The change in scotopic signaling amplitude in the outer and middle layers of retina in subjects with diabetes was proportional to the change in capillary glucose. Cone amplitude was not influenced by hyperglycemia in this study.

AimTo record ocular vascular events following injections of vascular endothelium growth factor (VEGF) antagonists.MethodsCollaborative multicenter case series (48 cases), literature reviews (32 cases), and reports to the FDA (64 cases) of patients that had vascular occlusions during anti-VEGF therapy were collected and analyzed.ResultsA total of 144 cases of ocular vascular events were identified, with these diagnosed a median of 15 days after anti-VEGF injection. The majority of patients had pre-existing risk factors for cardiovascular events and nine patients had a prior history of glaucoma. Mean visual acuity dropped by 6.4 lines with severe visual loss after injection to NLP (five eyes), LP (six eyes), and HM (two eyes). The overall risk of ocular vascular events following a VEGF antagonist injection was 0.108% in the general population and 2.61% in the diabetic population. Mean retinal arterial constriction after intravitreal bevacizumab in 13 eyes was 21% (standard deviation = 27%), and mean retinal venous constriction was 8% (standard deviation = 30%).ConclusionOcular vascular events are rare during anti-VEGF therapy, but can lead to severe visual loss and may be caused by a number of factors including the vasoconstrictor effect of the drug, a post-injection rise of intraocular pressure, patient stress as a result of the procedure, and the patient’s natural history of underlying ocular or systemic diseases. The diabetic population appears to have a tendency towards ocular vascular occlusions.

ABSTRACT.Purpose: To examine retinal function in relation to retinal perfusion pressure in patients with carotid artery stenosis. Methods: Thirteen patients with carotid artery stenosis without clinical eye disease underwent assessment of ophthalmic artery systolic blood pressure (OSP) by ocular pneumoplethysmography, carotid artery obstructive disease by ultrasonography, intraocular pressure by applanation tonometry, retinal perfusion by fluorescein angiography and retinal function by multifocal electroretinography (mfERG). Data analysis compared the eye on the most stenotic side with the fellow eye in the same patient. Results: Ophthalmic systolic pressure was 95.8 ± 13.1 mmHg on the side with the highest degree of carotid artery stenosis (mean 94.0%) and 111.7 ± 10.3 mmHg in the fellow eyes on the side with the lesser degree of stenosis (mean 33.9%). Summed mfERG implicit times (N1 and P1) were 3.4% and 2.0% longer (p = 0.013 and 0.021), and N1 and P1 amplitudes were 18.0% and 16.0% (p = 0.0041 and 0.020) lower in eyes on the side with the higher stenosis compared with the contralateral eyes. Shorter implicit times and higher amplitudes were correlated with higher brachial systolic arterial blood pressure (p = 0.0028, 0.011, 0.041 for N1, P1, N2 implicit times, respectively, and p = 0.0086, 0.016, 0.040 for N1, P1, N2 for amplitudes, respectively, corrected for OSP). Conclusion: Cone function deviation was observed in clinically healthy eyes on the side with highest degree of carotid artery stenosis and was found correlated to arterial blood pressure.

PURPOSE.To examine retinal function in chronic ocular ischemia using multifocal electroretinography (mfERG). METHODS. Thirteen patients with unilateral ocular ischemic syndrome (OIS) underwent assessment of ophthalmic systolic blood pressure by ocular pneumoplethysmography, carotid artery patency by ultrasonography, intraocular pressure (IOP) by applanation tonometry, retinal perfusion by fluorescein angiography, and retinal function by mfERG. RESULTS. Ophthalmic systolic blood pressure was 67.0 Ϯ 11.6 mm Hg in eyes with OIS and 106.1 Ϯ 18.0 mm Hg in fellow eyes, whereas IOP was 13.8 Ϯ 3.2 and 14.4 Ϯ 1.7 mm Hg, respectively. Summed mfERG implicit times (N1, P1, N2) were prolonged in eyes with OIS, by 7.6%, 6.2%, and 7.5%, respectively, compared with fellow eyes (P Յ 0.0048). The retardation of retinal function was significant outside the macula, whereas the assessment of responses from the central retina was limited by high variance. Second-order kernel (first slice) summed implicit times (N1, P1, N2) were also prolonged in OIS, by 6.6%, 7.3%, and 6.8%, respectively (P Յ 0.0058). Of the amplitudes, only the second-order N2 amplitude was significantly abnormal, being reduced by 23.2% in OIS (P ϭ 0.011). CONCLUSIONS. The function of the outer and middle layers of the retina was found to be suppressed in chronic ocular hypoperfusion. The moderate delay in retinal function does not appear to explain the prominent photopic symptom of diffuse glare in bright light, and the delay could be evidence of a functional adaptation that serves to maintain and optimize signaling under conditions of compromised perfusion. (ClinicalTrials.gov number, NCT00403195.) (Invest Ophthalmol Vis Sci.O cular ischemic syndrome (OIS) was first recognized as a result of severe carotid artery obstruction in 1963. 1 Definite diagnostic criteria have not been established. The principal symptoms are mild to severe visual loss, ocular pain that can be relieved by lying down, and diffuse glare in bright light. Findings include aqueous flare, iris rubeosis, cataract, narrow retinal arteries, dilated nontortuous retinal veins, retinal hemorrhages, microaneurysms, cotton-wool spots, and preretinal neovascularization. Fluorescein angiography reveals delayed and patchy choroidal filling and diffuse leakage from the retinal vessels and the optic nerve head. 2 OIS is relatively rare. The largest study so far included 52 eyes with OIS in 43 patients collected retrospectively from a background of 1.5 million outpatient visits. 3 Patients found to have OIS are often referred with a diagnosis of diabetic retinopathy, central retinal vein occlusion, or neovascular glaucoma, showing that OIS is underdiagnosed in general clinical practice.There is no strict correlation between the degree of carotid artery stenosis and the presence or severity of ipsilateral OIS, probably because there is considerable variation in the capacity of collateral and retrograde filling of the ophthalmic artery from the external carotid artery and the contralateral internal carotid arter...