Altered spontaneous brain activity patterns in hypertensive retinopathy using fractional amplitude of low-frequency fluctuations:a functional magnetic resonance imaging study

AIM:To study functional brain abnormalities in patients with hypertensive retinopathy(HR)and to discuss the pathophysiological mechanisms of HR by fractional amplitude of low-frequency fluctuations(fALFFs)method.METHODS:Twenty HR patients and 20 healthy controls(HCs)were respectively recruited.The age,gender,and educational background characteristics of the two groups were similar.After functional magnetic resonance imaging(fMRI)scanning,the subjects’spontaneous brain activity was evaluated with the fALFF method.Receiver operating characteristic(ROC)curve analysis was used to classify the data.Further,we used Pearson’s correlation analysis to explore the relationship between fALFF values in specific brain regions and clinical behaviors in patients with HR.RESULTS:The brain areas of the HR group with lower fALFF values than HCs were the right orbital part of the middle frontal gyrus(RO-MFG)and right lingual gyrus.In contrast,the values of fALFFs in the left middle temporal gyrus(MTG),left superior temporal pole(STP),left middle frontal gyrus(MFG),left superior marginal gyrus(SMG),left superior parietal lobule(SPL),and right supplementary motor area(SMA)were higher in the HR group.The results of a t-test showed that the average values of fALFFs were statistically significantly different in the HR group and HC group(P<0.001).The fALFF values of the left middle frontal gyrus in HR patients were positively correlated with anxiety scores(r=0.9232;P<0.0001)and depression scores(r=0.9682;P<0.0001).CONCLUSION:fALFF values in multiple brain regions of HR patients are abnormal,suggesting that these brain regions in HR patients may be dysfunctional,which may help to reveal the pathophysiological mechanisms of HR.

Restoration of outer segments of foveal photoreceptors after resolution of malignant hypertensive retinopathy

Dear Sir,I am Dr. Xiao-Qiang Liu, from the Department of Ophthalmology, Shanghai Tenth People’s Hospital,Tongji University School of Medicine, Shanghai, China. I write to report a case of malignant hypertensive retinopathy demonstrated by spectral domain optical coherence

Hypertensive Retinopathy in Guinean Hypertensive Women: Epidemiological, Clinical and Therapeutic Aspects

Introduction: Hypertensive retinopathy is the set of retinal and papillary manifestations secondary to acute or chronic acute or chronic high blood pressure. Its frequency increases with age in women, its treatment requires the balance of blood pressure figures. Purpose: To study in women the epidemiological, clinical and therapeutic aspects of Hypertensive retinopathy at the application center of the Diploma of Specialized Studies in Ophthalmology (CADES/O). Patients and Methods: Prospective study conducted on 92 women who met the inclusion criteria over a period of six (6) months, from October 1, 2021 to March 31, 2022 in whom the diagnosis of Hypertensive Retinopathy was retained according to the Kirkendall classification. Results: We collected 92 patients with an average age of 57.88 years. The hypertensive Retinopathy was present at 61.75%. The age group of 60 - 69 years was the most represented at 40.22%. The socio-professional stratum most affected was housewives. The duration of the evolution of high blood pressure was from 2 - 5 years representing 57.61% of our study cases;the most common grade of high blood pressure was Grade II at 60.87%. Treatment of hypertension was irregularly followed in 73.91%. Stage II according to Kirkendall’s classification was 58.70% common;the recurrent sign was retinal hemorrhage at 30.43%. Blood pressure balance was the treatment recommended to our patients at 80.48%. Conclusion: Hypertensive retinopathy is common in women and its management remains the balance of blood pressure figures with periodic and multidisciplinary monitoring.

Epidemiological study of hypertensive retinopathy in the primary care setting: Retrospective cross-sectional review of retinal photographs

Objective:The objective is to estimate the prevalence and grading of hypertensive retinopa-thy in the primary care setting;examine the patient characteristics associated with hypertensive retinopathy;and examine the association of hypertensive retinopathy and other hypertension complications.Methods:This is a retrospective cross-sectional study.Subjects included adult hypertensive patients with available and gradable retinal photographs.Results:Two hundred fifty-six male hypertensive patients(34.3%)and 491 female hyper-tensive patients(65.7%)were included.The average duration of hypertension was 7.2 years,and 49.8%and 41.2%of patients were taking one or two antihypertensive medications respectively.Among 1491 qualified retinal photographs(744 right eye and 747 left eye),24.9%,62.6%,and 12.5%were classified as showing normal,mild,and moderate hypertensive retinopathy respec-tively.The three commonest retinal signs were generalized or focal arteriolar narrowing(650 cases,43.6%),hard exudates(168 cases,11.3%),and opacity(copper or silver wiring)of the arteriolar wall(166 cases,11.1%).Patients older than 61 years,having hypertension for more than 15 years,or taking three or more antihypertensive medications were significantly associated with hyperten-sive retinopathy(P<0.05).Conclusion:In a primary care clinic in Hong Kong,77.1%of hypertensive patients had hypertensive retinopathy.Advanced hypertensive retinopathy was the commonest target organ damage for hypertensive patients in a primary care clinic.

Biomarkers of Lipid Status and Metabolism in Retinal Hypertensive Disorder

Background. Hypertension (HTN) is a preventable risk factor for morbidity and mortality worldwide. Hypertensive retinopathy (HR), its ocular complication, is characterized by progressive metabolic disorders and structural damage of the retina. Lipids play an essential role in retina homeostasis, so an alteration of lipid metabolism specific for HTN may be of great significance in the development of hypertensive retinal injury. The study aimed to investigate the association between HR, traditional lipid biomarkers changes, and the atherogenic index, as well as to highlight a possible role of lipid metabolism markers in HR diagnosis and prognosis. Methods. A total of 90 hypertensive patients from the Republic of Moldova, admitted to the Ovisus Medical Center, Chisinau, Republic of Moldova, for a vision check and firstly diagnosed with HR were recruited in our study. The enrolment period is between February 2018 and December 2019. They were divided into three groups based on fundoscopy, using Keith-Wagner-Barker grading system of HR—GI: 36 patients;GII: 35 patients;GIII: 19 patients. The level of serum lipids: triglycerides, total cholesterol, LDL-Chol, and HDL-Chol was determined, followed by the calculation of the atherogenic index of plasma. Results are displayed as the median and interquartile range (IQR). Kolmogorov-Smirnov and Shapiro-Wilk normality tests were used, followed by Levene’s homogeneity of variance test. The groups were compared using the non-parametric Kruskal-Wallis and Mann-Whitney tests. The Spearman correlation coefficient was calculated (SPSS 23.0): p < 0.05—statistically significant. Results. It was attested a statistically significant increase of serum total cholesterol levels between the groups as the HR advanced (p = 0.017). In paired group comparisons, the total cholesterol level in GII significantly enhanced compared to GI 5.63 (IQR 0.69) mM/L vs. 5.49 (IQR 0.51) mM/L, p = 0.05 and in GIII compared to GI 5.76 (IQR 0.82) μM/L vs. 5.49 (IQR 0.51) mM/L, p = 0.04, showing a significant weak positive correlation with the degree of HR (r = 0.292**, p = 0.005). A resembled tendency to increase was highlighted also in serum TAG levels between groups (p = 0.061), with a significant weak and positive correlation with the degree of HR (r = 0.249*, p = 0.018). The results for HDL-Chol, LDL-Chol and atherogenic index were insignificant. Conclusion. The study revealed statistically conclusive changes associated with the HR degree of the TAG and total cholesterol levels and the absence of changes in plasma lipoprotein content—LDL-Chol and HDL-Chol. Extended research is mandatory to conclude the role of lipid metabolism in the advancement of HR and to ascertain the potential diagnostic importance of the presented lipid status changes.

Impact of coronary artery bypass grafting surgery on the chorioretinal biomicroscopic characteristics

BACKGROUND Most patients with cardiovascular disorders suffer from coronary artery diseases,which can be treated successfully using coronary artery bypass grafting(CABG).One of the unpleasant events following CABG is postoperative vision loss(POVL).Vulnerability of retinal vessels to hemodynamic changes,an expectable event following CABG,may contribute to the development of POVL,which might be associated with the changes in the choroidal and retinal structures.AIM To investigate postoperative changes in chorioretinal and peripapillary nerve fiber layer(NFL)thickness,and progression of diabetic and hypertensive retinopathy after CABG.METHODS In this prospective,cross-sectional study,49 eyes in 25 candidates for CABG underwent both ophthalmic and cardiovascular examinations within 6 mo prior to and 9 mo after surgery.RESULTS Among the study participants,56%were male with a mean age of 62.84 years±10.49 years(range 33–80 years).Diabetes mellitus was observed in eight participants(32%).None of the patients suffered from postoperative anterior or posterior ischemic optic neuropathy,central retinal artery occlusion,and cortical blindness.The mean value of the preoperative best corrected visual acuity was 0.11±0.10 logMAR(range,0–0.4),which worsened to 0.15±0.08 logMAR(range,0–0.4)after CABG(P=0.031).No significant difference was observed between the preand postsurgical choroidal(P=0.853)and macular(P=0.507)thickness,NFL thickness in the subfoveal(P>0.999)and peripapillary areas(P=0.659),as well as the severity of diabetic and hypertensive retinopathy.CONCLUSION CABG may reduce visual acuity without affecting ocular structures.Postoperative vision reduction might be attributable to molecular or cellular variations,changes in visual pathway function,or central nervous system.

Classifiers fusion for improved vessel recognition with application in quantification of generalized arteriolar narrowing

This paper attempts to estimate diagnostically relevant measure,i.e.,Arteriovenous Ratio with an improved retinal vessel classification using feature ranking strategies and multiple classifiers decision-combination scheme.The features exploited for retinal vessel characterization are based on statistical measures of histogram,different filter responses of images and local gradient in-formation.The feature selection process is based on two feature ranking approaches(Pearson Correlation Coefficient technique and Relief-F method)to rank the features followed by use of maximum classification accuracy of three supervised classifiers(κ-Nearest Neighbor,Support Vector Machine and Naïve Bayes)as a threshold for feature subset selection.Retinal vessels are labeled using the selected feature subset and proposed hybrid classification scheme,i.e.,decision fusion of multiple classifiers.The comparative analysis shows an increase in vessel classification accuracy as well as Arteriovenous Ratio calculation performance.The system is tested on three databases,a local dataset of 44 images and two publically available databases,INSPIRE-AVR containing 40 images and VICAVR containing 58 images.The local database also contains images with pathologically diseased structures.The performance of the proposed system is assessed by comparing the experimental results with the gold standard estimations as well as with the results of previous methodologies.Overall,an accuracy of 90.45%,93.90%and 87.82%is achieved in retinal blood vessel separation with 0.0565,0.0650 and 0.0849 mean error in Arte-riovenous Ratio calculation for Local,INSPIRE-AVR and VICAVR dataset,respectively.