In the present study, the RBF significantly decreased (48.4%) after initiation of hyperoxia in the PBS control group
(Fig. 1) . Hyperoxia has been reported to induce a pronounced reduction in RBF in animals
5 6 and humans.
1 2 3 4 7 8 32 Although there may be differences among species and with different measurement techniques, the magnitude and time course of the decrease in RBF during hyperoxia in the present study were comparable with previously reported findings.
The current data showed a trend for changes in blood velocity to occur before the changes in diameter just after the initiation of hyperoxia in the PBS group
(Fig. 1) . Our results, that the blood velocity decreased but the vessel diameter did not change significantly 2 minutes after the beginning of hyperoxia, suggested that the downstream vessels, which were more peripheral than the points measured by laser Doppler velocimetry, contract just after the onset of hyperoxia. These rapid changes in velocity with no changes in diameter also were observed during systemic hypoxia,
23 suggesting that the downstream vessels react to changes in oxygen tension. Gilmore et al.
4 reported that the response times during hyperoxia did not differ between diameter and velocity in the retinal arterioles in healthy humans. This finding differed from ours and may reflect differences in the vessel sizes measured in the previous study (average diameter, 85 μm in the present study and 111 μm in the previous study). The vessel size in the arterioles is considered important to data interpretation, because three different vasoregulatory mechanisms (metabolic, myogenic, and flow-induced mechanisms) coordinate the overall microvascular response from the downstream arterioles to the upstream arteries in the microcirculation.
33 Moreover, preliminary data reported by Rosa et al. (
IOVS 2005;46:ARVO E-Abstract 3900) indicated that second-order arterioles are more sensitive to the flow-induced dilation than first-order arterioles. Although Gilmore et al. did not report if they measured the first- or second-order retinal arterioles in their human study, the discrepancy may have been the result of our measuring second-order arterioles in the present study and their measuring larger arterioles.
In addition, we continuously observed changes in the retinal circulation for 20 minutes after hyperoxia because we focused on changes in the retinal circulation not only during but also after hyperoxia. The decreased RBF returned to baseline almost 10 minutes after hyperoxia and the baseline value was maintained until the end of the examination in the PBS group
(Fig. 1) . The recovery of the retinal circulation is comparable to that in previous human studies.
4 34 The current data also indicated that the blood velocity returned to the baseline level 4 minutes after hyperoxia, whereas the vessel diameter returned to the baseline level 6 minutes after hyperoxia
(Fig. 1) , suggesting that blood velocity recovers faster than the vessel diameter. A previous human study reported that the time course of the response to hyperoxia did not differ between the diameter and velocity both during and after hyperoxia.
4 As discussed previously, this discrepancy may have resulted from the difference in species or vessel size of the measured retinal arterioles.
The strength of the present study was the use of laser Doppler velocimetry, which enables simultaneous measurement of the vessel diameter and blood velocity. Using these two independent retinal circulatory parameters, we can evaluate changes in the WSR in the retinal circulation.
35 Most previous studies
1 2 32 did not report WSR data, which is an index of wall shear stress,
28 because the vessel diameter and blood velocity were not measured simultaneously as a result of methodologic difficulties. Only one study reported decreased WSR in the retinal arterioles in response to systemic hyperoxia.
8 In the present study, the WSR decreased significantly at 2 minutes of hyperoxia
(Fig. 1) , whereas the WSR returned to the baseline level at 4 minutes of hyperoxia because of decreased vessel diameter, suggesting that the WSR remains constant in response to hyperoxia. Although inconsistent with results in a previous study,
8 this finding seems reasonable because shear stress should remain constant under physiologic conditions.
36 As stated previously, this may be caused by differences in vessel sizes between our observations and a previous human study.
4 If the WSR remains constant by the flow-induced mechanism in response to hyperoxia, hyperoxia-induced changes in the retinal circulation may be good indicators of endothelial function, because the flow-induced mechanism can be used to evaluate endothelial function.
We have provided new evidence that intravitreous injection of
l-name markedly inhibits recovery of the decreased RBF to baseline after hyperoxia ends, whereas there was no difference in the decrease in RBF during hyperoxia between the PBS and
l-name groups
(Fig. 2) . Inhibition of NOS as a mechanism of the effects of
l-name is supported by the fact that
d-NAME did not affect RBF in response to hyperoxia
(Fig. 2) . To our best knowledge, this is the first study to show that NO is associated with the response of the RBF to hyperoxia.
Because inducible NOS activity was thought to be minimal in the acute response to hyperoxia, we evaluated which constitutive NOS was involved in the changes in RBF in response to hyperoxia. We examined the effect of the selective inhibitor of nNOS, one of two constitutive NOS isoforms, on the regulation of RBF in response to hyperoxia. There was no significant difference in any retinal or systemic parameters with and without (vehicle only) 7-NI
(Fig. 4) , suggesting that retinal nNOS may not be associated with increased RBF in response to hyperoxia. Moreover, although we did not use a specific eNOS inhibitor, our findings indicated that eNOS in the vascular endothelium may be involved in the recovery of RBF after hyperoxia.
ET is considered crucial in vascular control because there is increasing evidence that ET-1 also plays an important role in ocular blood flow control.
6 14 15 37 In the present study, BQ-123 blunted the decrease in RBF during hyperoxia
(Fig. 2) . This result seems to agree with those in previous studies in which enhanced ET-1 activity played a primary role in regulating the retinal hemodynamic during hyperoxia.
1 5 6 11 12 However, in the present study, intravitreous injections of BQ-123 and -788 did not have a substantial effect on retinal circulatory parameters before the induction of hyperoxia, suggesting that ET-1 does not play an important role in regulating retinal circulation under basal condition (normoxia). Polak et al.
11 reported that intravenous injection of BQ-123 does not affect the retinal hemodynamic parameters, which supports our findings.
Based on our experiments, the contribution of ETB receptors was excluded in hyperoxia-induced vasoconstriction, because there was no difference between the PBS group and BQ-788 group during hyperoxia. In contrast, BQ-788 suppressed RBF recovery after hyperoxia
(Fig. 3) , which was comparable to that in the
l-name group. Therefore, NO production in the retinal vascular endothelium may contribute to RBF recovery after hyperoxia via ETB receptor activation. Haefliger et al.
38 reported that ET-1 induced potent contractions that were more pronounced in the ciliary artery than in the ophthalmic artery, suggesting that the effect of ET may depend on vessel size and increase with decreasing vascular diameter. Therefore, the differences in vessel size may be associated with differences in the time course of the diameter and velocity changes between the findings of Gilmore et al.
4 and ours, as discussed previously. The ability of BQ-123 to reduce the velocity and flow but not to alter the diameter of second-order vessels
(Fig. 3)further supports the idea that the smaller downstream arterioles may have greater sensitivity to ET-1 and initiate constriction in response to hyperoxia.
ET-1 induces an initial biphasic action (brief vasodilation followed by prolonged constriction) on systemic blood pressure.
39 ET-1 first stimulates the endothelial ETB receptors, occupies all the receptors, and then diffuses into the media to act on receptors on the smooth muscle.
40 If this biphasic effect of ET-1 occurs in the retinal circulation, high-dose ET-1 during hyperoxia should constrict the retinal arterioles via the ETA receptors, whereas a reduction of the increase in ET-1 after the end of hyperoxia may cause vasodilation via the ETB receptors.
The present study had some limitations. First, we did not measure ET-1 and NO concentrations in the retina or retinal vessels. Knowledge of the ET-1 concentration after hyperoxia may be essential when considering a balance between the vasodilatory actions of ETB in the endothelium and the vasoconstrictive actions of ETA in the smooth muscle in the retinal arterioles. Further studies including those measurements are crucial to an understanding of the mechanism in the retinal circulation after hyperoxia. Second, we did not measure the intraocular pressure (IOP), which is important in retinal circulation. In our preliminary study, there was no substantial difference in the IOP changes between the PBS group and the other groups. We also confirmed that hyperoxia did not affect the IOP during and after hyperoxia (
n = 4, data not shown) and that the IOP transiently increased but returned to the preinjection level within 5 minutes (
n = 4, data not shown). Taken together, we believe that the IOP had little effect on our results. Third, we did not examine the role of other vasoactive factors on the response to hyperoxia. Zhu et al.
5 reported that thromboxane and 20-hydroxyeicosetetraenoic acid also are involved in the hyperoxia-induced decrease in RBF in newborn pigs. Further study is needed to determine whether mechanisms other than ET-1 are associated with hyperoxia-induced reduction of the RBF. Fourth, we could not exclude the possible role of ETB receptors and eNOS in the endothelium and neural/glial cells in this in vivo study, because the ETB receptors have been localized in the optic nerve head
41 and retinal ganglion cell layer
42 and eNOS has been identified in retinal Müller cells
43 and ganglion cells.
44 Further histologic study may be needed to determine the location of ETB receptors and eNOS in the feline retina.
We believe that the current results have great potential for future clinical investigation. Because NO production via eNOS diminishes in the presence of endothelial dysfunction, measuring the vascular reaction after hyperoxia may allow evaluation of the retinal endothelial function and the reduced magnitude of retinal vascular reactivity to hyperoxia in patients with diabetes, as reported by numerous clinical studies.
7 8 9 10 Future study of the retinal circulation after hyperoxia is needed to compare healthy subjects and subjects with diabetes, in the latter of whom the retinal vessels have endothelial dysfunction, such as in diabetic retinopathy.
In summary, the present study showed that NO contributes to RBF recovery after hyperoxia and that eNOS in the vascular endothelium may be involved in the reaction. We concluded that NO plays a major role in the regulatory mechanism of RBF after hyperoxia. ET-1, probably produced from the endothelium during hyperoxia, may be involved in NO production in the endothelium via activation of the ETB receptor in the retinal endothelium when the RBF begins to return to baseline after hyperoxia.