Perforating and ophthalmic artery variants from the anterior cerebral artery:Two case reports

BACKGROUND The diagnosis and therapy during surgery depend largely on a full account of anatomic characteristics.Apart from regular structures,the common,less common or even uncommon anatomic variations are critical for procedural planning.This is especially true during craniocerebral microsurgery,where small vascular variations can affect the final surgical results and patient prognosis.CASE SUMMARY Herein,two rare variations concerning the A1(horizontal)segment of anterior cerebral artery(ACA1)were introduced.One enabled the communication between perforating branch of ACA1 and dural artery of anterior skull base,which was discovered during autopsy.The other was ophthalmic artery(OA)originating from ACA1,shown on digital angiography.CONCLUSION In this study,we found two rare anatomical variations.One was an abnormal OA originated from the anterior communicating artery.The other was a perforating branch of the A1 segment of the anterior cerebral artery,which communicated with meningeal vessels in the anterior skull base.This finding is of great significance for the treatment of anterior communicating artery aneurysm or in other anterior skull base surgery.

Transcranial Doppler for detection of changes in ophthalmic artery blood flow

The ophthalmic artery （OA） is a main branch of the internal carotid artery （ICA）. Severe internal carotidartery stenosis or occlusion may not only affect the blood supply to the brain, but may also cause OA insufficiency, leading to ocular ischemia. Therefore, research on the hemodynamic changes in the OA in patients with ICA stenosis or occlusion has increasingly attracted more ophthalmologists＇ attention.1 Transcranial Doppler （TCD） is simple and noninvasive, has been widely used in the inspection of cerebrovascular disease,

Foreign body embolus to ophthalmic artery following penetrating trauma of the neck

Migration of metallic foreign body into the cerebral circulation is rarely seen. Most of the cases reported were due to gunshot wounds and shotgun wounds to the neck and face. When the foreign body is near the great vessel, it must be removed immediately or will cause complications. This study reported a case of delayed metallic foreign body embolus to the ophthalmic artery resulting from an injury to the right neck, which arose from the presence of metallic emboli to the cerebral circulation.

Treatment of Dissection at the Ophthalmic Segment of Internal Carotid Artery

Objective Intracranial internal carotid artery dissection is a rare case. The purpose of this study was to report the treatment of intracranial internal carotid dissection and the radiologic and clinical result.Material And Method A 67 year-old female patient admitted for lower leg fracture at the outside university hospital. After 6 days later, she presented with left hemiparesis, verbal disturbance and visual disturbance. She transferred to our hospital and evaluated with MRI and Angiography. Angiography show stenosis with ulceration and pseudoaneurysm at the internal carotid artery. The stenosis rate was 63%. At the lesion, ophthalmic artery was poor visualized. Results The intracranial lesion was treated with angioplasty and stenting. After stenting, angiography showed good ophthalmic artery flow. Patients improved visual acuity just after stenting. Conclusions Intracranial angioplasty and stenting will be a good treatment option in a highly selected case.

Subfoveal choroidal thickness and volume in severe internal carotid artery stenosis patients

AIM：To demonstrate the differences of retinal and choroidal structure changes in internal carotid artery（ICA） patients of China by enhanced-depth imaging optical coherence tomography（EDI-OCT）.METHODS：A retrospective review was conducted of 46 patients with a diagnosis of ICA stenosis greater than 65% on only one side（the opposite ICA Stenosis had less than 40% stenosis） from June 2015 through June 2016.All of the patients were combined with amaurosis fugax,but without any abnormality with other ocular examination.Thickness and volume of choroid and retina were manually measured by EDI-OCT.Differences were compared between ICA stenosis eyes and fellow eyes.RESULTS：There were no significant differences in the retinal thickness,macular retinal nerve fiber layer（m RNFL） thickness,inner thickness,or outer retinal thickness between the ICA Stenosis group and the control group（P=0.834,0.187,0.552,and 0.903,respectively）.The mean central choroidal thickness of the ICA Stenosis group was significantly lower than that of the control group（239.70±23.76 μm vs 257.46±22.13 μm,P〈0.001）.The percentage of ICA stenosis was significantly associated with the central choroidal thickness,central retinal thickness,foveal center choroidal volume,and foveal center retinal volume（r=0.854,0.678,0.729,and 0.785,respectively;P〈0.001）.There were no significant differences in the retinal and choroidal volume values in the 4 inner and 4 outer sectors between the two groups.CONCLUSION：The choroidal thickness in severe ICA stenosis eyes is lower than in fellow eyes.The choroidal thinning may occur before the retinal changes in patients with ocular ischemic syndrome.Evaluations of choroidal thickness may be useful to choose the optimal therapeutic schedule for ICA patients.

Central retinal artery resistive index and optical coherence tomography in assessment of glaucoma progression

AIM: To assess the relation between central retinal artery(CRA) resistive index(RI) and retinal nerve fiber thickness measured by optical coherence tomography(OCT) in assessment of disease progress in cases of open angle glaucoma.METHODS: Twenty-three patients with diagnosed open angle glaucoma were included in this study. They were examined by colored duplex ultrasonography of CRA with estimation of RI of CRA and ophthalmic artery(OA)with estimation of CRA/OA RI ratio as well as OCT measurement of the average retinal nerve fiber layer(RNFL) thickness in order to assess the disease progress.RESULTS: There was strong inverse relation between the increased RI in CRA as well as the increased CRA/OA RI ratio and the decrease in average RNFL thickness in cases of open angle glaucoma.CONCLUSION: Assessment of CRA RI can indirectly assess the vascular changes associated with glaucoma and can assess the degree of retinal atrophy helping in evaluating prognosis thus guiding the choice of treatment.

Observation on 108 Normal Ophthalmic Arteries in 80 Patients by Digital Subtraction Angiography

By digital subtraction angiography(DSA), the authors made observations on 108 normal ophthalmic arteries in 80 patients with regard to the origins, courses, branching, morphology and anastomoses of the vessels. The merits and demerits of DSA in observing the ophthalmic artery were discussed. Eye Science 1994; 10: 157- 162.

Fundus artery occlusion caused by cosmetic facial injections

Background With the increasing popularity of cosmetic facial filler injections in recent years, more and more associated complications have been reported. However, the causative surgical procedures and preventative measures have not been studied well up to now. The aim of this stady was to investigate the clinical characteristics and visual prognosis of fundus artery occlusion resulting from cosmetic facial filler injections. Methods Thirteen consecutive patients with fundus artery occlusion caused by facial filler injections were included. Main outcome measures were filler materials, injection sites, best-corrected visual acuity （BCVA）, fundus fluorescein angiography, and associated ocular and systemic manifestations. Results Eleven patients had ophthalmic artery occlusion （OAO） and one patient each had central retinal artery occlusion （CRAO） and anterior ischemic optic neuropathy （AION）. Injected materials included autologous fat （seven cases）, hyaluronic acid （five cases）, and bone collagen （one case）. Injection sites were the frontal area （five cases）, periocular area （two cases）, temple area （two cases）, and nose area and nasal area （4 cases）. Injected autologous fat was associated with worse final BCVA than hyaluronic acid. The BCVA of seven patients with autologous fat injection in frontal area and temple area was no light perception. Most of the patients with OAO had ocular pain, headache, ptosis, ophthalmoplegia, and no improvement in final BCVA. Conclusions Cosmetic facial injections can cause fundus artery occlusion. Autologous fat injection tends to be associated with painful blindness, ptosis, ophthalmoplegia, and poor visual outcomes. The prognosis is much worse with autologous fat injection than hyaluronic acid iniection.