University of Oulu

Erikson et al. Critical Care (2017) 21:86, DOI 10.1186/s13054-017-1676-3

Retinal arterial blood flow and retinal changes in patients with sepsis : preliminary study using fluorescein angiography

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Author: Erikson, Kristo1; Liisanantti, Janne Henrik1; Hautala, Nina2;
Organizations: 1Division of Intensive Care Medicine, Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Department of Anesthesiology, Oulu University Hospital, Medical Research Center Oulu, University of Oulu
2Department of Ophthalmology, Medical Research Center and PEDEGO Research Unit, University of Oulu and Oulu University Hospital
3Institute of Biomedicine and Biocenter of Oulu, University of Oulu
4Medical Research Center Oulu and Oulu University Hospital
5Department of Gastroenterology and Metabolism, Poznan University of Medical Sciences
6Department of Infection Control, Oulu University Hospital, Medical Research Center Oulu, University of Oulu
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
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Language: English
Published: Springer Nature, 2017
Publish Date: 2017-07-07


Background: Although tissue perfusion is often decreased in patients with sepsis, the relationship between macrohemodynamics and microcirculatory blood flow is poorly understood. We hypothesized that alterations in retinal blood flow visualized by angiography may be related to macrohemodynamics, inflammatory mediators, and retinal microcirculatory changes.

Methods: Retinal fluorescein angiography was performed twice during the first 5 days in the intensive care unit to observe retinal abnormalities in patients with sepsis. Retinal changes were documented by hyperfluorescence angiography; retinal blood flow was measured as retinal arterial filling time (RAFT); and intraocular pressure was determined. In the analyses, we used the RAFT measured from the eye with worse microvascular retinal changes. Blood samples for inflammation and cerebral biomarkers were collected, and macrohemodynamics were monitored. RAFT was categorized as prolonged if it was more than 8.3 seconds.

Results: Of 31 patients, 29 (93%) were in septic shock, 30 (97%) required mechanical ventilation, 22 (71%) developed delirium, and 16 (51.6%) had retinal angiopathies, 75% of which were bilateral. Patients with prolonged RAFT had a lower cardiac index before (2.1 L/kg/m² vs. 3.1 L/kg/m², P = 0.042) and during angiography (2.1 L/kg/m² vs. 2.6 L/kg/m², P = 0.039). They more frequently had retinal changes (81% vs. 20%, P = 0.001) and higher intraocular pressure (18 mmHg vs. 14 mmHg, P = 0.031). Patients with prolonged RAFT had lower C-reactive protein (139 mg/L vs. 254 mg/L, P = 0.011) and interleukin-6 (39 pg/ml vs. 101 pg/ml, P < 0.001) than those with shorter RAFT.

Conclusions: Retinal angiopathic changes were more frequent and cardiac index was lower in patients with prolonged RAFT, whereas patients with shorter filling times had higher levels of inflammatory markers.

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Series: Critical care
ISSN: 1364-8535
ISSN-E: 1466-609X
ISSN-L: 1364-8535
Volume: 21
Article number: 86
DOI: 10.1186/s13054-017-1676-3
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: This work was supported by an EVO grant from Oulu University Hospital.
Copyright information: © The Author(s). 2017. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.