Evaluation of microvascular changes in optic disc and retina by optical coherence tomography angiography during Valsalva
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ORIGINAL PAPER
Evaluation of microvascular changes in optic disc and retina by optical coherence tomography angiography during Valsalva maneuver Sait Coskun Ozcan . Bengi Ece Kurtul . Deniz Ozarslan Ozcan
Received: 12 March 2020 / Accepted: 2 June 2020 Ó Springer Nature B.V. 2020
Abstract Purpose Optical coherence tomography angiography (OCTA) is an increasingly widespread imaging tool that allows the visualization of the microvascular structures of the eye. It should be kept in mind in clinical practice, Valsalva maneuver (VM) may have an effect on OCTA findings. We aimed to evaluate the effect of VM on the optic nerve and retinal blood flow parameters measured by OCTA. Methods Sixty age- and sex-matched healthy volunteers were included into this prospective study. Optic disc status for radial peripapillary capillary (RPC) network [whole image, inside disc and peripapillary capillary densities], superficial and deep capillary plexus whole, foveal, parafoveal and perifoveal densities and foveal avascular zone (FAZ) densities of volunteers were examined by OCTA both at rest and during VM. Results The mean age of the subjects was 31.48 ± 7.49 (18–50) years and 51.7% were male. Superficial whole, parafoveal and perifoveal vessel densities were found to be significantly decreased during VM (p = 0.008, p= 0.015, p = 0.017, respectively). Lower levels of deep whole, parafoveal and perifoveal vessel densities were also detected while VM (p \ 0.001
S. C. Ozcan B. E. Kurtul (&) D. Ozarslan Ozcan Department of Ophthalmology, Hatay Mustafa Kemal University Tayfur Ata So¨kmen Faculty of Medicine, Antakya, Hatay, Turkey e-mail: [email protected]
for all). However, there were no significant differences in terms of foveal vessel and FAZ densities. Additionally, VM significantly decreased RPC densities for whole image, inside and peripapillary capillary (p = 0.005, p \ 0.001, p = 0.039, respectively). Conclusion VM may cause a significant decrease in optic nerve and para-perifoveal blood flow. Therefore, patient instruction about not holding breath is required before OCTA scanning. Keywords Valsalva maneuver Optical coherence tomography angiography Retina Optic disc Microvasculature
Introduction The Valsalva maneuver (VM) is a forced exhalation against a closed airway. It is carried out usually in normal daily life, because of heavy lifting, powerful coughing and sneezing, straining on the toilet, vomiting, or constipation. It leads multiple systemic transient physiological changes, such as elevated blood pressure (BP), increased intrathoracic pressure, reduced venous return, increased peripheral venous pressure, and stimulation of the peripheral sympathetic adrenergic system [1–3]. The VM also affects ophthalmic functions, by elevating the IOP, significantly narrowing the anterior chamber angles, increasing the lens thickness and pupil diameter, and
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decreasing the central corneal thickness. VM, with these properties, is one of the validated
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