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Assesment of Conjunctival Microangiopathy in a Patient with Diabetes Mellitus Using the Retinal Function Imager.

Stuebiger N, Smiddy W, Wang J, Jiang H, DeBuc DC - J Clin Exp Ophthalmol (2015)

Bottom Line: Diabetes mellitus (DM) is notorious for causing retinal microangiopathy, but bulbar conjunctival microangiopathy (CM) mirroring the established retinal vessel changes, has also been observed.Recent studies suggest that CM occurs in all DM patients in various degrees depending on disease severity and occur even before non-proliferative retinopathy develops.Thus, CM might provide a means of early detection or even form a basis for early intervention of disease progression in DM patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, Florida, 33136, USA ; Charite, Universitaetsmedizin Berlin, Campus Benjamin Franklin, University Eye Hospital, Hindenburgdamm 30, 12200 Berlin, Germany.

ABSTRACT

Diabetes mellitus (DM) is notorious for causing retinal microangiopathy, but bulbar conjunctival microangiopathy (CM) mirroring the established retinal vessel changes, has also been observed. Recent studies suggest that CM occurs in all DM patients in various degrees depending on disease severity and occur even before non-proliferative retinopathy develops. Thus, CM might provide a means of early detection or even form a basis for early intervention of disease progression in DM patients. Herein we present - to our knowledge for the first time-the feasibility and applicability in diagnostic imaging of CM in a diabetic patient using a commercially available Retinal Function Imager (RFI, Optical Imaging Ltd, Rehovot, Israel).

No MeSH data available.


Related in: MedlinePlus

Figure 1A: Bulbar conjunctiva of the left eye imaged in a 50 degrees red-free mode with the RFI. Temporal conjunctiva of the patients left eye with microangiopathy of the conjunctival vessels (red dashed-square): microaneurysms (orange arrow is indicating one of them), vessel dilatation (blue arrows), and vascular tortuosity (yellow arrow).Figure 1B: Bulbar conjunctival capillary perfusion map (nCPM). Note the microvasculature visualization enhancement showing the microvasculature anatomy in detail, otherwise invisible even in the sharpest red-free image (Figure 1A). The microvasculature anatomy appeared unevenly distributed.Figure 1C: Analysis of the BF velocity of the conjunctiva. The positive values with the purple lines are representing the veins, the negative values with the red lines are representing the arteries, the numbers are the BF velocity in mm/s. Values in the area with the red-dashed square are representing the BF data of the area with the vascular abnormalities. The symbol on the cornea (white arrow) marks the direction of the arterial BF.Figure 1D: Analysis of the BF velocity of the central retina imaged in a 20 degrees red-free mode. Note that the positive values with the purple lines are representing the veins, the negative values with the red lines, which indicate BF moving away from the heart, are showing the arteries. The numbers closed to vessel segments outlined are the mean BF velocity in mm/s. The avascular zone was evident in the fovea. The symbol in the fovea (white arrow) is indicating the direction of the arterial BF. Note that no clinical signs of DR are present.Figure 1E: Bulbar conjunctiva of a human healthy’s left eye imaged in a 50 degrees red-free mode with the Retinal Function Imager.Figure 1F: Bulbar conjunctival capillary perfusion map (nCPM) of the same human healthy eye (Figure 1E). Note the microvasculature visualization enhancement showing the microvasculature anatomy in detail, otherwise invisible even in the sharpest red-free images (Figure 1E). The microvasculature anatomy appeared evenly distributed and lower number of blood vessels along with lower degree of complexity of their branching patterns increased density and complexity is evident when compared with the diabetic eye (Figure 1B).
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Figure 1: Figure 1A: Bulbar conjunctiva of the left eye imaged in a 50 degrees red-free mode with the RFI. Temporal conjunctiva of the patients left eye with microangiopathy of the conjunctival vessels (red dashed-square): microaneurysms (orange arrow is indicating one of them), vessel dilatation (blue arrows), and vascular tortuosity (yellow arrow).Figure 1B: Bulbar conjunctival capillary perfusion map (nCPM). Note the microvasculature visualization enhancement showing the microvasculature anatomy in detail, otherwise invisible even in the sharpest red-free image (Figure 1A). The microvasculature anatomy appeared unevenly distributed.Figure 1C: Analysis of the BF velocity of the conjunctiva. The positive values with the purple lines are representing the veins, the negative values with the red lines are representing the arteries, the numbers are the BF velocity in mm/s. Values in the area with the red-dashed square are representing the BF data of the area with the vascular abnormalities. The symbol on the cornea (white arrow) marks the direction of the arterial BF.Figure 1D: Analysis of the BF velocity of the central retina imaged in a 20 degrees red-free mode. Note that the positive values with the purple lines are representing the veins, the negative values with the red lines, which indicate BF moving away from the heart, are showing the arteries. The numbers closed to vessel segments outlined are the mean BF velocity in mm/s. The avascular zone was evident in the fovea. The symbol in the fovea (white arrow) is indicating the direction of the arterial BF. Note that no clinical signs of DR are present.Figure 1E: Bulbar conjunctiva of a human healthy’s left eye imaged in a 50 degrees red-free mode with the Retinal Function Imager.Figure 1F: Bulbar conjunctival capillary perfusion map (nCPM) of the same human healthy eye (Figure 1E). Note the microvasculature visualization enhancement showing the microvasculature anatomy in detail, otherwise invisible even in the sharpest red-free images (Figure 1E). The microvasculature anatomy appeared evenly distributed and lower number of blood vessels along with lower degree of complexity of their branching patterns increased density and complexity is evident when compared with the diabetic eye (Figure 1B).

Mentions: The conjunctival and retinal vasculature was imaged in a 38 years-old black female DM patient without DR with a commercially available RFI device. This patient was a non-smoking female with a history of Type-2 DM (T2DM) since 2009. She was being treated with Metformin 2 × 500 mg per day. Hemoglobin A1C was 5.3% (34 mmol/mol) and glucose was 87 mg/dL. Diastolic blood pressure was slightly elevated (120/90 mmHg). Ocular history included a nasally located pterygium removal in both eyes in 2010 and occasional seasonal allergic eye disease. The eye examination disclosed CM in the temporal area of the DM patient’s left eye (Figure 1A).


Assesment of Conjunctival Microangiopathy in a Patient with Diabetes Mellitus Using the Retinal Function Imager.

Stuebiger N, Smiddy W, Wang J, Jiang H, DeBuc DC - J Clin Exp Ophthalmol (2015)

Figure 1A: Bulbar conjunctiva of the left eye imaged in a 50 degrees red-free mode with the RFI. Temporal conjunctiva of the patients left eye with microangiopathy of the conjunctival vessels (red dashed-square): microaneurysms (orange arrow is indicating one of them), vessel dilatation (blue arrows), and vascular tortuosity (yellow arrow).Figure 1B: Bulbar conjunctival capillary perfusion map (nCPM). Note the microvasculature visualization enhancement showing the microvasculature anatomy in detail, otherwise invisible even in the sharpest red-free image (Figure 1A). The microvasculature anatomy appeared unevenly distributed.Figure 1C: Analysis of the BF velocity of the conjunctiva. The positive values with the purple lines are representing the veins, the negative values with the red lines are representing the arteries, the numbers are the BF velocity in mm/s. Values in the area with the red-dashed square are representing the BF data of the area with the vascular abnormalities. The symbol on the cornea (white arrow) marks the direction of the arterial BF.Figure 1D: Analysis of the BF velocity of the central retina imaged in a 20 degrees red-free mode. Note that the positive values with the purple lines are representing the veins, the negative values with the red lines, which indicate BF moving away from the heart, are showing the arteries. The numbers closed to vessel segments outlined are the mean BF velocity in mm/s. The avascular zone was evident in the fovea. The symbol in the fovea (white arrow) is indicating the direction of the arterial BF. Note that no clinical signs of DR are present.Figure 1E: Bulbar conjunctiva of a human healthy’s left eye imaged in a 50 degrees red-free mode with the Retinal Function Imager.Figure 1F: Bulbar conjunctival capillary perfusion map (nCPM) of the same human healthy eye (Figure 1E). Note the microvasculature visualization enhancement showing the microvasculature anatomy in detail, otherwise invisible even in the sharpest red-free images (Figure 1E). The microvasculature anatomy appeared evenly distributed and lower number of blood vessels along with lower degree of complexity of their branching patterns increased density and complexity is evident when compared with the diabetic eye (Figure 1B).
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Related In: Results  -  Collection

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Figure 1: Figure 1A: Bulbar conjunctiva of the left eye imaged in a 50 degrees red-free mode with the RFI. Temporal conjunctiva of the patients left eye with microangiopathy of the conjunctival vessels (red dashed-square): microaneurysms (orange arrow is indicating one of them), vessel dilatation (blue arrows), and vascular tortuosity (yellow arrow).Figure 1B: Bulbar conjunctival capillary perfusion map (nCPM). Note the microvasculature visualization enhancement showing the microvasculature anatomy in detail, otherwise invisible even in the sharpest red-free image (Figure 1A). The microvasculature anatomy appeared unevenly distributed.Figure 1C: Analysis of the BF velocity of the conjunctiva. The positive values with the purple lines are representing the veins, the negative values with the red lines are representing the arteries, the numbers are the BF velocity in mm/s. Values in the area with the red-dashed square are representing the BF data of the area with the vascular abnormalities. The symbol on the cornea (white arrow) marks the direction of the arterial BF.Figure 1D: Analysis of the BF velocity of the central retina imaged in a 20 degrees red-free mode. Note that the positive values with the purple lines are representing the veins, the negative values with the red lines, which indicate BF moving away from the heart, are showing the arteries. The numbers closed to vessel segments outlined are the mean BF velocity in mm/s. The avascular zone was evident in the fovea. The symbol in the fovea (white arrow) is indicating the direction of the arterial BF. Note that no clinical signs of DR are present.Figure 1E: Bulbar conjunctiva of a human healthy’s left eye imaged in a 50 degrees red-free mode with the Retinal Function Imager.Figure 1F: Bulbar conjunctival capillary perfusion map (nCPM) of the same human healthy eye (Figure 1E). Note the microvasculature visualization enhancement showing the microvasculature anatomy in detail, otherwise invisible even in the sharpest red-free images (Figure 1E). The microvasculature anatomy appeared evenly distributed and lower number of blood vessels along with lower degree of complexity of their branching patterns increased density and complexity is evident when compared with the diabetic eye (Figure 1B).
Mentions: The conjunctival and retinal vasculature was imaged in a 38 years-old black female DM patient without DR with a commercially available RFI device. This patient was a non-smoking female with a history of Type-2 DM (T2DM) since 2009. She was being treated with Metformin 2 × 500 mg per day. Hemoglobin A1C was 5.3% (34 mmol/mol) and glucose was 87 mg/dL. Diastolic blood pressure was slightly elevated (120/90 mmHg). Ocular history included a nasally located pterygium removal in both eyes in 2010 and occasional seasonal allergic eye disease. The eye examination disclosed CM in the temporal area of the DM patient’s left eye (Figure 1A).

Bottom Line: Diabetes mellitus (DM) is notorious for causing retinal microangiopathy, but bulbar conjunctival microangiopathy (CM) mirroring the established retinal vessel changes, has also been observed.Recent studies suggest that CM occurs in all DM patients in various degrees depending on disease severity and occur even before non-proliferative retinopathy develops.Thus, CM might provide a means of early detection or even form a basis for early intervention of disease progression in DM patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, Florida, 33136, USA ; Charite, Universitaetsmedizin Berlin, Campus Benjamin Franklin, University Eye Hospital, Hindenburgdamm 30, 12200 Berlin, Germany.

ABSTRACT

Diabetes mellitus (DM) is notorious for causing retinal microangiopathy, but bulbar conjunctival microangiopathy (CM) mirroring the established retinal vessel changes, has also been observed. Recent studies suggest that CM occurs in all DM patients in various degrees depending on disease severity and occur even before non-proliferative retinopathy develops. Thus, CM might provide a means of early detection or even form a basis for early intervention of disease progression in DM patients. Herein we present - to our knowledge for the first time-the feasibility and applicability in diagnostic imaging of CM in a diabetic patient using a commercially available Retinal Function Imager (RFI, Optical Imaging Ltd, Rehovot, Israel).

No MeSH data available.


Related in: MedlinePlus