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Observation of Erythrocyte Dynamics in the Retinal Capillaries and Choriocapillaris Using ICG-Loaded Erythrocyte Ghost Cells

¹From the Department of Ophthalmology, New York University School of Medicine, New York, New York; the ²Department of Ophthalmology, University of Maryland School of Medicine, Baltimore, Maryland; the ³LuEsther T. Mertz Retinal Research Center and ⁴The Macula Foundation, Manhattan Eye, Ear, and Throat Hospital, New York, New York; the ⁵Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy; ⁶Istituto di Chimica Biologica "G. Fornaini", Universtà degli Studi di Urbino "Carlo Bo," Urbino, Italy; and the ⁷Departments of Molecular Biology, ⁸Immunology, ⁹Cell Biology, and ¹⁰Genetics, Health Science Center of the University of North Texas, Fort Worth, Texas.

PURPOSE. To find evidence of retinal vasomotion and to examine the relationship between erythrocyte dynamics and previously observed high-frequency pulsatile blood flow through the choriocapillaris.

METHODS. An osmotic shock technique was used to encapsulate indocyanine green (ICG) dye in erythrocyte ghost cells at a concentration that produced maximum cell fluorescence. By obviating the plasma staining that results from aqueous ICG’s high affinity for plasma proteins, high contrast was maintained between reinjected ICG-loaded erythrocytes and their plasma background. High-speed, high-magnification ICG angiograms showing individual cell movement were recorded from the intact eyes of four monkeys and three rabbits for periods up to 30 seconds.

RESULTS. In monkey retinal perifoveal capillaries, numerous erythrocytes were seen to pause for as long as 20 seconds and then resume transit. Similar pausing behavior was observed in the subfoveal choriocapillaris. Individual erythrocytes also were seen to pause in the rabbits’ choriocapillaries below the medullary rays, where visualization of the cells was uninhibited by overlying retinal vasculature or dense pigment.

CONCLUSIONS. Reinjected ICG-loaded erythrocytes permit routine visualization of retinal capillary and choriocapillaris hemodynamics of the intact eye. It is speculated that erythrocyte-pausing in both microcirculations facilitates metabolic exchange across capillary walls. In retinal capillaries, pausing is presumed to result from vasomotion—which has been postulated as necessary for the inhibition of retinal edema—and in choriocapillaries, to result from the shifting distributions of local perfusion pressures within the network of capillary vessel segments that comprise each lobular area of the choriocapillaris vascular plexus.