The effect of preset intraoperative intraocular pressure during phacoemulsification on the blood flow velocity in the central retinal artery

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Abstract

Aim. To evaluate the effect of preset elevated intraocular pressure (IOP) level during phacoemulsification on central retina artery and central retinal vein hemodynamics and to determine possible compensatory mechanisms of the ocular blood flow autoregulation in response to intraoperational IOP jump.

Methods. This prospective study included 23 cataract patients without concomitant ocular vascular conditions (15 women and 8 men) aged from 62 to 83 years. The mean age was 72.5 ± 5.7 years. In all patients, an intraoperational color duplex scanning in the regimens of color Doppler imaging and pulsed wave velocity imaging using ultrasound scanner Logiq S8 (GE). The blood flow was estimated in retrobulbar vessels: central retinal artery, central retinal vein with maximal systolic velocity, end-diastolic velocity of the blood flow, and resistance index (RI). The investigation was performed under IOP control, which was measured using Icare Pro tonometer, and under blood pressure control using patient monitoring system Draeger Vista 120. In the operating room, ocular blood flow was examined three times: immediately before surgery, straight after the surgical incision sealing at preset intraoperational IOP level, and after IOP normalization and repeated sealing of the corneal tunnel.

Results. Under preset intraoperational IOP maintenance on 58.01 ± 8.10 mm Hg level, there was a clinically significant (p < 0.05) decrease of blood flow velocity in the central retinal artery. In 30.4% of cases, the blood flow velocity in the central retinal artery during diastolic phase was not registered. The flow velocity in central retinal vein did not change significantly, and did not depend on IOP level (p < 0.05).

Conclusions. At the 55–60 mm Hg IOP level, in humans, compensatory blood flow autoregulation mechanisms in response to intraoperational IOP jumps are absent, up to complete blood flow stop in the central retinal artery at the diastolic phase, and this could be a risk factor for retinal ischemia.

About the authors

Yuri V. Takhtaev

Academician I.P. Pavlov First St Petersburg State Medical University of the Ministry of Healthcare of Russia

Email: ytakhtaev@gmail.com

MD, Prof. of the Ophthalmology department

Russian Federation, Saint Petersburg

Tatyana N. Kiseleva

Helmholtz National Medical Research Center of Eye Diseases

Email: tkiseleva05@gmail.com
ORCID iD: 0000-0002-9185-6407

MD, Head of Ultrasound Diagnostic Department

Russian Federation, Moscow

Roman B. Shliakman

I.P. Pavlov First St Petersburg State Medical University of the Ministry of Healthcare of Russia

Author for correspondence.
Email: romanshlyakman@gmail.com

Postgraduate Student, Ophthalmology department

Russian Federation, Saint Petersburg

References

  1. Labiris G, Gkika M, Katsanos A, et al. Anterior chamber volume measurements with Visante optical coherence tomography and Pentacam: repeatability and level of agreement. Clin Exp Ophthalmol. 2009;37(8):772-774. https://doi.org/10.1111/j.1442-9071.2009.02132.x.
  2. Khng C, Packer M, Fine H, et al. Intraocular pressure during phacoemulsification. JCRS. 2006;32(Issue 2):301-308. https://doi.org/10.1016/j.jcrs.2005.08.062.
  3. Нестеров А.П. Глаукома. – М.: МИА, 2008. – 360 с. [Nesterov AP. Glaukoma. Moscow: Meditsinskoye informatsionnoye agenstvo, 2008. 360 р. (In Russ.)]
  4. Leveny R. Low tension glaucoma: critical review and new material. Surv Ophthalmol. 1980;24(6):621-664. https://doi.org/10.1016/0039-6257(80)90123-x.
  5. Linnér E. Ocular hypertension. I. The clinical course during ten years without therapy. Aqueous humour dynamics. Acta Ophthalmol (Copenh). 1976;54(6):707-720. https://doi.org/10.1111/j.1755-3768.1976.tb01790.x.
  6. Федоров С.Н. Патогенез первичной открытоугольной глаукомы // Вопросы патогенеза и лечения глаукомы: сб. науч. тр. М.: Моск. НИИ микрохирургии глаза, 1981. – С. 3–7. [Fedorov SN. Patogenez pervichnoi otkrytougol’noi glaukomy. In: (Collection of scientific articles) Voprosy patogeneza i lecheniya glaukomy. Moscow: Mosk. NII mikrokhirurgii glaza; 1981. P. 3-7. (In Russ.)]
  7. Фламмер Дж. Глаукома. – Минск: ПРИНТКОРП, 2003. – 416 с. [Flammer G. Glaucoma. Minsk: PRINTKORP; 2003. 416 р. (In Russ.)]
  8. Harris A. Vascular Considerations in Glaucoma. Kugler Publications; 2012. 123 p.
  9. Астахов Ю.С., Джалиашвили О.А. Современные направления в изучении гемодинамики глаза при глаукоме // Офтальмологический журнал. – 1990. – № 3. – С. 179–183. [Astakhov YuS, Dzhaliashvili OA. Sovremennye napravleniya v izuchenii gemodinamiki glaza pri glaukome. Oftal’mologicheskiy zhurnal. 1990;(3):179-183. (In Russ.)]
  10. Астахов Ю.С., Лисочкина А.Б., Тарасова О.В. Исследование внутриглазного и системного кровообращения у больных первичной открытоугольной глаукомой // Глаукома (диагностика, клиника и лечение): сб. науч. тр. – Л., 1988. – С. 52–58. [Astakhov YuS, Lisochkina AB, Tarasova OV. Issledovaniye vnutriglaznogo i sistemnogo krovoobrashcheniya u bol’nykh pervichnoy otkrytougol’noy glaukomoy. In: (Collection of scientific articles) Glaukoma (diagnostika, klinika i lecheniye). Leningrad; 1988. P. 52-58. (In Russ.)]
  11. Hirrlinger PG, Ulbricht E, Iandiev I, et al. Alterations in protein expression and membrane properties during Müller cell gliosis in a murine model of transient retinal ischemia. Neurosci Lett. 2010;472(1):73-78. https://doi.org/10.1016/j.neulet.2010.01.062.
  12. Joachim SC, Wax MB, Boehm N, et al. Up-regulation of antibody response to heat shock proteins and tissue antigens in an ocular ischemia model. Invest Ophthalmol Vis Sci. 2011;52(6):3468-3474. https://doi.org/10.1167/iovs.10-5763.
  13. Peachey NS, Green DJ, Ripps H. Ocular ischemia and the effects of allopurinol on functional recovery in the retina of the arterially perfused cat eye. Invest Ophthalmol Vis Sci. 1993;34(1):58-65.
  14. Киселева Т.Н., Чудин А.В. Экспериментальное моделирование ишемического поражения глаза // Вестник РАМН. – 2014. – Т. 69. – № 11–12. – С. 97–103. [Kiseleva TN, Chudin AV. Experimental model of ocular ishemic diseases. Annals of the Russian Academy of Medical Sciences. 2014;69(11-12):97-103. (In Russ.)]. https://doi.org/10.15690/vramn.v69i11–12.1190.
  15. Киселева Т.Н., Чудин А.В, Хорошилова-Маслова И.П., и др. Морфологические изменения в тканях сетчатки при регионарной ишемии-реперфузии в эксперименте in vivo // Бюллетень экспериментальной биологии и медицины. – 2019. – Т. 167. – № 2. – С. 250–256. [Kiseleva TN, Chudin AV, Khoroshilova-Maslova IP, et al. Morphological changes in retinal tissues in regional ischemia-reperfusion in an in vivo experiment. Byulleten’ eksperimental’noy biologii i meditsiny. 2019;167(2):250-256. (In Russ.)]
  16. Chidlow G, Schmidt KG, Wood JP, et al. Alpha-lipoic acid protects the retina against ischemia-reperfusion. Neuropharmacology. 2002;43(6): 1015-1025. https://doi.org/10.1016/s0028-3908(02)00129-6.
  17. Bui BV, Edmunds B, Cioffi GA, Fortune B. The gradient of retinal functional changes during acute intraocular pressure elevation. Invest Ophthalmol Vis Sci. 2005;46(1):202-213. https://doi.org/10.1167/iovs.04-0421.
  18. Li M, Yuan N, Chen X, et al. Impact of acute intraocular pressure elevation on the visual acuity of non-human primates. EBioMedicine. 2019;44:554-562. https://doi.org/10.1016/j.ebiom.2019.05.059.
  19. Azuara-Blanco A, Harris A, Cantor LB, et al. Effects of short term increase of intraocular pressure on optic disc cupping. Br J Ophthalmol. 1998;82(8):880-883. https://doi.org/10.1136/bjo.82.8.880.
  20. Астахов Ю.С., Иркаев С.М., Ржанов Б.И. Гамма-резонансная велосиметрия глаза // Вестник офтальмологии. – 1989. – Т. 105. – № 5. – С. 59–62. [Astakhov YuS, Irkayev SM, Rzhanov BI. Gamma-rezonansnaya velosimetriya glaza. Annals of ophthalmology. 1989;105(5):59-62. (In Russ.)]
  21. Руховец А.Г., Астахов Ю.С. Методы исследования гемодинамики глаза, основанные на регистрации пульсовых колебаний объема глазного яблока // Регионарное кровообращение и микроциркуляция. – 2016. – Т. 15. – № 4. – С. 30–38. [Rukhovets AG, Astakhov YS. Methods of pulsatile ocular hemodynamics assessment. Regional blood circulation and microcirculation. 2016;15(4):30-38. (In Russ.)]. https://doi.org/10.24884/1682-6655-2016-15-4-30-38.
  22. Kurysheva NI, Parshunina OA, Shatalova EO, et al. Value of structural and hemodynamic parameters for the early detection of primary open-angle glaucoma. Curr Eye Res. 2017;42(3):411-417. https://doi.org/10.1080/02713683.2016.1184281.
  23. Ультразвуковые исследования в офтальмологии: руководство для врачей / Под ред. В.В. Нероева, Т.Н. Киселевой. – М.: Икар, 2019. – 324 с. [Ul’trazvukovye issledovaniya v oftal’mologii: rukovodstvo dlya vrachey. Ed. by V.V. Neroyev, T.N. Kiseleva. Moscow: Ikar; 2019. 324 р. (In Russ.)]
  24. Joos KM, Kay MD, Pillunat LE, et al. Effect of acute intraocular pressure changes on short posterior ciliary artery haemodynamics. Br J Ophthalmol. 1999;83(1):33-38. https://doi.org/10.1136/bjo.83.1.33.
  25. Trost A, Motloch K, Bruckner D, et al. Time-dependent retinal ganglion cell loss, microglial activation and blood-retina-barrier tightness in an acute model of ocular hypertension. Exp Eye Res. 2015;136:59-71. https://doi.org/10.1016/j.exer.2015.05.010.
  26. Vasavada V, Raj S, Praveen M, et al. Real-time dynamic intraocular pressure fluctuations during microcoaxial phacoemulsification using different aspiration flow rates and their impact on early postoperative outcomes: a randomized clinical trial. J Refract Surg. 2014;30(8): 534-540. https://doi.org/10.3928/1081597X-20140711-06.
  27. Jarstad JS, Jarstad AR, Chung GW, et al. Immediate postoperative intraocular pressure adjustment reduces risk of cystoid macular edema after uncomplicated micro incision coaxial phacoemulsification cataract surgery. Korean J Ophthalmol. 2017;31(1):39-43. https://doi.org/10.3341/kjo.2017.31.1.39.

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2. Fig. 1. The Doppler spectral analysis of blood flow velocities in the central retinal artery: a – before cataract surgery (Vsyst = 12.3 cm/s, Vdiast = 4.1 cm/s); b – immediately following cataract surgery (Vsyst = 9.4 cm/s, Vdiast = 3.3 cm/s)

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3. Fig. 2. The Doppler spectral analysis of blood flow velocities in the central retinal artery after normalization of intraocular pressure (Vsyst = 12.7 cm/s, Vdiast = 3.5 cm/s)

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4. Fig. 3. Peak systolic velocity and end-diastolic velocity of blood flow in the central retinal artery with varying levels of intraocular pressure

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5. Fig. 4. The effect of intraocular pressure on the peak systolic velocity of blood flow in the central retinal artery

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6. Fig. 5. The effect of intraocular pressure on the end systolic blood flow in the central retinal artery

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Copyright (c) 2020 Takhtaev Y.V., Kiseleva T.N., Shliakman R.B.

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