Analysis of Fluorescein Angiography and Optical Coherence Tomography in Acute Cerebral Infarction Patients

Yeob Han Jung; Cheol Kim Yu

doi:10.3341/jkos.2017.58.8.930

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Jung and Yu: Analysis of Fluorescein Angiography and Optical Coherence Tomography in Acute Cerebral Infarction Patients

Original Article

J Korean Ophthalmol Soc 2017;58(8):930-936.

Published online: 8 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.8.930

Analysis of Fluorescein Angiography and Optical Coherence Tomography in Acute Cerebral Infarction Patients

Yeob Han Jung, M.D., Cheol Kim Yu, M.D., PhD

Department of Ophthalmology, Keimyung University School of Medicine, Daegu, Korea

Address reprint requests to Yu Cheol Kim, MD, PhD Department of Ophthalmology, Keimyung University Dongsan Medical Center, #56 Dalseong-ro, Jung-gu, Daegu 41931, Korea Tel: 82-53-250-8026, Fax: 82-53-250-7705 E-mail: eyedr@dsmc.or.kr

* This study was presented as a poster at the 116th Annual Meeting of the Korean Ophthalmological Society 2016.

* Conflicts of Interest: The authors have no conflicts to disclose.

Received 25 May 20171 July 2017 Accepted 28 July 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate ocular findings of patients with acute cerebral infarction by analyzing fluorescein angiography (FAG) and optical coherence tomography (OCT).

Methods

We retrospectively reviewed the medical records of patients with acute cerebral infarction. FAG was used to analyze arm to retina time and arteriovenous (AV) transit time. The peripapillary retinal nerve fiber layer (pRNFL) was analyzed using OCT, and the data were compared with those of patients diagnosed with idiopathic epiretinal membrane (control group).

Results

Seventy-three patients were included in the patient group, and 56 participants were in the control group. In 27% of the subjects in the patient group, retinal abnormality was incidentally identified. Atrial fibrillation (p < 0.050) was the only systemic disease with a significantly higher incidence in the patient group. AV transit time (p < 0.050) showed a significant delay in the patient group, but there was no significant difference in the arm to retina time. pRNFL thickness did not significantly differ between the ipsilateral and contralateral locations of brain lesion. In addition, there was no significant difference in the subgroup analysis according to cerebral ischemic territory and no correlation between the severity of symptoms and the findings of ophthalmologic examination.

Conclusions

Patients with acute cerebral infarction show delayed AV transit time in FAG, and about 27% of them have unrecognized retinal abnormalities.

Keywords: Cerebral infarction, Fluorescein angiography, Optical coherence tomography, Retina

References

1. Pei YF, Rhodin JA. The prenatal development of the mouse eye. Anat Rec. 1970; 168:105–25.

2. Douglas DJ, Schuler JJ, Buchbinder D. . The association of central retinal artery occlusion and extracranial carotid artery disease. Ann Surg. 1988; 208:85–90.

3. Park SJ, Choi NK, Seo KH. . Nationwide incidence of clin-ically diagnosed central retinal artery occlusion in Korea, 2008 to 2011. Ophthalmology. 2014; 121:1933–8.

4. Benavente O, Eliasziw M, Streifler JY. . Prognosis after tran-sient monocular blindness associated with carotid-artery stenosis. N Engl J Med. 2001; 345:1084–90.

5. Greven CM, Slusher MM, Weaver RG. Retinal arterial occlusions in young adults. Am J Ophthalmol. 1995; 120:776–83.

6. Arnold M, Koerner U, Remonda L. . Comparison of in-tra-arterial thrombolysis with conventional treatment in patients with acute central retinal artery occlusion. J Neurol Neurosurg Psychiatry. 2005; 76:196–9.

7. Inatomi Y, Hino H, Hashimoto Y. . Transesophageal echo-cardiography for detection of cardiac diseases in patients with reti-nal artery occlusion. Intern Med. 2001; 40:475–8.

8. Furie KL, Kasner SE, Adams RJ. . Guidelines for the pre-vention of stroke in patients with stroke or transient ischemic at-tack: a guideline for healthcare professionals from the american heart association/american stroke association. Stroke. 2011; 42:227–76.

9. Broderick JP, Adeoye O, Elm J. Evolution of the modified rankin scale and its use in future stroke trials. Stroke. 2017; 48:2007–12.

10. Wong TY, Klein R, Sharrett AR. . Cerebral white matter lesions, retinopathy, and incident clinical stroke. JAMA. 2002; 288:67–74.

11. Lindley RI, Wang JJ, Wong MC. . Retinal microvasculature in acute lacunar stroke: a cross-sectional study. Lancet Neurol. 2009; 8:628–34.

12. De Silva DA, Liew G, Wong MC. . Retinal vascular caliber and extracranial carotid disease in patients with acute ischemic stroke: the Multi-Centre Retinal Stroke (MCRS) study. Stroke. 2009; 40:3695–9.

13. Yatsuya H, Folsom AR, Wong TY. . Retinal microvascular ab-normalities and risk of lacunar stroke: Atherosclerosis Risk in Communities Study. Stroke. 2010; 41:1349–55.

14. Rim TH, Kim DW, Han JS, Chung EJ. Retinal vein occlusion and the risk of stroke development: a 9-year nationwide population- based study. Ophthalmology. 2015; 122:1187–94.

15. Rim TH, Han J, Choi YS. . Retinal artery occlusion and the risk of stroke development: Twelve-Year Nationwide Cohort Study. Stroke. 2016; 47:376–82.

16. Chang YS, Jan RL, Weng SF. . Retinal artery occlusion and the 3-year risk of stroke in Taiwan: a nationwide population-based study. Am J Ophthalmol. 2012; 154:645–52.e1.

17. Fiebach JB, Schellinger PD, Jansen O. . CT and diffusion- weighted MR imaging in randomized order. Stroke. 2002; 33:2206–10.

18. Lutsep HL, Albers GW, DeCrespigny A. . Clinical utility of diffusion-weighted magnetic resonance imaging in the assessment of ischemic stroke. Ann Neurol. 1997; 41:574–80.

19. Hayreh SS, Podhajsky PA, Zimmerman MB. Retinal artery occlusion: associated systemic and ophthalmic abnormalities. Ophthalmology. 2009; 116:1928–36.

20. Gunes A, Inal EE, Demirci S. . Changes in retinal nerve fiber layer thickness in patients with cerebral infarction: evidence of transneuronal retrograde degeneration. Acta Neurol Belg. 2016; 116:461–6.

21. Park HY, Park YG, Cho AH, Park CK. Transneuronal retrograde degeneration of the retinal ganglion cells in patients with cerebral infarction. Ophthalmology. 2013; 120:1292–9.

22. Yoon KC, Mun GH, Kim SD. . Prevalence of eye diseases in South Korea: data from the Korea National Health and Nutrition Examination Survey 2008-2009. Korean J Ophthalmol. 2011; 25:421–33.

23. Yang JY, Kim NK, Lee YJ. . Prevalence and factors associated with diabetic retinopathy in a Korean adult population: the 2008-2009 Korea National Health and Nutrition Examination Survey. Diabetes Res Clin Pract. 2013; 102:218–24.

24. Shin YU, Cho H, Kim JM. . Prevalence and associated factors of retinal vein occlusion in the Korean National Health and Nutritional Examination Survey, 2008-2012: A cross-sectional ob-servational study. Medicine (Baltimore). 2016; 95:e5185.

Table 1.

Demographics and clinical characteristics of the study subjects

	Total (n = 109)	Patient group (n = 53)	Control group (n = 56)	p-value^†	p-value^‡
Sex (male:female)	49:60	29:24	20:36	<0.050^*
Age (years)	64.57 ± 10.88	65.92 ± 12.07	63.29 ± 9.56	0.207^§	0.180
HTN	50 (46)	28 (53)	22 (39)	0.156	0.123
DM	15 (14)	9 (17)	6 (11)	0.342	0.301
AF	12 (11)	10 (19)	2 (4)	<0.050^*	<0.050^*
HL	9 (8)	5 (9)	4 (7)	0.664	0.564
CRF	1 (1)	1 (2)	0 (0)	0.302	0.407
IHD	8 (7)	6 (11)	2 (4)	0.121	0.099

Values are presented as mean ± SD or n (%) unless otherwise indicated. HTN = hypertension; DM = diabetes mellitus; AF = atrial fibrillation; HL = hyperlipidemia; CRF = chronic renal failure; IHD = ischemic heart disease.

^* Statistically significant.

^† Analyzed with Pearson chi-square test.

^‡ Analyzed with analysis of covariance (ANCOVA) test.

^§ Analyzed with Independent t-test.

Table 2.

Fluorescein angiographic characteristics of the study subjects

	Total (n = 109)	Patient group (n = 53)	Control group (n = 56)	p-value^†	p-value^‡
Arm to retina time	17.98 ± 3.75	18.63 ± 4.49	17.36 ± 2.79	0.082	0.305
AV transit time	9.45 ± 2.21	10.06 ± 2.34	8.87 ± 1.92	<0.010^*	<0.050^*

Values are presented as mean ± SD unless otherwise indicated. AV = arteriovenous.

^* Statistically significant.

^† Analyzed with independent t-test.

^‡ Analyzed with analysis of covariance (ANCOVA) test.

Table 3.

Comparison of retinal nerve fiber layer thickness between ipsilateral and contralateral eye

pRNFL thickness(μ m)	Total (n = 104)	Ipsilateral eye (n = 52)	Contralateral eye (n = 52)	p-value^*
Average	100.75 ± 11.55	100.63 ± 11.90	100.87 ± 11.31	0.919
Superior	127.80 ± 17.38	128.15 ± 18.04	127.44 ± 16.87	0.836
Temporal	74.80 ± 12.80	75.25 ± 13.75	74.35 ± 11.89	0.721
Inferior	125.90 ± 19.16	126.02 ± 19.70	125.79 ± 18.90	0.951
Nasal	77.04 ± 14.79	76.29 ± 15.46	77.79 ± 14.20	0.607

Values are presented as mean ± SD unless otherwise indicated pRNFL = peripapillary retinal nerve fiber layer.

^* Analyzed with independent t-test.

Table 4.

Comparison between normal group and delayed group in fluorescein angiography

	Normal group (n = 34)	Delayed group (n = 19)	p-value^†	p-value^‡
Sex (male:female)	15:19	14:5	<0.050^*
Age (years)	65.76 ± 10.80	66.21 ± 14.40	0.636^§	0.645
Arm to retina time	16.04 ± 2.30	23.26 ± 3.63	<0.001^*^§	<0.001^*
AV transit time	9.50 ± 2.12	11.08 ± 2.44	<0.050^*^§	<0.050^*
HTN	18 (53)	10 (53)	0.983	0.850
DM	7 (21)	2 (11)	0.349	0.236
AF	1 (3)	9 (47)	<0.001^*	<0.001^*
HL	5 (15)	0 (0)	0.079	0.061
CRF	0 (0)	1 (5)	0.177	0.265
IHD	2 (6)	4 (21)	0.095	0.074

Values are presented as mean ± SD or n (%) unless otherwise indicated. AV = arteriovenous; HTN = hypertension; DM = diabetes mellitus; AF = atrial fibrillation; HL = hyperlipidemia; CRF = chronic renal failure; IHD = ischemic heart disease.

^* Statistically significant.

^† Analyzed with Pearson chi-square test.

^‡ Analyzed with analysis of covariance (ANCOVA) test.

^§ Analyzed with Mann-Whitney test.

Table 5.

Subgroup analysis according to cerebral infarction territory

	ACA territory (n = 4)	MCA territory (n = 30)	PCA territory (n = 10)	p-value^*
Fluorescein angiographic biometry
Arm to retina time	14.93 ± 3.44	18.90 ± 3.93	17.11 ± 3.03	0.120
AV transit time	10.93 ± 1.71	9.55 ± 2.49	10.88 ± 2.25	0.132
pRNFL thickness
Average (μ m)	102.33 ± 11.93	99.20 ± 12.67	102.60 ± 6.88	0.886
Superior (μ m)	134.00 ± 17.52	123.53 ± 19.45	136.00 ± 12.35	0.091
Temporal (μ m)	83.67 ± 23.03	74.10 ± 13.89	72.40 ± 8.68	0.609
Inferior (μ m)	121.00 ± 15.52	124.83 ± 18.59	124.90 ± 13.37	0.849
Nasal (μ m)	73.00 ± 15.00	75.83 ± 16.15	79.20 ± 14.12	0.734

Values are presented as mean ± SD unless otherwise indicated. ACA = anterior cerebral artery; MCA = middle cerebral artery; PCA = posterior cerebral artery; AV = arterivenous; pRNFL = peripapil-lary retinal nerve fiber layer.

^* Analyzed with Kruskal-Wallis test.

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