Impaired Retinal Perfusion Resulting From Vitreoretinal Traction: A Mechanism of Retinal Vascular Insufficiency

Kashani, Amir H; Zhang, Youning; Capone, Antonio; Drenser, Kimberly A.; Puliafito, Carmen A.; Moshfeghi, Andrew A; Williams, George A.; Trese, Michael T.

doi:10.3928/23258160-20160229-03

Cited by 14 publications

(13 citation statements)

References 28 publications

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“…The post-ocriplasmin VMT release (complete or incomplete) might justify the observed tissue relaxation, together with microvascular density reduction. This hypothesis might consolidate the findings made by Kashani [11], and Mastropasqua [8].…”

Section: Discussionsupporting

confidence: 90%

“…The rationale of our study was to investigate possible microvascular alterations in VMT, and to observe changes after intravitreal ocriplasmin injection. Kashani et al used fluorescein angiography to show microvascular pattern alterations produced by vitreoretinal traction, and also demonstrated their reversibility, suggesting a possible direct mechanical effect of vitreous traction on retinal perfusion [11].…”

Section: Discussionmentioning

confidence: 99%

“…Alterations of the capillary plexuses have also been found in patients affected by idiopathic and secondary epiretinal membrane (ERM), even after surgical removal [8–10]. In addition, recent fluorescein angiography studies show how vitreoretinal traction can alter the microvascular pattern in a reversible fashion, suggesting that there might be a direct mechanical effect of vitreous traction on retinal vascular perfusion [11].…”

Section: Introductionmentioning

confidence: 99%

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Reduced perfusion density of superficial retinal capillary plexus after intravitreal ocriplasmin injection for idiopathic vitreomacular traction

et al. 2019

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Background To investigate, using optical coherence tomography angiography (OCT-A), changes in perfusion density and in the foveal avascular zone (FAZ) in eyes with idiopathic vitreomacular traction (VMT) after ocriplasmin injection. Methods In this pilot study, we enrolled sixteen VMT eyes treated with intravitreal ocriplasmin injection. Sixteen healthy eyes were considered as controls. Macular perfusion density in 3 plexuses [superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris (CC)] was calculated at baseline and at 1 month after injection. Results After injection, VMT anatomically resolved in 9 eyes (56.2%), whereas 7 eyes (43.8%) achieved an incomplete VMT separation. Superficial capillary plexus perfusion density was reduced significantly after injection (from 0.427 ± 0.027 to 0.413 ± 0.028; p = 0.0146), while no differences were noted in the DCP ( p = 0.2717) nor in the CC ( p = 0.6848). Study-eye perfusion density was statistically similar to control eyes in all three plexuses, both at baseline and at follow-up. The FAZ in the SCP area remained unchanged after injection ( p = 0.168) but was significantly inferior to controls both at baseline and at 1 month (0.198 ± 0.074 vs. 0.196 ± 0.070; p = 0.007). Conclusions Eyes with VMT have a perfusion density comparable to healthy controls, but a smaller FAZ. After ocriplasmin injection the perfusion density in the SCP is reduced, regardless the anatomical success. Limited by the small sample size and the pilot nature of the study, we found microvascular changes after ocriplasmin injection, which may be due to retinal traction release.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Reduced perfusion density of superficial retinal capillary plexus after intravitreal ocriplasmin injection for idiopathic vitreomacular traction

et al. 2019

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“…The following were analyzed as potential confounders: presence of vitreomacular traction [ 18 ], epiretinal membrane(H. [ 19 ]), macular hole [ 20 ], myopia [ 21 ], previous vitreoretinal surgery [ 22 ], diabetes [ 23 ], systemic arterial hypertension [ 24 ], cognitive impairment [ 25 ], previous stroke [ 26 ], chronic kidney disease [ 27 ].…”

Section: Methodsmentioning

confidence: 99%

Retinal capillary involvement in early post-COVID-19 patients: a healthy controlled study

Savastano

Gambini

Cozzupoli

et al. 2021

Graefes Arch Clin Exp Ophthalmol

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Background Systemic vascular involvement in COVID-19 has been identified in several patients: not only endothelial derangement and increased permeability are reported to be early hallmarks of organ damage in patients with COVID-19 but are also the most important cause of worsening of clinical conditions in severe cases of SARS-CoV-2 infection. There are several reasons to hypothesize that the eye, and the retina in particular, could be a target of organ damage in SARS-CoV-2 infection. Methods This cohort observational study analyzes OCT angiography and structural OCT of 70 post-COVID-19 patients evaluated at 1-month hospital discharge and 22 healthy control subjects. Primary outcomes were macular vessel density (VD) and vessel perfusion (VP); structural OCT features were evaluated as secondary outcomes. In addition, patients and healthy volunteers were evaluated for best corrected visual acuity, slit lamp photograph, and fundus photo image. Results VD and VP in 3 × 3 and 6 × 6 mm scans for SCP and DCP showed no significant differences between the groups. Similarly, CMT and GCL did not reveal significant differences between post-COVID-19 and healthy patients. Nine patients (12.9%) featured retinal cotton wool spots and 10 patients had vitreous fibrillary degeneration. The prevalence of epiretinal membrane and macular hole was similar in the two groups. One case of extra papillary focal retinal hemorrhage was reported in the post-COVID-19 group. Conclusions Macula and perimacular vessel density and perfusion resulted unaltered in mild post-COVID-19 patients at 1-month hospital discharge, suggesting no or minimal retinal vascular involvement by SARS-CoV-2.

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“…In one study, Pierro et al [19] proposed the hypothesis that tangential traction could cause vasodilation and congestion in the formation of macular hole. It has also been reported that vitreous retinal traction can cause reversible changes in retinal vascular perfusion, indicating that vitreous traction has direct force on retinal vessels [20] . Therefore, we believe that in the process of MH, the number and total area of cysts in the OPL+HFL complex continue to increase, which produces certain tension to the SCP of the retina and changes the structure of the capillaries located in the layer of ganglia cells and nerve bers, which may cause the congestion of blood vessels, and then cause the change of vascular density.…”

Section: Discussionmentioning

confidence: 95%

The formation of perifoveal cysts in idiopathic macular holes and their relationship with retinal blood flow

Yang

Hao

Zhou

et al. 2020

Preprint

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Background : To study the formation and distribution of perifoveal cysts in an idiopathic macular hole and their correlation with retinal blood flow. Method: There were 16 patients in the small hole group, and 23 patients in the large hole group. In the preoperative procedure, we measured the number, the total area and the average size of the cysts in the inner nuclear layer, outer plexiform and Henle fiber layer complex around the hole; and the vascular density of the retinal capillary plexuses of all cases. Postoperatively, we measured the retinal capillary plexuses vascular density in 17 eyes. Results: The number and the total area of the cysts in the inner nuclear layer of the large hole group were greater than those of the small hole group (t=-2.882, P =0.007, t= -3.412 P =0.002). And we came to the same conclusion in the outer plexiform and Henle fiber layer complex (t=-3.935 P =0.000, t=-4.335 P =0.000). The average cystic area of the inner nuclear layer and outer plexiform and Henle fiber layer complex had no significant difference between the two groups (t=0.178 P =0.860, t=-1.767 P =0.085). There was a significant correlation among the idiopathic macular hole diameter, the number and the total area of cysts in the outer plexiform and Henle fiber layer complex, the vascular density of the retinal superficial capillary plexuses and deep capillary plexuses; the respective coefficients were -0.725, -0.474, -0.314, -0.768, and +0.624. Conclusions: 1. The diameter of the idiopathic macular hole was related to the formation of cysts around the hole. 2. Multiple mechanisms are involved in the interaction between the cystic space around the idiopathic macular hole and the retinal capillary plexuses.

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Impaired Retinal Perfusion Resulting From Vitreoretinal Traction: A Mechanism of Retinal Vascular Insufficiency

Cited by 14 publications

References 28 publications

Reduced perfusion density of superficial retinal capillary plexus after intravitreal ocriplasmin injection for idiopathic vitreomacular traction

Reduced perfusion density of superficial retinal capillary plexus after intravitreal ocriplasmin injection for idiopathic vitreomacular traction

Retinal capillary involvement in early post-COVID-19 patients: a healthy controlled study

The formation of perifoveal cysts in idiopathic macular holes and their relationship with retinal blood flow

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