Color Doppler Imaging of the Ophthalmic Artery Blood Flow Spectra of Patients Who Have Had a Transient Ischemic Attack: Correlations with Generalized Iris Transluminance and Pseudoexfoliation Syndrome

doi:10.1016/S0161-6420(95)30890-1

Ophthalmology

Volume 102, Issue 8, August 1995, Pages 1199-1205

https://doi.org/10.1016/S0161-6420(95)30890-1 Get rights and content

Purpose: To study the interrelations among pseudoexfoliation syndrome (PXS), abnormal iris transluminance, and ophthalmic artery blood flow in a controlled study.

Methods: Ultrasonographic examination using color Doppler imaging (CDI) was performed on the ophthalmic arteries of 46 unselected patients (92 eyes) who have had at least one transient ischemic attack (TIA) and on 32 healthy subjects (64 eyes). The authors recorded the peak systolic and end diastolic velocities and determined the resistivity indices. Iris transillumination photographs were evaluated by two ophthalmologists in a blind trial to show the presence of abnormal iris transluminance of these eyes. Biomicroscopic examination was performed to show the presence of PXS.

Results: The frequency of abnormal iris transluminance in the whole group of patients who had had a TIA and in control subjects was 63% and 28%, respectively (P <0.05). Pseudoexfoliation syndrome was found in 41 % of the right eyes and in 43% of the left eyes in the group of patients who had had a TIA. The difference between the resistivity indices for the ophthalmic arteries of patients who had had a TIA with positive iris transluminance and healthy subjects without transluminance was statistically significant (P <0.05, Student's t test). Pseudoexfoliation syndrome was detectable in 55.6% of the right eyes and in 61.5% of the left eyes of patients who had had a TIA with abnormal iris transluminance.

Conclusion: The exceptionally high frequency of PXS in the eyes of patients who had had a TIA with positive iris transluminance suggests pathologic changes in the blood supply of PXS eyes. High values of resistivity indices for the ophthalmic arteries of these eyes suggest that disturbances in the ciliary circulation may be the possible cause of these changes.

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To investigate the relationship between ophthalmic artery (OA) blood flow parameters and retinal nerve fiber layer (RNFL) thickness in eyes with pseudoexfoliation (PEX).
We compared PEX eyes without glaucoma (group A, n = 53) and those with glaucoma (group B, n = 18) with control eyes (group C, n = 44). Subsequently, eyes in groups A and B were compared. Finally, OA color Doppler imaging measurements were recorded, and peripapillary RNFL analysis was performed.
The total RNFL measurements differed significantly among the groups (P = 0.012), being thicker in group C than in group A (P = 0.010) and significantly different between group B and groups A and C (both P = 0.001). The peak systolic velocity (PSV) and end diastolic velocity (EDV) measurements of groups A and B were lower than those of group C (PSV: P = 0.001 and P = 0.001, respectively; EDV: P = 0.001 and P = 0.001, respectively). No significant difference was noted in resistive index (RI) measurements (P = 0.370). In group B, significant negative correlations were noted between total RNFL and PSV (r = –0.743; P = 0.001) and between total RNFL and EDV (r = –0.691; P = 0.001), but not between total RNFL and RI measurements (P = 0.548).
Pseudoexfoliation syndrome (PXS) with or without glaucoma was associated with a decrease in the PSV and EDV values of the OA. An extensive study may be needed to further explore the role of PXS in OA blood flow parameters. Total RNFL thickness values were lower in eyes with PEX than in those without.
Étudier le lien entre les paramètres du débit sanguin de l’artère ophtalmique (AO) et l’épaisseur de la couche des fibres nerveuses rétiniennes (CFNR) dans les yeux présentant une pseudo-exfoliation (PEX).
Nous avons comparé des yeux PEX sans glaucome (groupe A, n = 53) et avec glaucome (groupe B, n = 18) avec des yeux témoins (groupe C, n = 44). Par la suite, les yeux des groupes A et B ont été comparés entre eux. Enfin, des relevés d’imagerie Doppler Couleur de l’AO et une analyse de la CFNR péripapillaire ont été effectués.
Les relevés de la CFNR totale présentaient des différences significatives selon les groupes (p = 0,001). Ils étaient plus élevés dans le groupe C que dans le groupe A (p = 0,010) et présentaient des différences significatives entre les groupes B et C (p = 0,001). Les relevés de la vitesse maximale systolique (VMS) et de la vitesse diastolique finale (VDF) dans les groupes A et B étaient inférieurs à ceux du groupe C (respectivement p = 0,007 et p = 0,001; respectivement p = 0,004 et p = 0,001).
Le syndrome de pseudo-exfoliation (SPE) avec ou sans glaucome a été associé à une diminution des valeurs VMS et VDF de l’AO. Une étude plus approfondie peut être nécessaire pour explorer davantage le rôle du SPE dans les paramètres du débit sanguin de l’AO. Les valeurs de l’épaisseur totale de la CFNR étaient réduites dans les yeux présentant une PEX.
Association of pseudoexfoliation syndrome with cardiovascular and cerebrovascular disease: a systematic review and meta-analysis
2018, Canadian Journal of Ophthalmology
Citation Excerpt :
Ultimately, PEX was found to be significantly associated with CVA in every sensitivity analysis performed. Of note, 2 studies by Repo et al.44,45 were excluded from analysis despite reporting prevalence of CVA among PEX and non-PEX groups because they reported the number of eyes with PEX instead of the number of individuals with PEX. Summary ORs were generated to include these articles, both with generous (i.e., 1 eye to 1 individual) and conservative (i.e., 2 eyes to 1 individual) numbers; results were statistically significant, although ORs were inflated and heterogeneity was induced.
Pseudoexfoliation syndrome (PEX) is a systemic disease, but evidence of its association with cardiovascular disease (CVD) and cerebrovascular disease (CVA) is controversial. A quantitative systematic review will provide an accurate summary of the current body of the literature.
Meta-analysis.
Not applicable.
A comprehensive literature search of published and unpublished English-language studies was performed. Summary statistics were calculated using inverse variance weighting and are presented in forest plots. Sources of variance were evaluated statistically.
After screening 4547 studies, 47 articles were reviewed, and 25 eligible studies were selected that reported patients from around the world. Twenty studies enrolling 9583 individuals with PEX evaluated CVD, providing a summary odds ratio (OR) of 1.61 (95% CI 1.37–1.90). Eleven studies, enrolling 1308 PEX patients, evaluated CVA and generated a summary OR of 1.76 (1.40–2.22). For any vascular event (AVE) using all 25 studies, there were 9716 PEX patients and 363,312 control patients, yielding a summary OR of 1.64 (95% CI 1.39–1.92). Analysis for publication bias with the Egger’s test was not significant for studies reporting CVD and AVE (p = 0.92 and 0.64, respectively) but was significant for CVA (p = 0.03). Asymmetry of Begg’s funnel plot was noted for the CVA and AVE analyses. Multiple sensitivity analyses were performed, including assessment of study quality; the OR for all 3 outcomes varied minimally and remained significant in all analyses.
There is strong evidence that PEX is significantly associated with both CVD and CVA.
Le syndrome de pseudo-exfoliation (PEX) est une affection systémique, mais les données qui l’associent à la maladie cardiovasculaire (CV) et à la maladie cérébrovasculaire (CR) sont discutables. Un examen quantitatif et systématique de la littérature médicale actuelle donnera un portrait fidèle de la question.
Méta-analyse.
On a procédé à une recherche exhaustive des études publiées et non publiées de langue anglaise. Les statistiques du résumé ont été calculées au moyen d’une pondération par l’inverse de la variance et présentées sous la forme de graphiques en forêt. Les sources de variance ont fait l’objet d’une évaluation statistique.
Après avoir passé en revue 4547 études, 47 articles ont été examinés et de ce nombre, on a extrait 25 études admissibles qui portaient sur des patients provenant de l’ensemble de la planète. Vingt études ayant regroupé 9583 sujets présentant un PEX se sont penchées sur la maladie CV et ont fourni un rapport de cotes (RC) global de 1,61 (IC à 95 %: 1,37–1,90). Onze études ayant regroupé 1308 sujets présentant un PEX se sont penchées sur la maladie CR et ont fourni un RC global de 1,76 (1,40–2,22). Pour tout épisode vasculaire (ÉV) dans l’ensemble des 25 études, on a recensé 9716 sujets présentant un PEX et 363 312 sujets témoins, ce qui donne un RC global de 1,64 (IC à 95 %: 1,39–1,92). L’analyse pour tenir compte du biais de publication réalisée au moyen du test de Egger n’était pas significative dans le cas des études qui portaient sur la maladie CV et les ÉV (p = 0,92 et 0,64, respectivement), mais l’était dans le cas des études qui portaient sur la maladie CR (p = 0,03). On a remarqué une asymétrie du graphique en entonnoir de Begg en ce qui a trait aux analyses pour la maladie CR et les ÉV. Des analyses de sensibilité multivariées ont été réalisées, notamment l’évaluation de la qualité de l’étude: le RC des 3 critères d’évaluation a très peu varié et est demeuré significatif dans toutes les analyses.
On dispose de données solides selon lesquelles le PEX est associé de manière significative à la fois à la maladie cardiovasculaire et à la maladie cérébrovasculaire.
Major review: Exfoliation syndrome; advances in disease genetics, molecular biology, and epidemiology
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Citation Excerpt :
XFS is a systemic disorder that is increasingly being associated with non-ocular diseases. Epidemiological studies show that XFS increases risk for coronary artery disease (Andrikopoulos et al., 2009; Citirik et al., 2007; Demir et al., 2011; Mitchell et al., 1997; Wang et al., 2014), hypertension (Katsi et al., 2013), cerebrovascular disease (Repo et al., 1995; Ritland et al., 2004; Yuksel et al., 2006), abdominal aortic aneurysm (Djordjevic-Jocic et al., 2012; Schumacher et al., 2001), peripheral vascular disease (Praveen et al., 2011), renal artery stenosis (Gonen et al., 2013), erectile dysfunction (Gokce and Gokce, 2015), Alzheimer's-like dementia (Linner et al., 2001; Cumurcu et al., 2013), sensorineural hearing loss (Cahill et al., 2002; Yazdani et al., 2008), and, most recently, pelvic organ prolapse (Wirostko et al., 2016). The exact mechanism underlying the development of vascular complications in XFS remains poorly understood, although abnormal elastic fiber synthesis in vessel walls, elevated serum antiphospholipid antibody levels, increased oxidative stress, endothelial dysfunction and hyperhomocysteinemia are all hypothesized to play contributory roles (Ritch, 2014; Akarsu and Unal, 2005; Visontai et al., 2006; Naji et al., 2008; Altintas et al., 2012; Hollo, 2014; Tosun et al., 2012).
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