Effect of Valsalva Maneuver on Choriocapillary Retinal Microvasculature

Abstract

Purpose We aimed to identify and evaluate possible quantitative changes in retinal and choriocapillary blood flow utilizing optical coherence tomography angiography (OCTA) imaging in healthy study subjects during the Valsalva maneuver (VM).

Methods OCTA imaging with a ZEISS PlexElite 9000 on one eye was performed. OCTA images were acquired before VM and 5 seconds after. Images were segmented and underwent projection removal using algorithms supplied by the manufacturer. Analysis of vessel density (VD) and vessel length density (VLD) were performed on superficial (SCP) and deep capillary plexus (DCP) layer slabs using ImageJ. ImageJ was also utilized for analyzing flow voids (FVs) in the choriocapillary slabs.

Results Ten (8 right, 2 left) eyes of 10 (5 male, 5 female) healthy study subjects were included. Pre-VM, -VD, and -VLD were 0.428 (± 0.291) and 17.871 mm⁻¹ (± 2.22 mm⁻¹) in the SCP and 0.423 (± 0.0213) and 23.850 mm⁻¹ (± 1.023 mm⁻¹) in the DCP. Pre-VM and -FV were measured at 19.686 (± 1.959). During VM, VD, and VLD in the SCP were 0.417 (± 0.024) and 17.376 mm⁻¹ (± 2.007 mm⁻¹), and in the DCP, 0.426 (± 0.221) and 23.944 mm⁻¹ (± 1.021 mm⁻¹), respectively. FV post-VM was 20.440 (± 2.062). A paired samples t-test test revealed no significant changes in any of the observed parameters.

Conclusion We did not observe any significant changes in the VD, VLD, or FV. This might be due to autoregulatory processes in the ocular vasculature. Due to the small sample size, confidence intervals are comparatively large. Further study with more probands might yield different results.

Zusammenfassung

Zielsetzung Die Detektion allfälliger quantitativer Veränderungen des retinalen und choriokapillären Blutflusses mittels optischer Kohärenztomografieangiografie (OCTA) bei gesunden Probanden während des Valsalva-Manövers (VM).

Methoden Die OCTA-Bildgebung wurde mit einem ZEISS PlexElite 9000 an einem Auge durchgeführt. Die Aufnahmen erfolgten vor dem VM und 5 Sekunden danach. Die Segmentation erfolgte mittels eines vom Hersteller des Gerätes zur Verfügung gestellten Algorithmus. Die Analyse der Vessel Density (VD) und der Vessel Length Density (VLD) wurde an Segmentationen des oberflächlichen (SCP) und tiefen Kapillarplexus (DCP) mit ImageJ durchgeführt. ImageJ wurde auch für die Analyse von Flow Voids (FVs) in den choriokapillären Segmentationen verwendet.

Ergebnisse Zehn (8 rechts, 2 links) Augen von 10 (5 männlich, 5 weiblich) gesunden Studienteilnehmern wurden eingeschlossen. Prä-VM, -VD und -VLD betrugen 0,428 (± 0,291) und 17,871 mm⁻¹ (± 2,22 mm⁻¹) im SCP und 0,423 (± 0,0213) und 23,850 mm⁻¹ (± 1,023 mm⁻¹) im DCP. Prä-VM und -FV betrugen 19,686 (± 1,959). Während des VM betrugen die VD und die VLD im SCP 0,417 (± 0,024) und 17,376 mm⁻¹ (± 2,007 mm⁻¹) und im DCP 0,426 (± 0,221) bzw. 23,944 mm⁻¹ (± 1,021 mm⁻¹). Die FV nach dem VM waren 20,440 (± 2,062). Ein t-Test für gepaarte Stichproben ergab keine signifikanten Veränderungen bei den beobachteten Parametern.

Schlussfolgerung Wir beobachteten keine signifikanten Veränderungen bei der VD, der VLD oder den FV. Dies könnte auf autoregulatorische Prozesse der okulären Vaskulatur zurückzuführen sein. Aufgrund der geringen Stichprobengröße sind die Konfidenzintervalle vergleichsweise groß. Weitere Studien mit mehr Probanden sind angezeigt.

Key words

Valsalva maneuver - ocular physiology - medical retina - multimodal imaging - optical coherence tomography angiography

Schlüsselwörter

Valsalva-Manöver - okuläre Physiologie - medizinische Retina - multimodale Bildgebung - OCTA

^* Both Wiest Maximilian Robert Justus and Hamann Timothy contributed equally as shared first authors.

Publication History

Received: 20 September 2021

Accepted: 06 February 2022

Article published online:
26 April 2022

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