Robert D. Steigerwalt

Ocular and orbital blood flow in cigarette smokers.

Objective: To report the effect of cigarette smoking on the blood flow velocity of the ophthalmic artery (OA), central retinal artery (CRA), and posterior ciliary artery (PCA) in patients who smoke at least 20 cigarettes a day. Methods: The color duplex scanner was used to measure the systolic and diastolic flow velocity of the OA, CRA, and PCA in 10 smokers and 11 nonsmokers. Results: Both the systolic and diastolic flow velocity decreased in the OA, CRA, and PCA in smokers compared with nonsmokers. The systolic flow decreased by as much as 36% and the diastolic flow by as much as 52%. This decrease was significant for the flow velocity of the CRA and PCA but not for the OA, An increase in the resistance index was also found. Conclusion: The authors believe that the decrease in the flow velocity of these vessels may be due to an increase in the vascular resistance of the vessels of the retina and optic nerve head in smokers. This may be important in patients with eye disease in whom altered blood flow already contributes to the ocular or orbital pathology.

OCULAR AND ORBITAL BLOOD FLOW IN PATIENTS WITH ESSENTIAL HYPERTENSION TREATED WITH TRANDOLAPRIL

Purpose: To study the effect of essential hypertension on flow velocity in the central retinal (CRA) and posterior ciliary arteries (PCA). Flow velocity was also evaluated in these arteries in patients with hypertension treated with trandolapril, an oral angiotensin‐converting enzyme inhibitor. Methods: Using the duplex scanner, flow velocity of the CRA and PCA was measured in 12 medication‐free patients with hypertension and 10 normal controls. The hypertensive patients were then treated with oral trandolapril, 1 mg/day for 1 week. After 1 week of treatment, flow velocity was again measured in the arteries of the patients with hypertension. Results: There was a significant reduction in systolic and diastolic flow velocity of the vessels tested in the medication‐free hypertensive patients when compared with those in the normal controls. In controls, the CRA had a peak systolic flow velocity (PSFV) of 34 cm/sec and an end diastolic flow velocity (EDFV) of 14 cm/sec; the PCA had a PSFV of 38 cm/sec and an EDFV of 16 cm/sec. In the hypertensive patients off medication, the CRA had a PSFV of 16 cm/sec and an EDFV of 6 cm/sec; the PCA had a PSFV of 17 cm/sec and an EDFV of 5 cm/sec. The diastolic component also was significantly decreased in the patients with hypertension. Flow velocity significantly increased in the hypertensive patients treated with trandolapril for 1 week, but did not reach the level of flow measured in normal controls. Conclusion: The decreased flow velocity in hypertensive patients may result from a peripheral vasospasm in the vessels of the eye and orbit. This decreased flow velocity may be important in eyes that already have ocular disease. Improvement in flow velocity was noted with oral trandolapril but it did not reach the levels seen in normal controls.

Pycnogenol® Improves Microcirculation, Retinal Edema, and Visual Acuity in Early Diabetic Retinopathy

PURPOSE The growing numbers of diabetes cases in the developed world are followed by increasing numbers of people diagnosed with diabetic complications. Diabetic microangiopathies in the eye lead to the development of retinopathy involving gradual loss of vision. Previous studies with Pycnogenol showed effectiveness for stopping progression of preproliferative stages of retinopathy. The aim of our study was to show protective effects of Pycnogenol in early stages of retinopathy, characterized by mild to moderate retinal edema in the absence of hemorrhages or hard exudates in the macula center. METHODS Following treatment with Pycnogenol (24 patients) for 3 months, retinal edema score (dilated ophthalmology) and retinal thickness (high resolution ultrasound) showed statistically significant improvement as compared to the placebo group (22 patients), which showed negligible changes to baseline. Laser Doppler flow velocity measurements at the central retinal artery showed a statistically significant increase from 34 to 44 cm/s in the Pycnogenol group as compared to marginal effects in the control group. RESULTS The major positive observation of this study is the visual improvement, which was subjectively perceived by 18 out of 24 patients in the Pycnogenol group. Testing of visual acuity using the Snellen chart showed a significant improvement from baseline 14/20 to 17/20 already, after 2 months treatment, whereas no change was found in the control group. CONCLUSIONS Pycnogenol taken at this early stage of retinopathy may enhance retinal blood circulation accompanied by regression of edema, which favorably improves vision of patients.

Management of superficial vein thrombosis and thrombophlebitis : Status and expert opinion document

Superficial vein thrombosis is characterized by clotting of superficial veins (ie, following direct trauma) with minimal inflammatory components. Superficial thrombophlebitis is a minimally thrombotic process of superficial veins associated with inflammatory changes and/or infection. Treatments generally include analgesics, elastic compression, anti-inflammatory agents, exercise and ambulation, and, in some cases, local or systemic anticoagulants. It is better to avoid bed rest and reduced mobility. Topical analgesia with nonsteroidal, anti-inflammatory creams applied locally to the superficial vein thrombosis/superficial thrombophlebitis area controls symptoms. Hirudoid cream (heparinoid) shortens the duration of signs/symptoms. Locally acting anticoagulants/antithrombotics (Viatromb®, Lipohep ®, spray Na-heparin) have positive effects on pain and on the reduction in thrombus size. Intravenous catheters should be changed every 24 to 48 hours (depending on venous flow and clinical parameters) to prevent superficial vein thrombosis/superficial thrombophlebitis and removed in case of events. Low molecular weight heparin prophylaxis and nitroglycerin patches distal to peripheral lines may reduce the incidence of superficial vein thrombosis/superficial thrombophlebitis in patients with vein catheters. In case of superficial vein thrombosis/superficial thrombophlebitis, vein lines should be removed. In neoplastic diseases and hematological disorders, anticoagulants may be necessary. Exercise reduces pain and the possibility of deep vein thrombosis. Only in cases in which pain is very severe is bed rest necessary. Deep vein thrombosis prophylaxis should be established in patients with reduced mobility. Antibiotics usually do not have a place in superficial vein thrombosis/superficial thrombophlebitis unless there are documented infections. Prevention of superficial vein thrombosis should be considered on the basis of patients history and clinical evaluation.

Pressure and microcirculatory effects of treatment with lercanidipine in hypertensive patients and in vascular patients with hypertension

The aim of this study was to evaluate the macrocirculatory and microcirculatory effects of treatment with lercanidipine, a new antihypertensive agent acting both on blood pressure and microcirculation in patients with moderate essential hypertension and without vascular disease and in patient with hypertension and vascular disease. In hypertensive subjects target-organ damage associated with high blood pressure may now be objectively documented by noninvasive tests. These alterations constitute a model to evaluate not only the pressure effects of antihypertensive treatment but also the normalization of the peripheral microcirculatory network. With color duplex scanning, flow velocity in the central retinal artery and retinal flow velocity can be measured and with use of laser-Doppler-flowmetry, it is also possible to evaluate microcirculation alterations in hypertensive subjects. These evaluation methods are completely noninvasive and may be used to assess the microcirculatory effects of antihypertensive drugs.

Doppler ultrasonography of the central retinal artery in normals treated with topical timolol

Using high-resolution Duplex scanning it is possible to evaluate the blood flow velocity in the central retinal artery of eyes of normal individuals. The flow velocity can be divided into its systolic and diastolic phases. Topical timolol maleate 0.5%, a non-selective beta-adrenergic receptor blocking agent, was then administered to one eye in each of the normals and the flow velocity was again recorded. The flow velocity improvement was significant, with a 43.58% increase in the systolic phase and a 61.53% increase in the diastolic phase. The diastolic component increased from 49.29% to 55.56%. The increased flow velocity may be due to a vasodilatory effect of timolol. The technique is briefly described and the significance of the results discussed.

Ocular and Retrobulbar Blood Flow in Ocular Hypertensives Treated with Topical Timolol, Betaxolol and Carteolol

The purpose of this study was to evaluate the effect of topical timolol 0.5%, betaxolol 0.5% and carteolol 2% on the blood flow velocity of the central retinal artery (CRA), the posterior ciliary artery (PCA) and the ophthalmic artery (OA) in patients with ocular hypertension. A group of 14 patients with ocular hypertension and a group of 11 normals were studied. The color Doppler was used to measure the peak systolic flow velocity (PSFV) and the end diastolic flow velocity (EDFV) of the CRA, the PCA and the OA in the normals and in the patients. The normals were under no treatment, while the patients were studied before and after treatment with topical timolol 0.5%, betaxolol 0.5% and carteolol 2%. In the systolic phase, there was a significant increase in the flow velocity of the CRA with all three drugs. In the diastolic phase of the CRA, the increase was significant for timolol 0.5% and carteolol 2% but not for betaxolol 0.5%. The flow velocity of the PCA and OA remained unchanged. In this study of 14 patients with ocular hypertension, topical timolol 0.5%, betaxolol 0.5% and carteolol 2% led to a significant increase in the flow velocity of the CRA without creating a steal or decrease in the flow velocity of the PCA.

Ocular and Orbital Blood Flow Velocity in Patients with Peripheral Vascular Disease and Diabetes Treated with Intravenous Prostaglandin E1

The purpose of this study was to evaluate the effect of intravenous prostaglandin E1 (PGE1) on the flow velocity of the ophthalmic artery and the central retinal artery in patients with peripheral vascular disease manifested by intermittent claudication. The flow velocity of these vessels is frequently decreased in vascular patients. Since these patients were already being treated with PGE1 for their intermittent claudication, the authors wanted to evaluate the effect on the flow velocity of the ocular vessels as well. A randomized 21-week study of two groups of vascular patients was performed. The first group had intermittent claudication. The second group had intermittent claudication and were also diabetics. Both groups were treated with intravenous PGE1 for their intermittent claudication. Using the color Doppler, the flow velocities of the ophthalmic artery and central retinal artery were measured before and after the intravenous treatment. Before treatment, the flow velocity of the ophthalmic artery and the central retinal artery was decreased when compared to that in the normals. After treatment, there was a significant increase in the systolic and diastolic phases of the flow velocity in both arteries. The systolic flow velocity increased by as much as 40%, and the diastolic flow velocity increased by as much as 80%. The flow velocities of the ophthalmic artery and the central retinal artery are frequently decreased in certain ocular diseases, and this decreased flow may contribute to the ocular pathology. If intravenous PGE1 is able to increase the flow velocity of these vessels in patients with peripheral vascular disease, it is possible that it is also able to increase the flow velocity of these vessels in patients with ocular disease as well. Intravenous PGE1 may prove to be a useful adjunct therapy in eyes when ischemia is part of the pathology.

Doppler ultrasonography of the central retinal artery in patients with diabetes and vascular disease treated with topical timolol

Using high-resolution duplex scanning it is possible to evaluate the blood flow velocity in the central retinal artery of the eye. Four different patient groups were studied with this technique: normals, diabetics with a decreased flow, diabetics with an increased flow and vascular patients with a decreased flow. The eyes of these patients were then treated with topical timolol and the flow measured again. An increase in the flow was found in three of the four groups. This increased flow velocity may be due to a vasodilatory effect of timolol. The results are presented and discussed.

Retina in rheumatic diseases: standard full field and multifocal electroretinography in hydroxychloroquine retinal dysfunction.

Background:  The purpose of this study was to evaluate and compare full‐field electroretinography (ERG) and multifocal electroretinography (mfERG) results in detecting retinal dysfunction in a large number of asymptomatic patients treated with hydroxychloroquine (Hy).