BACKGROUNDObstructive sleep apnea syndrome (OSAS) has been shown to generate hypertension and endothelial dysfunction. Retinal vessel is the only vessel that can be observed directly and noninvasively; retinal vascular abnormalities can serve as a predictive marker for the occurrence, clinical course, and prognosis of cardiovascular and cerebrovascular diseases. The objective of this study was to identify the effect of OSAS severity on the morphological changes of retinal vessels.

METHODSAdult patients complained of snoring were included in this study. The patients' general information, polysomnography, and fundus photography parameters including central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and arteriole-to-venule ratio (AVR) were collected. Patients were divided into four groups according to their apnea-hypopnea index (AHI) results: Group I, AHI ≤5/h; Group II, 5/h < AHI ≤30/h; Group III, 30/h < AHI ≤60/h; and Group IV, AHI> 60/h.

RESULTSA total of 133 patients were included in this study with 111 males (83.5%) and 22 females (16.5%). Mean age was 41.6 ± 9.9 years, and the mean body mass index was 28.1 ± 4.0 kg/m2. AHI ranged between 0 and 130.8/h with a mean of 39.1 ± 30.7/h. There were 24, 34, 35, and 40 patients in Group I, Group II, Group III, and Group IV, respectively. Significant differences were found for AHI (F = 388.368, P< 0.001), minimal pulse oxygen saturation (F = 91.902, P< 0.001), and arousal index (F = 31.014, P< 0.001) among four groups; no significant differences were found for CRAE (F = 0.460, P = 0.599) and CRVE (F = 0.404, P = 0.586) among groups; there were significant differences for AVR between Group I and Group IV (63.6 ± 5.1% vs. 67.2 ± 5.5%, P = 0.010) Group II and Group IV (64.5 ± 6.0% vs. 67.2 ± 5.5%, P = 0.030), and Group III and Group IV (64.7 ± 4.1% vs. 67.2 ± 5.5%, P = 0.043). A main group-by-AHI effect was found on the AVR: patients with higher AHI showed higher AVR results (r = 0.225, P = 0.009). Multivariate logistic regression analysis was used for multi-variable factors. A group-by-age effect was found on the AVR: younger patients showed higher AVR results (β = -0.001, P = 0.020).

CONCLUSIONSThis study indicated that increased AVR of retinal vessel can be observed in extremely severe OSAS patients. For patients with OSAS, retinal vascular abnormalities may become an early indication for further cardiovascular abnormalities.

Adult ; Female ; Humans ; Male ; Middle Aged ; Polysomnography ; Retina ; pathology ; physiopathology ; Retinal Artery ; pathology ; physiopathology ; Retinal Vein ; pathology ; physiopathology ; Sleep Apnea, Obstructive ; pathology ; physiopathology ; Young Adult

The aim of this study is to elucidate the association of neovascularization in branch retinal vein occlusion (BRVO) combined with major arterial insufficiency (MAI), compared with BRVO alone. The authors retrospectively reviewed the charts, color photographs, and fluorescein angiograms of 304 patients (308 eyes) who had BRVO from 1990 to 2002 at Hanyang University hospital. Patients with BRVO combined with MAI and patients with BRVO alone were differentiated by angiographic appearance. Of the 308 eyes, 12 (3.9%) had neovascularization, all of which were in the 56 eyes of the MAI group for which the neovascularization rate was 21.4%. Neovascularization in BRVO was more strongly associated with the non-perfusion caused by MAI, rather than with the extent of the non-perfusion area that originated from retinal capillary obstruction. MAI is considered as a risk factor for neovascularization and hence could be a prognostic factor.
Adult ; Aged ; Comparative Study ; Female ; Fluorescein Angiography ; Humans ; Male ; Middle Aged ; Retinal Artery/*physiopathology ; Retinal Diseases/*complications/physiopathology ; Retinal Neovascularization/diagnosis/*etiology/physiopathology ; Retinal Vein Occlusion/*complications/diagnosis/physiopathology ; Retrospective Studies

Blindness ; etiology ; Embolism ; Endoscopy ; adverse effects ; Humans ; Male ; Middle Aged ; Paranasal Sinuses ; surgery ; Postoperative Complications ; Retinal Artery ; physiopathology ; Retinal Artery Occlusion ; complications ; etiology

PURPOSE: To evaluate long-term visual outcome of arteriovenous adventitial sheathotomy in BRVO-induced macular edema. METHODS: The visual outcomes of 8 patients following vitrectomy with arteriovenous adventitial sheathotomy for BVO-induced macular edema (surgery group) were retrospectively evaluated. The three-year post-operative visual acuity of the surgery group was compared with that of the conservatively managed controls. RESULTS: All patients were followed for a minimum of 36 months. Mean BCVA (logMAR) in the surgery group changed from 1.10+/-0.34 to 1.19+/-0.70 and to 0.80+/-0.36 at 12 and 36 months, respectively (p=0.959 at 12 months, p=0.018 at 36 months). In the control group, visual acuity improved from 1.15+/-0.43 to 0.43+/-0.44 and to 0.43+/-0.39 at 12 and 36 months, respectively (p=0.015 at 12 months, at p=0.003 at 36 months). A strong trend toward better visual acuity at 12 months and final examination was observed for controls. (surgery vs. control group, p=0.052 at 12 months, p=0.066 at 36 months). CONCLUSIONS: Considering the favorable natural course of BVO and the unproven effect of reperfusion on macular edema, surgical efficacy of arteriovenous adventitial sheathotomy requires further evaluation.
Aged ; Connective Tissue/*surgery ; Decompression, Surgical/methods ; Female ; Humans ; Macular Edema/etiology/physiopathology/*surgery ; Male ; Middle Aged ; Retinal Artery ; Retinal Vein ; Retinal Vein Occlusion/complications/physiopathology/*surgery ; Retrospective Studies ; Treatment Outcome ; Visual Acuity/*physiology ; Vitrectomy/*methods

Branch retinal artery occlusion (BRAO) and branch retinal vein occlusion (BRVO) rarely cause neovascular glaucoma (NVG). A 58-year-old woman with hypertension and type 2 diabetic mellitus complained of progressive visual loss in her right eye for the previous 3 months. At initial examination, visual acuity was 20 / 63 in the right eye. Angle neovascularization was observed and the intraocular pressure (IOP) was 30 mmHg in her right eye. Fundus examination and fluorescein angiography showed BRAO combined with BRVO. We immediately injected intravitreal and intracameral bevacizumab in her right eye. The next day, we performed scatter photocoagulation in the nonperfusion area. One month later, visual acuity was 20 / 20 in her right eye and the IOP was 17 mmHg with one topical antiglaucoma agent. The neovascularization had regressed completely. We report a case of unilateral NVG which was caused by BRAO with concomitant BRVO and advise close ophthalmic examination of the iris and angle in BRVO with BRAO.
Diagnosis, Differential ; Female ; Fluorescein Angiography ; Fundus Oculi ; Glaucoma, Neovascular/diagnosis/*etiology/physiopathology ; Humans ; Intraocular Pressure ; Middle Aged ; Retinal Artery Occlusion/*complications/diagnosis ; Retinal Vein Occlusion/*complications/diagnosis

OBJECTIVETo study the clinical values of measurement of blood flow velocity in central retinal artery in thyroid-associated ophthalmopathy (TAO).

METHODSThirty normal subjects without any thyroid disorders or any eye abnormalities were assigned into the control group, and 30 TAO patients were assigned into the TAO group. Color Doppler ultrasonography was done to measure the blood flow velocity in central retinal artery. Measurement results were compared between these two groups.

RESULTSThe peak systolic velocity and end diastolic velocity of blood flow were significantly lower in TAO group (P < 0.001), while the resistance index significantly increased (P < 0.001).

CONCLUSIONMeasurement of blood flow velocity in central retinal artery with Color Doppler ultrasonography is an easy and useful way to appraise the hemodynamics of the central retinal artery in TAO patients.

Adult ; Aged ; Blood Flow Velocity ; Female ; Graves Disease ; physiopathology ; Hemodynamics ; Humans ; Male ; Middle Aged ; Regional Blood Flow ; Retinal Artery ; diagnostic imaging ; physiopathology ; Systole ; Ultrasonography, Doppler, Color

OBJECTIVETo investigate the factors regarding the recovery of postoperative blood pressure of aldosterone producing adenoma (APA) patients.

METHODSSixty-eight patients with APA were recruited and their data including retinal blood vessel by Doppler sonography, urinary trace albumin, pathological changes of renal biopsy and the adrenal tissues around the adenoma were analyzed in order to determine the correlation between these data and postoperative durative hypertension.

RESULTSPostoperative durative hypertension occurred in 14 cases (41.2%) with increased resistance of unilateral or bilateral central artery of retina, in 16 cases (66.7%) with increased level of urinary trace albumin. Fifteen cases underwent renal biopsy and all of them showed different pathological alterations, 11 cases (73.3%) of which presented with postoperative durative hypertension. The pathological changes of the adrenal tissues around the adenoma is either atrophy or non-atrophy (normal or hyperplasia), 8 cases (40%) and 10 cases (22.2%) of which showed postoperative durative hypertension, respectively.

CONCLUSIONThe renal pathological changes and increased resistance of retinal blood vessel are the main reasons leading to postoperative hypertension in patients with APA.

Adolescent ; Adrenal Cortex Neoplasms ; physiopathology ; surgery ; Adrenal Glands ; pathology ; Adrenocortical Adenoma ; physiopathology ; surgery ; Adult ; Blood Pressure ; physiology ; Female ; Humans ; Hyperaldosteronism ; etiology ; physiopathology ; surgery ; Hypertension ; etiology ; Kidney ; pathology ; Male ; Middle Aged ; Postoperative Period ; Retinal Artery ; physiopathology ; Retrospective Studies ; Vascular Resistance ; physiology

The purpose of this article is to report on the first known Korean case of Susac syndrome. An 18-year-old female came to our clinic reporting blurred vision of the left eye for 2 days. She also complained of decreased hearing with tinnitus of the right ear and mild headache. She was previously healthy and had no remarkable medical history. Best-corrected visual acuity was 20 / 50 in the left eye and 20 / 20 in the right eye. An axiomatic triad of ocular, cochlear, and neurologic involvement was observed in the patient. Fluorescein angiography showed branched retinal arterial occlusions in the left eye. A sudden right sensorineural hearing loss was observed on audimetry. Magnetic resonance images showed a hyperintense lesion in the white matter around the corpus callosum. The patient was treated with high doses of systemic corticosteroids, and no neuropsychological sequelae were observed. This is the first case report of Susac syndrome in Korea. In cases of retinal arterial occlusion with hearing loss or neuropsychological symptoms, Susac syndrome should be suspected.
Adolescent ; Diagnosis, Differential ; Female ; Fluorescein Angiography ; Fundus Oculi ; Hearing ; Hearing Loss, Sensorineural/*diagnosis/physiopathology ; Humans ; Magnetic Resonance Imaging ; Retinal Artery Occlusion/*diagnosis/physiopathology ; Susac Syndrome/*diagnosis/physiopathology ; Visual Acuity

Livedoid vasculopathy (LV) is characterized by a long history of ulceration of the feet and legs and histopathology indicating a thrombotic process. We report a case of acute central retinal artery occlusion in a 32-year-old woman who had LV. She showed no discernible laboratory abnormalities such as antiphospholipid antibodies and no history of cerebrovascular accidents. Attempted intra-arterial thrombolysis showed no effect in restoring retinal arterial perfusion or vision. The central retinal artery occlusion accompanied by LV in this case could be regarded as a variant form of Sneddon's syndrome, which is characterized by livedo reticularis and cerebrovascular accidents.
Acute Disease ; Adult ; Diagnosis, Differential ; Female ; Fluorescein Angiography ; Fundus Oculi ; Humans ; Retinal Artery Occlusion/diagnosis/*etiology/physiopathology ; Sneddon Syndrome/*complications/diagnosis ; *Visual Acuity

We report a very rare case of odontogenic orbital cellulitis causing blindness by severe tension orbit. A 41-yr old male patient had visited the hospital due to severe periorbital swelling and nasal stuffiness while he was treated for a periodontal abscess. He was diagnosed with odontogenic sinusitis and orbital cellulitis, and treated with antibiotics. The symptoms were aggravated and emergency sinus drainage was performed. On the next day, a sudden decrease in vision occurred with findings of ischemic optic neuropathy and central retinal artery occlusion. Deformation of the eyeball posterior pole into a cone shape was found from the orbital CT. A high-dose steroid was administered immediately resulting in improvements of periorbital swelling, but the patient's vision had not recovered. Odontogenic orbital cellulitis is relatively rare, but can cause blindness via rapidly progressing tension orbit. Therefore even the simplest of dental problems requires careful attention.
Adult ; Anti-Bacterial Agents/adverse effects/therapeutic use ; Blindness/*diagnosis/etiology ; Drainage ; Fluorescein Angiography ; Humans ; Male ; Optic Neuropathy, Ischemic/complications ; Orbit/*physiopathology ; Orbital Cellulitis/*diagnosis ; Retinal Artery Occlusion/complications ; Sinusitis/diagnosis/drug therapy ; Tomography, X-Ray Computed ; Tooth Root