IMPORTANCE A hemodynamic role in the pathogenesis of age-related macular degeneration (AMD) has been proposed, but to our knowledge, an association between retinal vasculature and late AMD has not been investigated. OBJECTIVE To determine whether the presence and location of a cilioretinal artery may be associated with the risk of late AMD in the Age-Related Eye Disease Study (AREDS). DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of prospective, randomized clinical trial data from 3647 AREDS participants. Fundus photographs of AREDS participants were reviewed by 2 masked graders for the presence or absence of a cilioretinal artery and whether any branch extended within 500 μm of the central macula. Multivariate regressions were used to determine the association of the cilioretinal artery and vessel location, adjusted for age, sex, and smoking status, with the prevalence of choroidal neovascularization (CNV) or central geographic atrophy (CGA) and AMD severity score for eyes at randomization and progression at 5 years. MAIN OUTCOMES AND MEASURES Association of cilioretinal artery with prevalence and 5-year incidence of CNV or CGA. RESULTS Among AREDS participants analyzed, mean (SD) age was 69.0 (5.0) years, with 56.3% female, 46.6% former smokers, and 6.9% current smokers. A total of 26.9% of patients had a cilioretinal artery in 1 eye, and 8.4% had the vessel bilaterally. At randomization, eyes with a cilioretinal artery had a lower prevalence of CNV (5.0% vs 7.6%; OR, 0.66; 95% CI, 0.51-0.85; P = .001) but no difference in CGA (1.1% vs 0.8%; OR, 1.33; 95% CI, 0.76-2.32; P = .31). In eyes without late AMD, those with a cilioretinal artery also had a lower mean (SD) AMD severity score (3.00 [2.35] vs 3.19 [2.40]; P = .02). At 5 years, eyes at risk with a cilioretinal artery had lower rates of progression to CNV (4.1% vs 5.5%; OR, 0.75; 95% CI, 0.56-1.00; P = .05) but no difference in developing CGA (2.2% vs 2.7%; OR, 0.83; 95% CI, 0.56-1.23; P = .35) or change in AMD severity score (0.65 [1.55] vs 0.73 [1.70]; P = .11). In patients with a unilateral cilioretinal artery, eyes with the vessel showed a lower prevalence of CNV than fellow eyes (4.7% vs 7.2%; P = .01). CONCLUSIONS AND RELEVANCE The presence of a cilioretinal artery is associated with a lower risk of developing CNV, but not CGA, suggesting a possible retinal hemodynamic contribution to the pathogenesis of neovascular AMD. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00000145
Purpose. Evaluate the relationship between retinal vascular caliber and age-related macular degeneration (AMD) severity or progression. Methods. A retrospective secondary analysis of 1172 fundus photographs and clinical data from the prospective Age-Related Eye Disease Study (AREDS). Central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and arteriole-to-venule ratio (AVR) were measured using the Parr–Hubbard–Knudtson formula. Univariate and multivariate regressions were used to determine the association of CRAE, CRVE, and AVR with age, sex, smoking status, presence of cilioretinal artery, and AMD severity at baseline and 5 years using the 9-step AMD severity score. Results. Only CRAE and CRVE were higher in men ( P < 0.001 ), current smokers ( P < 0.001 ), and the eyes with a cilioretinal artery ( P = 0.009 − 0.043 ). AMD severity was greater in older patients ( P = 0.001 ), current smokers ( P = 0.012 ), the eyes without a cilioretinal artery ( P = 0.001 ), and lower AVR ( P = 0.034 ) on multivariate regression but was not influenced by CRAE or CRVE ( P = 0.240 − 0.500 ). Choroidal neovascularization (CNV) presence was associated with older age ( P = 0.003 ) and absence of a cilioretinal artery ( P = 0.009 ), while central geographic atrophy (CGA) was associated with narrower CRAE ( P = 0.002 ) and possibly AVR ( P = 0.046 ). None of the retinal vessel parameters were predictive of AMD severity score or new onset of CNV or CGA at 5 years. Conclusion. A lower arteriole-to-venule ratio may be associated with AMD severity, with narrower arterioles seen in the eyes with geographic atrophy, suggesting a role of the retinal vasculature in AMD pathophysiology. This trial is registered with ClinicalTrials.gov Identifier: NCT00000145.
This is a report of the use, efficacy, and theoretic safety of negative-pressure wound therapy over ocular structures as a part of surgical treatment for necrotizing fasciitis. We treated a 65-year-old man with facial necrotizing fasciitis requiring serial debridement and closure of extensive periorbital and nasal wounds with skin grafts. Negative-pressure wound therapy was first used as a bridge to allow temporary closure and to encourage granulation tissue development. It was then used as a bolster dressing to stabilize skin grafts in the complex wound, not amenable to tie-over dressings. Excellent functional and cosmetic reconstruction of the periorbital and nasal regions was achieved. After treatment, the patient's corrected vision was 20/20. To our knowledge, the use of negative-pressure wound therapy directly over ocular structures has not been previously documented. In this case, it was safely used over the eyes with no sequelae to the patient's vision.
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