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Observational Study
. 2017 Apr 10;21(1):86.
doi: 10.1186/s13054-017-1676-3.

Retinal arterial blood flow and retinal changes in patients with sepsis: preliminary study using fluorescein angiography

Kristo Erikson  1 , Janne Henrik Liisanantti  2 , Nina Hautala  3 , Juha Koskenkari  2 , Remi Kamakura  4   5 , Karl Heinz Herzig  4   5   6 , Hannu Syrjälä  7 , Tero Ilmari Ala-Kokko  2
Affiliations
Observational Study

Retinal arterial blood flow and retinal changes in patients with sepsis: preliminary study using fluorescein angiography

Kristo Erikson et al. Crit Care. .

Abstract

Background: Although tissue perfusion is often decreased in patients with sepsis, the relationship between macrohemodynamics and microcirculatory blood flow is poorly understood. We hypothesized that alterations in retinal blood flow visualized by angiography may be related to macrohemodynamics, inflammatory mediators, and retinal microcirculatory changes.

Methods: Retinal fluorescein angiography was performed twice during the first 5 days in the intensive care unit to observe retinal abnormalities in patients with sepsis. Retinal changes were documented by hyperfluorescence angiography; retinal blood flow was measured as retinal arterial filling time (RAFT); and intraocular pressure was determined. In the analyses, we used the RAFT measured from the eye with worse microvascular retinal changes. Blood samples for inflammation and cerebral biomarkers were collected, and macrohemodynamics were monitored. RAFT was categorized as prolonged if it was more than 8.3 seconds.

Results: Of 31 patients, 29 (93%) were in septic shock, 30 (97%) required mechanical ventilation, 22 (71%) developed delirium, and 16 (51.6%) had retinal angiopathies, 75% of which were bilateral. Patients with prolonged RAFT had a lower cardiac index before (2.1 L/kg/m2 vs. 3.1 L/kg/m2, P = 0.042) and during angiography (2.1 L/kg/m2 vs. 2.6 L/kg/m2, P = 0.039). They more frequently had retinal changes (81% vs. 20%, P = 0.001) and higher intraocular pressure (18 mmHg vs. 14 mmHg, P = 0.031). Patients with prolonged RAFT had lower C-reactive protein (139 mg/L vs. 254 mg/L, P = 0.011) and interleukin-6 (39 pg/ml vs. 101 pg/ml, P < 0.001) than those with shorter RAFT.

Conclusions: Retinal angiopathic changes were more frequent and cardiac index was lower in patients with prolonged RAFT, whereas patients with shorter filling times had higher levels of inflammatory markers.

Keywords: Retinal arterial blood flow; Retinal changes; Sepsis.

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Figures

Fig. 1
Fig. 1
Cardiac index according to retinal arterial filling time measured by fluorescein angiography
Fig. 2
Fig. 2
Retinal changes in patients with sepsis. (retinal hemorrhages (a), micoaneurysms (b) and vitreous hemorrhages (c))
See this image and copyright information in PMC

Comment in

References

    1. Kur J, Newman EA, Chan-Ling T. Cellular and physiological mechanisms underlying blood flow regulation in the retina and choroid in health and disease. Prog Retin Eye Res. 2012;31(5):377–406. doi: 10.1016/j.preteyeres.2012.04.004. - DOI - PMC - PubMed
    1. Liew G, Wang JJ, Mitchell P, Wong TY. Retinal vascular imaging: a new tool in microvascular disease research. Circ Cardiovasc Imaging. 2008;1(2):156–61. doi: 10.1161/CIRCIMAGING.108.784876. - DOI - PubMed
    1. Rimpilainen R, Hautala N, Koskenkari J, Rimpilainen J, Ohtonen P, Mustonen P, et al. Comparison of the use of minimized cardiopulmonary bypass with conventional techniques on the incidence of retinal microemboli during aortic valve replacement surgery. Perfusion. 2011;26(6):479–86. doi: 10.1177/0267659111415564. - DOI - PubMed
    1. Arnold JV, Blauth CI, Smith PL, Jagoe JR, Wootton R, Taylor KM. Demonstration of cerebral microemboli occurring during coronary artery bypass graft surgery using fluorescein angiography. J Audiov Media Med. 1990;13(3):87–90. doi: 10.3109/17453059009055108. - DOI - PubMed
    1. Blauth CI, Arnold JV, Schulenberg WE, McCartney AC, Taylor KM. Cerebral microembolism during cardiopulmonary bypass: retinal microvascular studies in vivo with fluorescein angiography. J Thorac Cardiovasc Surg. 1988;95(4):668–76. - PubMed

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