[Measurement of flow physiology of the large vessels in retinal circulation in normal subjects].
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Biomedical subjects
Publications and source records attributed to A Jütte.
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Segmental blood flow, velocity, and vessel diameter were measured in 21 eyes of diabetic individuals with diabetes type 1 and 2. The results for arterial blood flow, velocity, arterial and venous vessel diameter in diabetes show significant differences from the results measured in normal individuals. These flow magnitudes, excluding arterial diameter, significantly depend on the duration time of diabetes. The retinal blood flow magnitudes alter before the marks of diabetic retinopathy are visible. There are differences between the results in diabetes type 1 and type 2 regarding dependence on the duration time of diabetes.
If there are differences in the density of black-and-white photographs of the fundus oculi taken at different times, they may be transformed into color differences by means of the multitemporal technique. A multitemporal picture is obtained by additive color mixing of black-and-white photographs transilluminated at the same time with one primary color each. Since, in a serial angiogram, the interrelation between the film density and the passage of the fluorescein concentration in the fundus oculi is known, it is possible to draw conclusions from the multitemporal picture regarding phase differences and changes in the curve shape of the fluorescein concentration.
The acoustic era is being transformed ever more rapidly into the audiovisual era. This development is also having an increasing effect on training methods in medicine. In ophthalmological training especially, "teaching to see" plays a decisive role. Every newcomer to the specialty first has to learn how to "see" correctly, to judge three-dimensional relationships. The dynamic processes in the retinal and choroidal circulation can easily be demonstrated to students and young ophthalmologists by fluorescein angiography and TV fundus photography. This study illustrates the importance of space and time and shows how they can be integrated into ophthalmological training.
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Flow-physical magnitudes are presented that describe the retinal circulatory system. The principal possibilities and limitations of fluorescent angiographic procedures for the measurement of these magnitudes are discussed. On this basis, we compare fluorescentophthalmoscopic measurements of time, serial angiography, and cinematography with densitometric evaluation of the negatives, integral fluorophotometry, 'two point' photometry, and the application of television with evaluation of the video signal.
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The generalized capillary dilatation demonstrable at the early stage of diabetic retinopathy can now, on the basis of recent results in biochemistry, be assessed as an attempt at autoregulation in relative hypoxia of tissue. In patients with diabetic retinopathy, an elevated HbA1c concentration in the blood can be observed. The DPG level, however, is reduced. Both facts cause reduced oxygen transmission from blood to tissue. Rheologic changes such as augmented aggregation of erythrocytes, decreased deformability of erythrocytes and increased viscosity of blood and plasma finally lead to disturbances of microcirculation in the terminal vascular system. From these latest findings concerning the development of microcirculation disorders in diabetic retinopathy possible consequences for new therapeutic procedures can be derived.
Six hypotheses relating to the mode of action of photocoagulation, based on comprehensive data gathered from the literature, are put forward and discussed. Particular emphasis is given to the question of achieving a lasting break through of the barrier represented by Bruch's membrane and the pigment epithelium and thus to the altered diffusion conditions between the choriocapillaries and the retina. In addition a peculiar marginal fluorescence in fluorescein serial angiograms of old light coagulation foci is described and compared with data from the literature. The authors put forward a new hypothesis concerning the mode of action of light coagulation; they believe that particularly in the marginal areas affected by photocoagulation, completely new conditions are created for the metabolic exchange between choroid and retina, including the formation of anastomoses and shunts.
A report on results of 186 32P tests is given. Radiation increases of more than 30%, compared with tumor-free areas, were considered as positive. 95 eyes were histologically examined. The 32P test gave 90 correct positive answers and 1 correct negative answer. Faulty positive results were found in 2 cases; faulty negative results were also found in 2 cases. This means that the diagnosis was correct in 95%. The literature is discussed concerning reliability and methods. The dangers of the use of 32P are stressed, and the development of noninvasive nuclear-medical diagnostic methods is suggested.
A combined measuring unit for the Retinophot is described which can be used to determine the blood flow through the great retinal vessels. This method is possible by combination of the two-point photometry with length measurements by means of rocking-plate micrometry. The first measuring results are presented.
Comparison of principles is presented for length measurements at the fundus of the eye and discussed with respect to minimum measuring errors. Measurements by photography or by optical dislocation of the measuring object to itself are the methods with the least uncertainty under the conditions taken into consideration.
An additional unit which can be used for length measurements at the fundus of the human eye is described for the ophthalmoscope. The principle of measurement is based on optical displacement of the measuring object to itself. The optical displacement of picture points is made possible by the use of a tilting flat glass plate in the intermediate image plane of the eyepiece. The relation between the optical displacement of picture points and the measuring movement is sufficiently linear for the described device.
Since 1966 photocoagulation has been performed in 52 cases and 54 eyes of choroiditis located on the posterior pole. The course of the cases treated is compared with a control group treated with drugs. Photocoagulation shortens the duration of the acute inflammatory process, decreases the frequency of recurrences by about 40% and improves the visual prognosis. The follow-up 1 year to 9 years later (average 7 years) showed in the control group a visual function of 0.5, in the treated group of 0.8.
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