PURPOSE: To evaluate the effect of panretinal photocoagulation and additive intravitreal bevacizumab injections on central retinal vessel diameters and characteristic retinal vascular caliber changes in diabetic retinopathy. METHODS: Changes in central retinal vessel diameters were retrospectively analyzed before and 6 months after panretinal photocoagulation with or without additive intravitreal bevacizumab injections in 64 eyes first diagnosed with diabetic retinopathy. Vessel diameters and arteriovenous ratio (AVR) were measured using Interactive Vessel Analysis (IVAN) software and the Big six formula. RESULTS: There were significant decreases in central retinal artery equivalent (CRAE) and central retinal vein equivalent (CRVE) in both groups, with and without additive intravitreal bevacizumab injections, 6 months after completion of panretinal photocoagulation (p < 0.001, p = 0.008), but no significant change in AVR (p = 0.338). Additive intravitreal bevacizumab injections did not produce significant changes in central retinal vessel diameters after 6 months compared to vessel diameters treated with panretinal photocoagulation only. Retinal vascular caliber of progressed diabetic retinopathy showed smaller CRAE, larger CRVE, and smaller AVR compared to those of normal or diabetic Korean subjects in a previous study and showed no significant association with age. CONCLUSIONS: CRAE and CRVE decreased significantly 6 months after panretinal photocoagulation in diabetic retinopathy, but additive intravitreal bevacizumab injections did not cause significant additive changes to central retinal vascular calibers in this study. We established the standard retinal vascular caliber of Korean subjects in diabetic retinopathy and analyzed the effects of retinopathy on retinal vessel caliber.
Bevacizumab* ; Diabetic Retinopathy* ; Light Coagulation* ; Retinal Artery ; Retinal Vein ; Retinal Vessels ; Retinaldehyde* ; Retrospective Studies

The author studied the perivascular and intervascular argyrophilic fibers of human retina suffered from some intraocular _ disease such as retinoblastoma, congenital anterior staphyloma, phthisis bulbi following after glaucoma surgery, two cases of absolute glaucoma following after traumatic ectopia lentis,endophthalmitis complicated by penetrating injury The technique of preparing slides to study the retinal vascular patterns consist of trypsin digestion according to the method of Kuwabara and Cogan. The stains adopted mainly in this study were either PAS (periodic acid-Schiff) -hematoxylin or Wilder's reticulin stain to demonstrate the perivascular and intervascular argyrophilic ficers cf the retina. Resulte obtained as follows: 1. In the congenital anterior staphyloma, retinal artery showed encircling wavy argyrophilic fibers but in the vein the argyrophilic fibers of circular arrangement were rather coarse those shown in the artery and those fibers of vertical arrangement were running more externally. The intervascular strands between artery and vein were continuous with argyrophilic perivascular network. 2. In the eye of absolute glaucoma, no specific changes found in argyrophilic fibers of retinal artery. Circular fiber was poorly stained and more coarse in dilated portion but relatively preserved vertical fibers of the retinal vein. Microaneurysmal dilatation(beaded) was found in venous capillaries. 3. In the endophthalmitis,relatively preserved argyrophilic fibers in the retinal artery but interrupted, reduced and irregular patterns of circular fibers were noticed in the retinal vein. 4. In non-tumorous parts of the retinoblastoma argyrophilic, fibers in the dilated vessel wall were more coarse those in than normal. 5. Proliferation of strands (spider like structure) between the peripheral fibrotic retinal vessels of atropia bulbi eye and some parts of intercapillary bridge were composed of argyrophilic fibers.
Arteries ; Capillaries ; Coloring Agents ; Digestion ; Glaucoma ; Humans ; Reticulin ; Retina* ; Retinal Artery ; Retinal Vein ; Retinal Vessels ; Retinaldehyde ; Retinoblastoma ; Running ; Trypsin ; Veins

Narrowing of the retinal vessels in chronic glaucoma has been recognized only recently. We performed this study to evaluate the vessel diameter in normal and glaucoma eyes, addressing whether the retinal vessel diameters differ with the degree of glaucomatous optic nerve damage. The diameters of the superior temporal and inferior temporal retinal artery and vein were measured at the optic disc border from optic disc photographs of 234 eyes of 141 patients with primary open-angle glaucoma and 139 eyes of 86 normal subjects. The photographic magnification was corrected according to Littmanns method. Only one eye per patient and subject was taken for statistical analysis. According to the neuroretinal rim/disc area ratio, the glaucoma group was divided into four stages(early; more than 0.61, medium; 0.60~0.41, advanced; 0.40~0.21, far advanced; less than 0.20). In the normal group the diameter of the inferior temporal vein(0.130+/-0.020mm) was the largest, followed by the superior temporal vein(0.117+/-0.017mm), the inferior temporal artery(0.102+/-0.016mm), finally the superior temporal artery(0.093+/-0.012mm). The retinal vessel diameter decreased significantly with decreasing of the neuroretinal rim/disc area ratio. In the glaucomatous eyes as compared to the normal eyes, the diameters of the inferior temporal and superior temporal retinal artery were significantly smaller at the early and medium stages(p<0.03, p<0.02, respectively). Whereas both inferior temporal and superior temporal retinal vein diameters were significantly samller at the far advanced stage(p=0.01, p=0.005, respectively). The results indicate that generalized reduction of the retinal vessel diameter throughout the retina is related to the severity of glaucoma. From a diagnostic point of view, evaluation of artery diameter rather than vein diameter may be helpful for the differentiation between normal and glaucomatous eyes.
Arteries ; Glaucoma* ; Glaucoma, Open-Angle ; Humans ; Optic Nerve ; Retina ; Retinal Artery ; Retinal Vein ; Retinal Vessels* ; Retinaldehyde* ; Veins

PURPOSE: To report a case of orbital apex syndrome (OAS) combined with central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO) following blunt trauma. CASE SUMMARY: A 4-year-old female visited the hospital following a traffic accident. She was admitted because of multiple fractures of the skull and pneumocephalus. On day 5, she was referred to us with decreased visual acuity in her right eye. Her initial visual acuity was hand motions in the right eye and 0.8 in the left eye. The right eye showed a dilated pupil, ptosis, and total ophthalmoplegia, and the left eye showed limited abduction. A fundus examination revealed multiple retinal hemorrhages, tortuous veins, and an edematous white retina with a cherry-red spot in the right eye. Brain magnetic resonance imaging revealed an entrapped right optic nerve because of bony fragments in the orbital apex. The patient was diagnosed with OAS accompanied by CRAO and CRVO in the right eye, and with traumatic abducens nerve palsy in the left eye. After 6 months, the visual acuity was hand motions, and the fundus examination showed absorbed retinal hemorrhages, pale discs, and general retinal thinning of the right eye. Ptosis of the right eye and extraocular muscle movement of both eyes were improved. CONCLUSIONS: Combined CRAO and CRVO following trauma is very rare and is even more rarely associated with OAS. It is important for clinicians to be aware of the potential for central retinal vessel occlusions and OAS in cases of blunt ocular trauma.
Abducens Nerve Diseases ; Accidents, Traffic ; Brain ; Child, Preschool ; Female ; Fractures, Multiple ; Hand ; Humans ; Magnetic Resonance Imaging ; Ophthalmoplegia ; Optic Nerve ; Orbit ; Pneumocephalus ; Pupil ; Retina ; Retinal Artery Occlusion ; Retinal Artery ; Retinal Hemorrhage ; Retinal Vein ; Retinal Vessels ; Retinaldehyde ; Skull ; Veins ; Visual Acuity

PURPOSE: To report a case of lipemia retinalis in a patient with diabetes. CASE SUMMARY: A 27-year-old female with type 2 diabetes visited our clinic with visual disturbance in her left eye while being followed up from a pars plana vitrectomy in her right eye for proliferative diabetic retinopathy. On fundus examination of both eyes, the retinal vessels were creamy white and the retinal veins were undistinguishable from the retinal arteries. The serum triglyceride level was 2,676 mg/dL. The patient was asymptomatic except for visual impairment due to vitreous hemorrhage in her left eye. The patient was diagnosed with lipemia retinalis and chylomicronemia syndrome. After controlling the triglyceride level, funduscopic findings in the both eyes were improved. However, the visual acuity in her right eye remained unchanged. CONCLUSIONS: Lipemia retinalis can be a sign of a systemic condition although it may not affect visual acuity. Fundus examination may be a useful tool in the early diagnosis of hyperlipidemia.
Adult ; Diabetic Retinopathy* ; Early Diagnosis ; Female ; Humans ; Hyperlipidemias* ; Retinal Artery ; Retinal Vein ; Retinal Vessels ; Triglycerides ; Vision Disorders ; Visual Acuity ; Vitrectomy ; Vitreous Hemorrhage

The retinal blood bessels exit the optic disc and branch in a complex pattern to serve the metabolic need of the inner retina. As the vessels traverse the retina, the arteries and veins frequently cross one another. Recently, there has been renewed iterest in the orientation of the crossing retinal vessels at arteriovenous intersections, particularly as it relates to the risk of branch retinal vein occlusion. The authors studied standard fundus photographs of 30 subjects(60 eyes) who don't habve any retinal and systemic disorders. Arteriovenous crossings were analized for fundus location and relative orientation of the crossing vessels(vein-posterior or vein-anterior). In the superotemporal quadrant, A-V crossings were a greater number, distributed closer to the optic disc than the inferotemporal quadrant. Also a greater proportion of crossings was vein-posterior than the inferotemporal quadrant. These findings may explain the predilection for branch retinal vein occlusions to occur frequency in the superotemporal quadrant.
Arteries ; Retina* ; Retinal Vein Occlusion ; Retinal Vessels ; Retinaldehyde ; Veins

The cilio-retinal artery appears on the temporal side of the optic disc margin and is concerned with the supply of the portion between the optic disc and the macula. So, the cilio-retinal artery preserves vision when occlusion of the central retinal artery occurs. The aberrant macular artery is very rare and in most of the cases have been derived from the inferior temporal arterial or venous trunks. When this artery is appeared, the corrected vision is normal but sometimes diminished. The authors have experienced two aberrant retinal vessels of a large cilio-retinal artery and aberrant macular artery combined with the Stargardt's maculopathies. It was reviewed clinically with the literature.
Arteries ; Retinal Artery ; Retinal Vessels* ; Retinaldehyde*

In 1937, Behcet's, a Turkish dermatologist, identified firstly as a distinct disease entity presenting the three cardinal symptoms of relapsing iridocyclitis with hypopyon, aphthous lesions in the mouth, and the ulceration of the genitalia, but although these may be the main features of the condition the numerous reports of involvement of other systems of the body such as the blood vessels, the nervous system, the skin and the joints make it clear that it is not restricted to the eyes, the skin and mucous membranes but is systemic in its incidence. Here, authors observed one typical case of Behcet's disease and its uvea-retinal tissues of an enucleated eyeball was studied by light and electron microscopies. MATERIALS AND METHODS: Left eye ball was enucleated from a patient with Behcet's disease in the stage of remission. This twenty yr. old boy was admitted due to visual disturbance of both eyes, ocular pain and left frontal headache. He was been suffered from recurrent attacks of aphthous lesion of mouth, ulceration of urogenital area, erythema nodosum on leg skin and lately uveitis for the last five years. And that time, he was been treated with Depo-Medrol and gamma globulin at local clinic. At admission, the visual acuity of both eyes were light perception with signs of uveitis and secondary glaucoma, the lens was also opacified mildly on anterior capsular and subcapsular areas due to the long exsisting posterior synechia. And the ocular tension of the right eye was in hypotony but of the left eye was increased up to 40 mmHg. He was been treated systemically at our Department. But his ocular conditions were not improved, inspite of combination surgery of cyclocryothermy especially for glaucomatous eye. The left eye was finally enucleated for pain control. For light and electron microscopy, this enucleated eye ball was sent to the pathologic laboratory. The half of sectioned eye ball was fixed in formalin and the tissues was then stained with hematcxylin-eosin and periodic acid-Schiff stains. Another half of anterior-posterior sectioned eyeball was fixed in 2.5% glutaraldehyde and 1% csmium acid for electron microscopy. And after routine procedures of preparation, this specim. RESULTS: Anterior chamber was filled moderately with some fibrinoid exudate and round cells especially atthe angle. The Schlemm's canal was patent but the trabecular meshwork was infiltrated with round cells. And anterior surface of the iris was covered with fibrinoid exudates. Perivascular round cell infiltration of iris stromal vessels and some atrophic changes of the iris stroma were prominent findings In ciliary body, there was evidenced diffuse non-specific inflammation and degenerative changes of the ciliary muscle. By electron microscopy, vacuolization of the basement membrane of capillaries and perivascular infiltration of plasma cells and round cells were presented in the ciliary body. Atrophic and degenerative changes of the choroid were another features with the roundu cell infiltration in perivascular area. The retina was totally detached from its pigment layer. Diffuse retinal degeneration with gliosis and focal hemorrhagic infarcts revealed in this case. The retina and the vitreous body showed pronounced permeation by round cells and polymorphoneutrophile leucocytes and by fibrinoid exudates. By electron microscopy, picknosis and necrobiosis of the outer nuclear layer was characterized with some thickened capillary walls which were accompanied with degenerated smooth muscles fi bers. COMMENTS: In 1953, Sezer stated that the severe necrosis in the ciliary body and peripheral choroid of nonspecific character were the specific findings. In all cases there was a chronic inflammatory mononuclear inflammation of the granulomatous type particularly around the vessels, mainly in the uveal tract where areas of necrosis result, and also around the retinal vessels. The retina is often detached, hemorrhagic and necrotic in course (Duke-Elder, 1966). Mano and Baghadassarian (1964) found a perivascular infiltration with lymphocytes and plasma cells which is marked in the uveal tract Berlin (1944) noted peri vascular round cell infiltration around the central retinal artery and in the choroid. In 1960, Fishop's case with enucleated eye showed massive hemorrhagic infarction of the retina secondary to a recent thrombosis of the central retinal vein. Shikano (1971) reported that the histopathology of iris tissues in Behcet's disease revealed almost total absence of tissue destruction or of focallized inflammatory center, with the extravasated leucocytes which show minimal tendency to leucoclasia. And in the retina there showed strong permeation by leucocytes and by exudates with some evidence of thinning its thickness due probably to characteristic lytic process of its visual elements. Sugiura et al (1974) described round wondering cells which were often accumulated around the vessels assuming perivascular cuffs. In the retina acellular capillaries filled with the processes of Muller cells were often observed, and tubular structure resembling the nucleocapsid of myxovirus in shape and size, were detected with tubular bodies in the endothelial cell of blood vessels in all tissues examined. In authors case, There was evidenced diffuse nonspecific inflammation of whole ocular tissues, with the accompany of perivascular infiltration of round cells and plasm cells in the uveo-retinal tissues.
Anterior Chamber ; Basement Membrane ; Berlin ; Blood Vessels ; Capillaries ; Choroid ; Ciliary Body ; Coloring Agents ; Endothelial Cells ; Ependymoglial Cells ; Erythema Nodosum ; Exudates and Transudates ; Formaldehyde ; gamma-Globulins ; Genitalia ; Glaucoma ; Gliosis ; Glutaral ; Headache ; Humans ; Incidence ; Infarction ; Inflammation ; Intraocular Pressure ; Iridocyclitis ; Iris ; Joints ; Leg ; Lymphocytes ; Male ; Microscopy ; Microscopy, Electron* ; Mouth ; Mucous Membrane ; Muscle, Smooth ; Necrobiotic Disorders ; Necrosis ; Nervous System ; Nucleocapsid ; Orthomyxoviridae ; Plasma Cells ; Retina ; Retinal Artery ; Retinal Degeneration ; Retinal Vein ; Retinal Vessels ; Skin ; Thrombosis ; Trabecular Meshwork ; Ulcer ; Uveitis ; Visual Acuity ; Vitreous Body

Fourteen cases of central retinal vein occlusion (CRVO) were studied with electroretinogram (ERG) and fluorescein angiogram. The cases were divided into a venous stasis retinopathy group (VSR,9 cases) and a hemorrhagic retinopathy group(HR, 5 cases). The b/a ratio and retinal circualtion time (RCT) were measured and compared with the control group. The mean b/a ratio of the HR group (0.86) was decreased as compared with the VSR group (1.18) and the control group (1.23). The RCT of the HR group was markedly delayed to 13.68 seconds as compared with the VSR group (11.09 sec) and the control group (6.4 sec). These facts suggest that both the b/a ratio and the RCT are possible parameters for estimating retinal ischemia and that the ERG is a reliable examination method for classification of CRVO.
Adult ; *Electroretinography ; Female ; Fluorescein Angiography ; Humans ; Male ; Middle Aged ; Retinal Vein Occlusion/diagnosis/*physiopathology ; Retinal Vessels/*physiopathology ; Time Factors

PURPOSE: To report the first case of central retinal vein occlusion (CRVO) in association with thyroid ophthalmopathy. METHODS: A 40-year-old woman was came to the ophthalmologic clinic due to conjunctival injection, lid swelling and decreased visual acuity in the left eye. She was ill with hyperthyroidism and was recovered completely. At the first visit, best corrected visual acuity of her left eye was 0.3. The left eye showed proptosis, episcleral vessel dilation, and moderate limitation of ocular movement. Orbit MRI revealed the enlargement of extraocular muscles. Fundus examination showed diffuse retinal hemorrhages with macular edema and retinal veins were dilated and tortuous. Fluorescein angiogram showed the diffuse leakage from the retinal vessels on the posterior pole, but nonperfusion area was not seen. RESULTS: One month after the first visit, best corrected visual acuity of her left eye was improved to 0.6. Proptosis and limitation of ocular movement was improved, and retinal hemorrhages with macular edema were decreased remarkably. CONCLUSIONS: Possible retinal vascular complications such as CRVO may occur in patients with thyroid ophthalmopathy. Therefore, in these cases, fundus examination along with other ophthalmologic examinations are necessary.
Adult ; Exophthalmos ; Female ; Fluorescein ; Humans ; Hyperthyroidism ; Macular Edema ; Magnetic Resonance Imaging ; Muscles ; Orbit ; Retinal Hemorrhage ; Retinal Vein* ; Retinal Vessels ; Retinaldehyde ; Thyroid Gland* ; Visual Acuity