10.14639/0392-100X-N1735
text/xml
1827-675X
1735
en
Lisa Toto
http://creativecommons.org/licenses/by-nc-nd/4.0
ACTA Otorhinolaryngologica Italica
Vascular disorders
Is there a gold standard to assess haemodynamic retina perfusion?
Text.Serial.Journal
https://www.actaitalica.it/
41
Letters to the Editor-in-Chief
2023-10-18
2021-06-14
2021-12-22
2023-10-18
574-575
1
Lisa Toto
2021
10.14639/0392-100X-N1735
574
Medicine and Aging Science Dept, “Gabriele d’Annunzio University” Chieti-Pescara, Italy
1827-675X
Vascular disorders
en
575
Is there a gold standard to assess haemodynamic retina perfusion?
https://www.actaitalica.it/article/download/1735/706
41
ACTA OTORHINOLARYNGOLOGICA ITALICA 2021;41:574-575; doi: 10.14639/0392-100X-N1735




Letter to the Editor


Is there a gold standard to assess haemodynamic
retina perfusion?
Esiste un gold standard per valutare la perfusione emodinamica della retina?
Giampiero Neri1, Lisa Toto2
1
  Neurosciences, Imaging and Clinical Sciences Dept, “Gabriele d’Annunzio University” Chieti-Pescara, Italy; 2 Medicine and Aging
Science Dept, “Gabriele d’Annunzio University” Chieti-Pescara, Italy


KEY WORDS: BPPV, Echocolordoppler, Vertebral artery, OCTA, Vascular disorders
PAROLE CHIAVE: BPPV, ecocolordoppler, arterie vertebrali, OCTA, vasculopatie


Dear Editor,
I thank Prof. Martini for having raised some criticism of our work that had the
objective of highlighting the aetiopathogenesis of the most frequent peripheral
vertiginous pathology 1.
When a great scientist criticises a paper, it means that it is worth reading.
The first observation concerns retinal fluorangiography (FA), considered by
Prof. Martini to be outdated, which lost its investigative value soon after the in-     Received: June 14, 2021
troduction of optical coherence tomography angiography (OCTA). However,                 Accepted: June 21, 2021
this is not entirely true.                                                              Published online: November 26, 2021
OCTA has been in use for a few years and is currently a widely used exam,
                                                                                        Correspondence
especially considering its remarkable diagnostic utility, but in reality, as Wei        Giampiero Neri
himself, cited by prof Martini, writes “multiple methods are used by research-          Gabriele d’Annunzio University, Neurosciences,
ers for assessment of (retinal) blood flow, but a gold standard is lacking” 2.          Imaging and Clinical Sciences Dept, SS.Annunziata
                                                                                        Hospital Chieti, via dei Vestini, (Pal G livello 6
One of the main deficiencies of OCTA is related to its limited field of view, sug-      stanza 625), 66100 Chieti, Italy
gesting a primary application in disorders affecting the macular region. Even           Fax +39 0871 358550
wide field OCTA scans and montage of wide field OCTA scans of the posterior             E-mail:giampiero.neri@unich.it
pole do not extend to the retinal periphery, which are easily and completely im-
                                                                                        Funding
aged by fluorescein angiography. Moreover, OCTA is influenced by the velocity           None.
of flow, and thus a slow flow inside vessels leading to a lack of signal could be
misinterpreted as non-perfusion. Thus, FA offers a more detailed and complete           Conflict of interest
                                                                                        The Authors declare no conflict of interest.
perfusion status of the retina 3. Our choice to use FA was therefore determined
not “from a lack of updated scientific literature search in absence of an ophthal-
mologist within the authors research group”, but by willingness to use a well-            How to cite this article: Neri G, Toto L. Is there a
                                                                                          gold standard to assess haemodynamic retina per-
structured, complete test backed by solid scientific literature that can give a com-      fusion. Acta Otorhinolaryngol Ital 2021;41:574-
plete and unequivocal result. The absence of a positive FA result was expected            575. https://doi.org/10.14639/0392-100X-N1735
and is not surprising. It is partly anatomically explainable 4 because the ophthal-
                                                                                        © Società Italiana di Otorinolaringoiatria
mic artery caliber is about 2 mm in diameter 5, while the average calibre of the        e Chirurgia Cervico-Facciale
internal auditory artery is 0.19 mm 6 (range 0.15-0.24 mm). It is thus much more
sensitive to flow reductions than the eye that is affected when the damage has                         OPEN ACCESS
already occurred. Micro-aneurysms, retinal haemorrhages and retinal arteriolar          This is an open access article distributed in accordance with
                                                                                        the CC-BY-NC-ND (Creative Commons Attribution-Non-
narrowing, in fact, may be markers for concomitant cerebral microangiopathy 7.          Commercial-NoDerivatives 4.0 International) license. The
In other words, the labyrinth is a peripheral sensor, which due to its “chronic         article can be used by giving appropriate credit and mentio-
                                                                                        ning the license, but only for non-commercial purposes and
ischaemia” can indicate a vascular disorder of the microcirculation much earlier        only in the original version. For further information: https://
than eye. This is the peculiarity that emerges from our study and that indicates        creativecommons.org/licenses/by-nc-nd/4.0/deed.en




574
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how echocolordoppler of the vertebral artery can confirm or               2
                                                                               Wei X, Balne PK, Meissner KE, et al. Assessment of flow dynam-
                                                                               ics in retinal and choroidal microcirculation. Surv Ophthalmol
not that benign paroxysmal positional vertigo (BPPV) is ac-                    2018;63:646-664. https://doi.org/10.1016/j.survophthal.2018.03.003
tually a risk factor for ischaemic stroke 8,9.                            3
                                                                               Pellegrini M, Cozzi M, Staurenghi G, et al. Comparison of wide
We have almost finished a study, which I hope to publish as                    field optical coherence tomography angiography with extended
                                                                               field imaging and fluorescein angiography in retinal vascular disor-
soon as possible, which indicates that in lack of oxygena-                     ders. PLoS One 2019;14: e0214892. https://doi.org/10.1371/journal.
tion the vestibular damage manifests itself in a subclinical                   pone.0214892
manner.                                                                   4
                                                                               Lang J, Kageyama I. The ophthalmic artery and its branches, meas-
                                                                               urements and clinical importance. Surg Radiol Anat 1990;12:83-90.
The second observation concerns the audiological aspect.                       https://doi.org/10.1007/BF01623328
I agree with Prof. Martini about the possibility of show-                 5
                                                                               Hedges TR. Ophthalmic artery blood flow in humans. Br J Ophthal-
ing audiological data relating to the cases examined, but                      mol 2002;86:1197. https://doi.org/10.1136/bjo.86.11.1197
we tried not to burden the work with too much data that                   6
                                                                               Haidara A, Peltier J, Zunon-Kipré Y, et al. Microsurgical anatomy
                                                                               of the labyrinthine artery and clinical relevance. Turk Neurosurg
could distract the reader from the core of the research. On                    2015;25:539-543. https://doi.org/10.5137/1019-5149.JTN.9136-13.0
the other hand, the study group was composed of patients                  7
                                                                               Wong TY. Is retinal photography useful in the measurement of
with recurrent BPPV which, as a rule, is not associated                        stroke risk? Lancet Neurol 2004;3:179-183. https://doi.org/10.1016/
                                                                               s1474-4422(04)00682-9
with hearing damage. In reality, the appearance of unilat-                8
                                                                               Kao CL, Cheng YY, Leu HB, et al. Increased risk of ischemic stroke
eral or bilateral auditory signs with vertigo 10,11 indicates a                in patients with benign paroxysmal positional vertigo: a 9-year fol-
more severe prognosis, due to the concrete possibility of                      low-up nationwide population study in Taiwan. Front Aging Neurosci
                                                                               2014;6:108.      https://doi.org/10.3389/fnagi.2014.00108.eCollection
ischaemia, in patients with acute vestibular deficit or audi-                  2014
tory symptoms and not with BPPV. However, I thank Prof.                   9
                                                                               Choi HG, Kim SY. Benign paroxysmal positional vertigo and the in-
Martini for the suggestion that I will certainly follow in the                 creased risk of ischemic stroke: a nested case-control study using a
future to improve the quality of my research.                                  national cohort sample. BioMed Res Int 2021;2021:6629028. https://
                                                                               doi.org/10.1155/2021/6629028
                                                                          10
                                                                               Whitman GT, Lim JG, Lee SD, et al. Bilateral sudden deafness as a
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