopted superselective ophthalmic artery thrombolytic treatment, which was categorized as the observation group. The visual acuity of the patients treated with traditional modality on the 4th day after the onset of the disease and the visual acuity of the patients treated with superselective ophthalmic artery thrombolysis on the 1st postoperative day were recorded, and the visual acuity improvement after different modalities of treatment was compared between the two groups. RESULTS: In the control group, 77 (89.5%) of the treated patients had no improvement in visual acuity, 9 (10.5%) had improvement, 0 (0.0%) had significant improvement, and the total improvement was 9 (10.5%); in the observation group, 18 (34.6%) of the treated patients had no improvement in visual acuity, 21 (40.4%) had improvement, 13 (25.0%) had significant improvement, and the total improvement was 34 (65.4%). The total improvement rate of treatment in the observation group was 65.4%, which was significantly higher than the 10.5% in the control group, and the difference was statistically significant (p < 0.05). CONCLUSION: Superselective ophthalmic artery thrombolysis for patients with CRAO is clinically effective, promotes improvement in patient vision, and has a high safety profile.
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Fibrinolíticos , Arteria Oftálmica , Oclusión de la Arteria Retiniana , Terapia Trombolítica , Agudeza Visual , Humanos , Oclusión de la Arteria Retiniana/diagnóstico , Oclusión de la Arteria Retiniana/tratamiento farmacológico , Oclusión de la Arteria Retiniana/fisiopatología , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Terapia Trombolítica/métodos , Fibrinolíticos/uso terapéutico , Anciano , Resultado del Tratamiento , Adulto , Estudios de Seguimiento , Activador de Tejido Plasminógeno/administración & dosificación , Activador de Tejido Plasminógeno/uso terapéuticoRESUMEN
BACKGROUND: Ophthalmic artery aneurysm (OAA) can be secured in endovascular or microsurgical approaches. Still there are controversies in technique selection and their long term outcomes. METHODS: All the patients with OAA were treated microsurgically and followed. Demographic data, neurological status, physical examination findings, angiographic data, operation details, and intraoperative and postoperative events were recorded and analyzed. P < 0.05 was considered significant. RESULTS: Among 55 patients, 38 were females (69.1%). Median preoperative glasgow coma scale (GCS), Fisher Grade, and Hunt and Hess(HH) scores were 15, 1 and 1, respectively. The most common neurologic manifestation was visual problems (n = 15). The most common anatomical projection was medial (43.6%) oriented lesions. 85.5% of them only had 1 ophthalmic aneurysm while multiple aneurysms were reported in 14.6%. In 52 patients temporary clip was used. in 21 patients (38.2%) intraoperative aneurysm rupture occurred. Larger aneurysm size and preoperative hydrocephalus were associated with higher rates of aneurysm rupture (P = 0.003 and 0.031). 28.5% of the patients with visual problems had clinical improvement in the postoperative period. The mean follow-up period was 5 years. Follow-up angiography showed a 100% obliteration rate with a 0.0% recurrence rate. Median values for follow-up glasgow outcome scale and modified Rankin scale were 5 and 0, respectively. favorable neurological outcomes were associated with better primary GCS and HH scores. CONCLUSION: OAA microsurgery is an effective and safe procedure with significant improvement in both visual and neurological status. Low recurrence rate and excellent clinical recovery are the most important advantages of microsurgery in OAA treatment.
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Aneurisma Intracraneal , Microcirugia , Arteria Oftálmica , Humanos , Femenino , Masculino , Microcirugia/métodos , Persona de Mediana Edad , Arteria Oftálmica/cirugía , Adulto , Estudios de Seguimiento , Aneurisma Intracraneal/cirugía , Aneurisma Intracraneal/complicaciones , Anciano , Resultado del Tratamiento , Estudios Retrospectivos , Adulto Joven , AdolescenteRESUMEN
OBJECTIVE: Transcranial Doppler ultrasound (TDUS), computed tomography angiography (CTA), and transcranial Doppler ultrasound to detect cerebral blood flow are among the adjunctive tests in diagnosing brain death. This study aimed to investigate the effectiveness of orbital doppler ultrasound (ODUS). METHODS: This prospective, single-blind study included 66 patients for whom brain death was to be diagnosed. Primary outcome measures were ODUS measurements, Ophthalmic artery peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive indices (RI) measurements recorded during the brain death determination process. Secondary outcome measures were computed tomography angio (CTA), transcranial Doppler ultrasound (TDUS), and demographic data. RESULTS: This study investigating the effectiveness of ODUS in diagnosing brain death provided diagnostic success with 100% sensitivity and 93% specificity compared to CT angiography. It was noted that anatomical variations may limit its use. CONCLUSION: ODUS was found to have high sensitivity and specificity in the diagnosis of clinical brain death. It may assist in early prognostic assessment and shorten patient follow-up and diagnostic processes.
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Muerte Encefálica , Ultrasonografía Doppler Transcraneal , Humanos , Muerte Encefálica/diagnóstico por imagen , Muerte Encefálica/diagnóstico , Masculino , Femenino , Persona de Mediana Edad , Método Simple Ciego , Adulto , Estudios Prospectivos , Ultrasonografía Doppler Transcraneal/métodos , Anciano , Angiografía por Tomografía Computarizada/métodos , Adulto Joven , Arteria Oftálmica/diagnóstico por imagen , Sensibilidad y Especificidad , Circulación Cerebrovascular/fisiología , Adolescente , Órbita/diagnóstico por imagen , Órbita/irrigación sanguíneaAsunto(s)
Aneurisma , Arterias Ciliares , Arteria Oftálmica , Oclusión de la Arteria Retiniana , Humanos , Arteria Oftálmica/diagnóstico por imagen , Oclusión de la Arteria Retiniana/etiología , Arterias Ciliares/diagnóstico por imagen , Arterias Ciliares/patología , Aneurisma/diagnóstico por imagen , Aneurisma/complicaciones , Masculino , Arteria Retiniana/diagnóstico por imagen , Femenino , Persona de Mediana EdadRESUMEN
PURPOSE: This study is to evaluate the correlation between retrobulbar perfusion deficits and glaucomatous visual field defects. METHODS: Eighty-four patients with glaucoma and 17 normal subjects serving as controls were selected. Color Doppler imaging (CDI) was used to measure the changes in blood flow parameters in the retrobulbar ophthalmic artery (OA), central retinal artery (CRA), and short posterior ciliary arteries (SPCAs). Visual field testing was performed using a Humphrey perimeter, categorizing the visual field deficits into four stages according to the Advanced Glaucoma Intervention Study (AGIS) scoring method. Subsequently, the correlation of retrobulbar hemodynamic parameter alterations among glaucomatous patients with varying visual field defects was examined. RESULTS: The higher the visual field stage, the lower the peak systolic velocity (PSV) of the OA, CRA, and SPCAs in glaucomatous patients. The CRA had the highest sensitivity to changes in its PSV. The PSV of the temporal SPCA (TSPCA-PSV) was lower in advanced glaucoma than in early-stage glaucoma. The PSVs of the OA, CRA, and TSPCA, as well as the resistance index of the CRA (CRA-RI), were positively correlated with the visual field index and the mean deviation. Except for that of OA, the PSV of the retrobulbar vessels was negatively correlated with the pattern standard deviation (PSD). The OA-PSV and end-diastolic velocity (EDV) of the CRA and TSPCA were lower in patients with superior visual field defects than in those with inferior visual field defects. CONCLUSIONS: Greater severity of visual field defects corresponded to poorer retrobulbar blood flow in glaucomatous patients. Patients suffered significant perfusion impairments in the CRA at the early stage, accompanied by SPCA perfusion disorder at the advanced stage. The presence of a bow-shaped defect in the superior or inferior region of the visual field in moderate-stage glaucoma was closely correlated with retrobulbar vascular EDV. TRIAL REGISTRATION: ChiCTR2200059048 (2022-04-23).
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Arterias Ciliares , Presión Intraocular , Arteria Oftálmica , Flujo Sanguíneo Regional , Arteria Retiniana , Ultrasonografía Doppler en Color , Pruebas del Campo Visual , Campos Visuales , Humanos , Campos Visuales/fisiología , Masculino , Femenino , Arteria Oftálmica/fisiopatología , Arterias Ciliares/fisiopatología , Arterias Ciliares/fisiología , Persona de Mediana Edad , Presión Intraocular/fisiología , Arteria Retiniana/fisiopatología , Flujo Sanguíneo Regional/fisiología , Velocidad del Flujo Sanguíneo/fisiología , Anciano , Trastornos de la Visión/fisiopatología , Trastornos de la Visión/diagnóstico , Glaucoma/fisiopatología , Glaucoma/diagnóstico , Órbita/irrigación sanguínea , Órbita/fisiopatología , Glaucoma de Ángulo Abierto/fisiopatología , Glaucoma de Ángulo Abierto/diagnósticoAsunto(s)
Arteria Carótida Interna , Progresión de la Enfermedad , Mucormicosis , Arteria Oftálmica , Neuropatía Óptica Isquémica , Humanos , Persona de Mediana Edad , Enfermedad Aguda , Arteria Carótida Interna/diagnóstico por imagen , Arteria Carótida Interna/patología , Mucormicosis/complicaciones , Mucormicosis/diagnóstico , Arteria Oftálmica/diagnóstico por imagen , Arteria Oftálmica/patología , Neuropatía Óptica Isquémica/diagnóstico , Neuropatía Óptica Isquémica/etiología , Trombosis/diagnóstico , Trombosis/diagnóstico por imagen , Trombosis/complicacionesRESUMEN
Retinoblastoma is the most common eye malignancy in children that if left untreated can invade intraocular structures, metastasize, and rarely lead to death. Traditionally treated with systemic chemotherapy, Intra-arterial chemotherapy is gaining popularity as it allows for the direct administration of chemotherapy through the ophthalmic artery, thus reducing systemic side effects. Intra-arterial chemotherapy procedures have evolved, with refinements to reduce risks and radiation exposure. Intra-arterial chemotherapy boasts an impressive technical success rate and one year ocular survival even amongst advanced cases. This review offers a thorough examination of the technique, indications, contraindications, outcomes, and alternative options for Intra-arterial chemotherapy.
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Exposición a la Radiación , Neoplasias de la Retina , Retinoblastoma , Niño , Humanos , Lactante , Retinoblastoma/inducido químicamente , Retinoblastoma/tratamiento farmacológico , Neoplasias de la Retina/inducido químicamente , Neoplasias de la Retina/tratamiento farmacológico , Infusiones Intraarteriales , Arteria Oftálmica/patología , Melfalán/uso terapéutico , Estudios RetrospectivosRESUMEN
BACKGROUND: There are serious complications associated with hyaluronic acid (HA) facial injections, including vision impairment due to retinal artery ischemia. In this study, we put forth a clinically relevant model of retinal ischemia and reperfusion in rabbit. We used this to verify the efficacy of hyaluronidase intra-artery thrombolysis in the treatment of hyaluronic acid-induced retinal artery occlusion. METHODS: Retinal artery ischemia was induced by injecting HA into the ophthalmic artery (OA) of adult chinchilla rabbit, and reperfusion was achieved by intra-artery thrombolysis therapy with hyaluronidase following 60 min and 4 h of occlusion. Digital subtraction angiography (DSA) and fundus fluorescein angiography (FFA) were used to evaluate blood flow in the retina. Electroretinogram (ERG), hematoxylin and eosin staining and transmission electron microscope were used to evaluate the structure and function of the retina after ischemia and reperfusion following 60 min and 4 h of occlusion. RESULTS: DSA and FFA images confirmed occlusion of the ophthalmic and central retinal arteries, as well as reperfusion after hyaluronidase thrombolysis. ERG indicated retinal dysfunction following ischemia, and thrombolysis partially rescued its impairment following 4 h of occlusion. Hematoxylin and eosin staining and TUNEL staining revealed ischemia-induced histological damages in the retina at different time windows, and hyaluronidase thrombolysis partially mitigated these damages. CONCLUSIONS: We report a method to establish a HA-induced retinal artery occlusion animal model. Hyaluronidase intra-artery thrombolysis was used to recanalize the embolized OA at different time points. Using our method, we achieved retinal reperfusion, and an improvement was observed in the visual function of rabbits after hyaluronidase thrombolysis following 4 h of occlusion. We believe that hyaluronidase intra-artery thrombolysis is an effective method to treat HA-induced retinal artery occlusion in clinic. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Modelos Animales de Enfermedad , Ácido Hialurónico , Hialuronoglucosaminidasa , Oclusión de la Arteria Retiniana , Terapia Trombolítica , Animales , Conejos , Oclusión de la Arteria Retiniana/tratamiento farmacológico , Oclusión de la Arteria Retiniana/inducido químicamente , Hialuronoglucosaminidasa/uso terapéutico , Hialuronoglucosaminidasa/administración & dosificación , Ácido Hialurónico/administración & dosificación , Terapia Trombolítica/métodos , Angiografía con Fluoresceína/métodos , Electrorretinografía , Arteria Oftálmica , Angiografía de Substracción Digital , MasculinoRESUMEN
BACKGROUND: Knowledge of the anatomy of the infraorbital artery (IOA) is crucial for the rejuvenation of the anterior medial aspect of the midface; however, studies adequately describing the anatomy of the IOA branches are lacking, and their connection with the ophthalmic artery branches remains unclear. OBJECTIVES: This study aims to elucidate the anatomical characteristics of the IOA in its deployment within the lower eyelid using three-dimensional (3D) technology, thereby offering an anatomical foundation for clinical surgical procedures. METHODS: An analysis was conducted on computed tomography scans of 132 cadaveric head sides post-contrast injection, utilizing the Mimics software for reconstruction. The study focused on examining the anastomosis of the IOA, its principal branches, and the branches emanating from the ophthalmic artery. RESULTS: The prevalence of type I IOA was observed at 38.6% (51/132), while Type II IOA was found in 61.4% (81/132) of cases. A 7.6% incidence (10/132) of IOA directly anastomosing with the angular artery was noted. The presence of palpebral branches (PIOA) was identified in 57.6% (76/132) of instances. In the lower eyelid, four distinct distribution patterns of IOA were discerned: The likelihood of Type I PIOA was 5.3%, whereas for Types IIA, IIB, and IIC PIOA, the probabilities were 8.3%, 32.6%, and 11.4%, respectively. The occurrence of the orbital branch of IOA was recorded at 41.7% (55/132). CONCLUSIONS: 3D technology can map IOA variants and identify the deployment patterns of IOA branches in the lower eyelid vascular vesicles at high resolution as a guide in clinical practice. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Cadáver , Imagenología Tridimensional , Tomografía Computarizada por Rayos X , Humanos , Tomografía Computarizada por Rayos X/métodos , Femenino , Masculino , Párpados/irrigación sanguínea , Párpados/diagnóstico por imagen , Párpados/anatomía & histología , Órbita/irrigación sanguínea , Órbita/diagnóstico por imagen , Órbita/anatomía & histología , Arteria Oftálmica/anatomía & histología , Arteria Oftálmica/diagnóstico por imagen , Anciano , Persona de Mediana Edad , Variación Anatómica , Anciano de 80 o más Años , Arterias/anatomía & histología , Arterias/diagnóstico por imagen , Relevancia ClínicaRESUMEN
BACKGROUND: Surgical closure of large nasoseptal perforation (NSP) is challenging. The use of an extended anterior ethmoidal artery (eAEA) flap to reconstruct NSP may present with difficulties for NSPs which have their upper edge in a high position. METHOD: We propose adding a "donut-shape" flap from surrounding septal tissue to the eAEA flap. Thus, the inverted edges of this flap allow to cover the uppermost aspect of the NSP. A series of 18 patients with complete closure of NSPs was included. CONCLUSION: This novel "Boot-on-Donut" technique consisting of the eAEA flap (Boot) and inverted edges (Donut) is a feasible procedure that allows to reconstruct large NSP located superiorly.
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Perforación del Tabique Nasal , Humanos , Perforación del Tabique Nasal/cirugía , Resultado del Tratamiento , Endoscopía/métodos , Colgajos Quirúrgicos/irrigación sanguínea , Arteria Oftálmica , Tabique Nasal/cirugíaRESUMEN
PURPOSE: To compare blood pressure (BP), intraocular pressure (IOP), ophthalmic artery flow (OAF) velocity, retinal nerve fiber layer (RNFL) thickness, and visual fields in newly diagnosed hypertension (HT) patients (before treatment), chronic HT (on antihypertensive medications >5 years) and normotensives. METHODS: A prospective, cross-sectional study at a tertiary care centre in India. Three groups of 45 patients each: group 1 - early HT, group 2 - chronic HT, and Group 3 - normotensives, underwent evaluation of BP, IOP by Goldmann applanation tonometry (GAT), OAF velocity by transcranial doppler (TCD), RNFL analysis by spectral-domain optical coherence tomography (SD-OCT), and visual fields. RESULTS: The BP was highest in early HT > chronic HT > normotensives (p < 0.001). The IOP of early HT, chronic HT, and normotensives were 15.87 ± 2.19 mmHg, 13.47 ± 1.92 mmHg, and 15.67 ± SD 1.75 mmHg (p < 0.001). The OAF velocity [peak systolic velocity (PSV), end-diastolic velocity (EDV) in cm/sec] was lowest in chronic HT (30.80 ± 7.05, 8.58 ± 1.58) < early HT (35.47 ± 5.34, 10.02 ± 1.74) < normotensives (36.29 ± 4.43, 10.44 ± 2.29), (p < 0.001). The average RNFL thickness was significantly lower in chronic HT (p = 0.022). The PSV, EDV, and MFV showed significant correlation with IOP (r = 0.247, p = 0.004; r = 0.206, p = 0.016; r = 0.266, p = 0.002) and average RNFL thickness (r = 0.309, p= <0.001; r = 0.277, p = 0.001; r = 0.341, p < 0.001). CONCLUSIONS: Patients with chronic HT demonstrated the lowest retrobulbar flows, IOP and lower RNFL measurements. Lower ocular perfusion may be associated with lower IOP and may be a risk factor for end-organ damage (RNFL) independent of IOP.
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Presión Sanguínea , Hipertensión , Presión Intraocular , Fibras Nerviosas , Flujo Sanguíneo Regional , Células Ganglionares de la Retina , Tomografía de Coherencia Óptica , Tonometría Ocular , Campos Visuales , Humanos , Presión Intraocular/fisiología , Estudios Transversales , Masculino , Femenino , Estudios Prospectivos , Fibras Nerviosas/patología , Tomografía de Coherencia Óptica/métodos , Células Ganglionares de la Retina/patología , Persona de Mediana Edad , Velocidad del Flujo Sanguíneo/fisiología , Flujo Sanguíneo Regional/fisiología , Presión Sanguínea/fisiología , Campos Visuales/fisiología , Hipertensión/fisiopatología , Hipertensión/complicaciones , Enfermedad Crónica , Arteria Oftálmica/fisiopatología , Arteria Oftálmica/diagnóstico por imagen , Arteria Oftálmica/fisiología , AdultoRESUMEN
AIM: The study aimed to define the coursing pattern of the anterior ethmoidal artery (AEA) in the orbit to minimize complications during endoscopic interventions. MATERIALS AND METHODS: A total of ten formalin-fixed cadaveric halves were included in the study. Orbital regions were shown with a superior approach. The superior rectus and superior oblique muscles, as well as the connective tissue and vessels were removed to observe the path of the anterior ethmoidal artery. Measurements such as the width of the artery, the anterior-posterior length of the U formation, the length of the intraorbital part of the ophthalmic artery, and the distance of the AEA from its opthalmic origin to the anterior ethmoidal foramen were made. RESULTS: Ten of the AEAs originated from the ophthalmic artery. The AEA branches originated from the ophthalmic artery approximately 18.4â¯mm after the orbital artery entered the orbital, and the mean width of the AEAs was 0.82â¯mm. In seven of the total anterior ethmoidal arteries, they coursed in the intraethmoidal cavities below the cranial base. The mean distance from the origin of AEAs to the medial wall of the orbit was 4.9â¯mm. After leaving the ophthalmic artery, seven of the AEAs were coursing forward and turned back ('U' turn formation), which have proximately 1.5â¯mm in anteroposterior direction. CONCLUSION: The anterior ethmoidal artery is 0.8â¯mm wide, originates from the distal part of the ophthalmic artery, entering the orbit after a 1.5â¯mm U-turn.
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Cadáver , Arteria Oftálmica , Órbita , Humanos , Órbita/irrigación sanguínea , Arteria Oftálmica/anatomía & histología , Arteria Oftálmica/diagnóstico por imagen , Senos Etmoidales/irrigación sanguínea , Senos Etmoidales/diagnóstico por imagen , Arterias/anatomía & histología , Masculino , Endoscopía , Femenino , AncianoRESUMEN
Soft tissue filler injections are among the most popular facial rejuvenation methods. Cerebral infarction and ophthalmic artery occlusion are rare and catastrophic complications, especially when facial cosmetic fillers are injected by inexperienced doctors. Radiologists and plastic surgeons need to increase their awareness of the complications associated with fillers, which allows early diagnosis and intervention to improve patient prognosis. Regarding the mechanism by which vascular occlusion occurs after facial filler injections, a retrograde embolic mechanism is currently the predominant theory. Numerous case reports have been presented regarding complications associated with injections of facial aesthetics. However, the small sample sizes of these studies did not allow for an adequate assessment of the clinical and imaging manifestations based on the location of the occlusion and the type of filler, and detailed elaboration of multiple cerebral infarctions is also lacking. Therefore, this study aimed to investigate the clinical and radiological features of severe cerebral and ocular complications caused by cosmetic facial filler injections. In addition, we discuss the pathogenesis, treatment, and prognosis of these patients. The clinical, computed tomography (CT), magnetic resonance imaging (MRI), and digital subtraction angiography (DSA) findings were described and analysed. Radiological examinations are crucial for demonstrating severe complications, and brain MRI is especially strongly suggested for patients with cosmetic filler-induced vision loss to identify asymptomatic cerebral infarctions. Extreme caution and care should be taken during facial injections by plastic surgeons.
Asunto(s)
Técnicas Cosméticas , Humanos , Técnicas Cosméticas/efectos adversos , Estudios Retrospectivos , Arteria Oftálmica , Cara/diagnóstico por imagen , Infarto Cerebral/patología , Ácido HialurónicoRESUMEN
OBJECTIVE: To evaluate the alterations in retrobulbar color Doppler imaging (CDI) parameters and retinal/choroidal optical coherence tomography angiography (OCTA) parameters and their association with the clinical activity and severity in thyroid-associated orbitopathy (TAO) patients. METHODS: In this study, the retrobulbar flow parameters including resistance index (RI), Pulsatile Index(PI), peak systolic velocity (PSV) and end diastolic velocity (EDV) in posterior ciliary artery (PCA), central retinal artery (CRA) and ophthalmic artery (OA) were determined by CDI. Moreover, the retina and choroidal vascularity including the superficial vessel density (SVD), deep vessel density (DVD), choroidal thickness (ChT) and choroidal vascularity, including total choroidal area (TCA), luminal area (LA), stromal area (SA) and Choroidal Vascularity Index (CVI), were determined by OCTA. All patients grouped as active TAO and inactive TAO based on Clinical activity score (CAS). We picked the severe eye among the subjects and compared all parameters between two groups. We analyzed the correlations among those parameters. RESULTS: There was a significant difference in CAS score, proptosis value, ChT, LA, CVI between patients with active TAO and inactive TAO. In the active group, PSV and EDV of PCA were significantly higher than the inactive group. On logistic regression analysis, CAS was closely associated with PSV-PCA. On multiple linear regression, proptosis value was closely associated with ChT, LA, SA and CVI. CONCLUSION: Choroidal vascularization and retrobulbar blood flow were concurrently higher in active TAO patients and several variables in choroid circulation was closely related to TAO clinical features.