title: Microvascular structure and network in the retina of patients with ischemic stroke.
abstract: OBJECTIVE
  Microvascular disease has been implicated in the pathogenesis of stroke. The retina provides a window to assess microcirculation noninvasively. We studied the association between quantitatively measured retinal microvascular characteristics and acute ischemic stroke.
  
  
  METHODS
  We conducted a case-control study with acute ischemic stroke patients recruited from a tertiary hospital in Singapore and controls from the Singapore Epidemiology of Eye Disease program matched by 10-year age strata, sex, and race. Strokes were classified using modified Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Retinal vascular parameters were measured from retinal fundus photographs using a computer program. Logistic regression models for stroke were constructed adjusting for age, sex, race, and additionally for smoking, hypertension, diabetes mellitus, and hypercholesterolemia.
  
  
  RESULTS
  We included 557 ischemic stroke cases (261 lacunar, 185 large artery, and 54 cardioembolic stroke) and 557 controls. After adjusting for vascular risk factors, decreased arteriolar fractal dimension (odds ratio [OR] per standard deviation [SD] decrease, 2.28; 95% confidence interval [CI], 1.80-2.87) and venular fractal dimension (OR per SD decrease, 1.80; 95% CI, 1.46-2.23), increased arteriolar tortuosity (OR per SD increase, 1.56; 95% CI, 1.25-1.95), and venular tortuosity (OR per SD increase, 1.49; 95% CI, 1.27-1.76), narrower arteriolar caliber (OR per SD decrease, 2.79; 95% CI, 2.21-3.53), and wider venular caliber (OR per SD increase, 1.57; 95% CI, 1.27-1.95) were associated with stroke. Stratification by stroke subtypes and further adjustment for retinopathy signs revealed similar results.
  
  
  CONCLUSIONS
  Patients with ischemic stroke have a sparser and more tortuous microvascular network in the retina. These findings provide insight into the structure and pattern of microcirculation changes in stroke.
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Ong
authors.forename: Deidre A
authors.initials: DA
authors.lastname: De Silva
authors.forename: Carol Y
authors.initials: CY
authors.lastname: Cheung
authors.forename: Hui-Meng
authors.initials: HM
authors.lastname: Chang
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Chen
authors.forename: Meng Cheong
authors.initials: MC
authors.lastname: Wong
authors.forename: Tien Yin
authors.initials: TY
authors.lastname: Wong
authors.forename: Mohammad Kamran
authors.initials: MK
authors.lastname: Ikram
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000473:pathology*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D055806:Microvessels / Q000033:anatomy & histology* / Q000473:pathology; D008875:Middle Aged; D012160:Retina / Q000033:anatomy & histology* / Q000473:pathology; D012171:Retinal Vessels / Q000033:anatomy & histology* / Q000473:pathology; D042262:Retinoscopy / Q000379:methods*; D012307:Risk Factors; D012846:Singapore; D020521:Stroke / Q000473:pathology*
keywords: imaging; ischemic microvascular dysfunction; stroke