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Mjerenje brzine krvnog protoka u oku i orbiti pomoću obojenog dopplera u dijabetičkoj retinopatiji : magistarski rad
Gračner, Tomaž
Background Diabetic retinopathy (DR) is the most common ocular complication of diabetes mellitus. In the developed world it still represent the main cause of blindness at an age between 20 and 74 ...years. Changes in circulation and consequently hemodynamic changes in the eye and orbit, which can be evaluated by color Doppler imaging (CDI), play the central role in pathogenesis of DR. CDI is a non-invasive ultrasonic method which combines conventional B-mode image of tissue structure, color-coded blood flow information and measurements of blood flow velocity. The aim of this investigation was to establish whether CDI can serve to determine changes of blood flow velocity in the ophthalmic artery (OA), central retinal artery (CRA) and posterior ciliary artery (PCA) in DR and to compare the results with those in healthy control subjects. We also investigated whether the changes of blood flow velocity in the OA, CRA and PCA are significant with consideration to the different stages of DR progression. Patients and methods In this investigation we included 44 eyes of 44 diabetic patients with different stages of DR forming the "DR" group and 22 eyes of 22 healthy age- and sex-matched subjects forming the control "ZD" group. With CDI we measured the peak systolic velocity (PSV, cm/s) and end diastolic velocity (EDV, cm/s) of blood flow in the OA, CRA and PCA. The resistence index (RI) of each vessel was then calculated. Statistical analysis comparing the results of group '"DR" with group "ZD" was carried out. To find out whether the changes of blood flow velocity in the OA, CRA and PCA are significant considering the different stages of DR progression, we divided group "DR" in group "NPDR" (11 eyes with mild and 11 eyes with moderate nonproliferative DR) and group "PPDR/PDR" (19 eyes with proliferative and 3 eyes with proliferative DR). Statistical analysis comparing the results of groups "NPDR", "PPDR/PDR" and "ZD" was carried out. Statistical significance was set at p<0.05. Results There was a statistically significant increase in PSV in the OA in group "DR" compared with group "ZD" [35.23 cm/s (SD 5.75) v 31.45 cm/s (SD 4.32)]. Considering the different stage of progression of DR there was a statistically singificant increase in PSV in the OA in group "PPDR/PDR" compared with group "ZD" [35.71 cm/s (SD 6.90) v 31.45 cm/s (SD 4.32)]. There was a stastically significant decrease in both PSV [7.92 cm/s (SD 1.78) v 10.61 cm/s (SD 1.75)] and EDV [2.29 cm/s (SD 0.66) v 3.00 cm/s (SD 0.81)] in the CRA in group "DR" compared with group "ZD". Considering the different stage of DR progression, there was a statistically significant decrease in PSV in the CRA in the group "NPDR" compared with group "ZD" [8.50 cm/s (SD 1.62) v 10.61 cm/s (SD 1.75)] and in group "PPDR/PDR" compared with group "ZD" [7.34 cm/s (SD 1.78) v 10.61 cm/s (SD 1.75)], also there was a statistically significant decrease in EDV in group "PPDR/PDR" compared with group "ZD" [2.05 cm/s (SD 0.53) v 3.00 cm/s (SD 0.81)]. A statistically significant decrease in EDV in the PCA in group "DR" compared with group "ZD" [3.24 cm/s (SD 1.06) v 3.95 cm/s (SD 0.98)] was found. Considering the different stage of DR progression, a statistically significant decrease in EDV in the PCA in the group "PPDR/PDR" compared with group "ZD" [2.95 cm/s (SD 1.04) v 3.95 cm/s (SD 0.98)] was found, also there was a statistically significant increase in RI group "PPDR/PDR" compared with group "NPDR" [0.72 (SD 0.05) v 0.67 (SD 0.07)] and in group "PPDR/PDR" compared with group "ZD" [0.72 (SD 0.05) v 0.67 (SD 0.05)]. Conclusions In this investigation, CDI was used to determine significant changes of blood flow velocity in the OA, CRA and PCA in DR compared with healthy control subjects and the changes of blood flow velocity become further significant considering the progression of DR. The points to the presence of circulatory changes in the OA, CRA and PCA in diabetic patients with DR. We believe the CDI can be a useful additional method to monitor the progression of DR and could therefore help in deciding on the right time to begin or continue DR therapy.
Type of material - master's thesis
; adult, serious
Publication and manufacture - Zagreb : [T. Gračner], 2003
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