A study on vascular retinal alterations in patients with coronary artery disease

Abstract

The paper describes the study carried out on a sample of 27 coronary artery disease patients, aiming to determine a correlation between coronary artery disease and anomalies in the retinal circulation. Patients underwent selective coronary arteriography and fundus fluorescein angiography that allowed us to investigate the dye dynamics and to detect abnormalities of time evolution, vessel walls, and flux. During the fluorescein angiography we measured time events as the choroidal flush (t_a) the start of the laminar phase (t_b), and the end of the laminar phase (t_c) and we took pictures that were digitally processed in order to compute the ROI₁/ROI₂ value, assumed as a numerical index of ischemia of the optic disc. In the examined sample we found t_a = 61 ± 109, t_b = 65 ± 107, t_c = 159 ± 155, and ROI₁/ROI₂ = 0.968 ± 0.300. Normal ranges for these parameters were determined by the fundus fluorescein angiography of a control group of 10 patients, unaffected by coronary artery disease and ischemic pathology of the retinal network; we found t_a = 12 ± 4, t_b = 16 ± 8.5, t_c = 44 ± 9.3, and ROI₁/ROI₂ = 0.735 ± 0.086. Eighty-five percent of coronaropatic patients showed ischemia of the optic disc, 89% anomalies of the epi-peripapillar network, 70% anomalies of the papillo-macular network, and 89% evidence of at least two findings of ischemia; 85% of patients showed a value of ROI₁/ROI₂ out of the normal range. The unpaired Student'st-test between the coronaropatic and the control group does not show significant differences between t_a and t_b; on the contrary, those with coronary disease and the control group were statistically different for t_c (p ≤ 0.02). Moreover, we have found a correlation between the numerical index of optic disc ischemia and the severity of coronary artery disease (r = 0.68,p ≤ 0.01). Hence, the vascular abnormalities shown by the fluorescein angiography can constitute valid noninvasive markers and can advise further cardiological tests for a coronary artery disease not yet diagnosed.