Artikel
Can you see it? Retinal vessel analysis (RVA) for cerebral vasospasm – A prospective pilot study
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Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: Timely detection of impending delayed cerebral ischemia after subarachnoid hemorrhage (SAH) is essential to improve outcome, but poses a diagnostic challenge. Retinal vessels as an embryological part of the intracranial vasculatur are easily accessible for analysis and may hold the key to a new and non-invasive monitoring technique. This investigation aims to determine the feasibility of standardized retinal vessel analysis (RVA) in the context of SAH.
Method: In a prospective pilot study, we performed RVA in six patients with SAH in the acute phase and eight patients at the time of follow-up, and included 33 age-matched healthy controls. Data was acquired using a manoeuvrable Dynamic Vessel Analyzer (Imedos Systems UG, Jena) for examination of retinal vessel dimension and autoregulation.
Results: Image quality was satisfactory in the majority of cases (93.3%). In the acute phase after SAH, retinal arteries were significantly dilated when compared to the control group (124.2±4.3MU vs 110.9±11.4MU, p<0.01), a difference that persisted to a lesser extent in the later stage of the disease (122.7±17.2MU, p<0.05). Autoregulatory capacity showed a trend towards impaired primary vasodilation and secondary vasoconstriction (p=0.08, p=0.09 resp.) initially and partial recovery at the time of follow-up, indicating a relative improvement in a time-dependent fashion.
Conclusions: RVA is technically feasible in patients with SAH and can detect fluctuations in vessel diameter and autoregulation. Preliminary data suggests potential for RVA as a new and non-invasive tool for advanced SAH monitoring, but clinical relevance and prognostic value will have to be determined in a larger cohort.