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Uveal vascular bed in health and disease: lesions produced by occlusion of the uveal vascular bed and acute uveal ischaemic lesions seen clinically. Paper 2 of 2

Eye volume 37, pages 2617–2648 (2023)Cite this article

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Abstract

From studies on postmortem anatomical descriptions of the uveal vascular bed, it was generally concluded that occlusion of PCA or its branches should not produce an ischemic lesion. However, in vivo studies have recorded that the PCAs and their branches, right down to the terminal choroidal arterioles, and the choriocapillaris, have a segmental distribution in the choroid, and that PCAs and choroidal arteries function as end-arteries. This explains the basis of the occurrence of isolated inflammatory, ischemic, metastatic, and degenerative choroidal lesions, which are usually localized. Thus, in vivo studies have completely revolutionized our concept of the uveal vascular bed in disease.

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Fig. 1: Fluorescein fundus angiogram of an eye with central retinal artery occlusion.
Fig. 2
Fig. 3
Fig. 4
Fig. 5: Fluorescein fundus angiograms of the macular region and the area temporal to it after lateral PCA occlusion 2 days after the occlusion in rhesus monkey.
Fig. 6: Diagram shows route of retrograde flow of blood via the vortex vein into the part of choroid supplied by an occluded PCA (large arrow).
Fig. 7: Schematic representation of blood supply of the optic nerve.
Fig. 8
Fig. 9
Fig. 10: Photomicrograph of the optic nerve head and retrolaminar optic nerve of right eye of a patient with 4-week-old arteritic AION, shows a well-defined area of infarction.
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15: Fluorescein fundus angiogram of a normal human eye, showing the sites of entry of the SPCAs and their course in the choroid.
Fig. 16
Fig. 17
Fig. 18: Diagrammatic representation of watershed zones between the four various vortex veins in rhesus monkeys.
Fig. 19
Fig. 20: Two illustrations demonstrating effect of reducing water pressure in eight garden sprinklers watering a lawn.
Fig. 21: Reticular pigmentary degeneration in the equatorial region of a patient with age-related macular degeneration.
Fig. 22: Fluorescein fundus angiograms of a rhesus monkey eye at the posterior pole.
Fig. 23
Fig. 24: Fluorescein photographs of anterior segment of an eye 21 h after occlusion of superior temporal and nasal vortex veins in a rhesus monkey (about 10 to 15 min after intravenous injection of fluorescein).
Fig. 25
Fig. 26: Photomicrograph of eye about 1 to 2 h after occlusion of all vortex veins, shows extensive choroidal and suprachoroidal haemorrhages.

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Funding

Supported by research grants from the British Medical Research Council, EY-1151, EY-1576, EY 3330 and RR-59 from the U.S. National Institutes of Health, in part by unrestricted grants from Research to Prevent Blindness, Inc., New York.

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  1. Departments of Ophthalmology and Visual Scence, College of Medicine, University of Iowa, Iowa City, 52242, USA

    Sohan Singh Hayreh

  2. (no affiliation), Iowa City, IA, USA

    Shelagh Bell Hayreh

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Hayreh, S.S., Hayreh, S.B. Uveal vascular bed in health and disease: lesions produced by occlusion of the uveal vascular bed and acute uveal ischaemic lesions seen clinically. Paper 2 of 2. Eye 37, 2617–2648 (2023). https://doi.org/10.1038/s41433-023-02417-y

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