Retinal Capillary Perfusion is Altered in Patients With Cerebrovascular Malfunction: Predictive Value of Fundus Imaging

Abstract

 

Purpose:

 

A close correlation between cerebral and retinal arteriolar findings has been demonstrated for patients suffering from stroke. Cerebrovascular diseases increase the ratio of wall thickness to lumen diameter in large vessels. We evaluated retinal capillary perfusion and wall/lumen ratio (WLR) of retinal arterioles in patients with history of cerebrovascular event (Transitory Ischemic Attack TIA or lacunar cerebral infarction) and in controls.

 

Methods:

 

Retinal capillary flow and wall/lumen ratio of retinal arterioles were assessed using scanning laser Doppler flowmetry at 670 nm (Heidelberg Retina Flowmeter). The retinal vessels were scanned 2 to 3 mm temporal superior to the optic nerve. Analyses were performed with automatic perfusion imaging analysis (SLDF version 3.7). Arteriolar diameters (AD) were measured in reflection (DC) images and lumen diameters (LD) in perfusion (flow) images. WLR was calculated using the formula: WLR = (AD-LD) / LD. Study population: All patients were male. The control group consisted of 74 healthy normotensive men without history of a cerebrovascular event. Patients with diabetes and ocular diseases were excluded. In the cerebrovascular event group 9 patients have had an episode of TIA and 9 patients an acute lacunar cerebral infarction within 1-7 days prior to examination. There were no significant differences between the control group and the cerebrovascular group concerning age, blood pressure, heart rate and body mass index.

 

Results:

 

In comparison to controls patients with a history of a cerebrovascular event showed a significant reduction of retinal capillary perfusion (- 40%) and a significant enhancement of wall to lumen ratio of retinal arterioles (+ 31% ) . The results are summarized in this table:  

 

Conclusions:

 

Our study indicates that alterations of cerebral vessels are reflected by similar changes of retinal vessels. Therefore, the investigation of the retinal vasculature may provide predictive information about cerebral vascular diseases such as stroke .

 

Keywords: retina • imaging/image analysis: clinical • clinical (human) or epidemiologic studies: risk factor assessment