Ophthalmic artery angioplasty for age-related macular degeneration

BackgroundThere is considerable overlap of contributors to cardiovascular disease and the development of age-related macular degeneration (AMD). Compromised ocular microcirculation due to aging and vascular disease contribute to retinal dysfunction and vision loss. Decreased choroidal perfusion is evident in eyes with dry AMD and is thought to play a role in retinal pigment epithelial dysfunction, the rate of development of geographic atrophy, and the development of neovascularization. The aim of the study was to demonstrate that AMD is correlated with a compromised blood flow in the ocular pathway and show OA angioplasty as a potential treatment of late-stage AMD.MethodsBased on the potential for the ophthalmic artery (OA) to be an anatomical target for the treatment of AMD as outlined above, five patients were found to be eligible for compassionate use treatment, presenting clinically significant late-stage AMD with profound vision loss in one or both eyes, and are included in this retrospective study.ResultsOA narrowing, or significant calcium burden at the ophthalmic segment of the internal carotid artery compromising the origin of the OA was confirmed in all cases. Subsequent OA cannulation was achieved in all patients with some difficulty. Subjective patient reports indicated that all patients perceived a benefit following the procedure; however, improved postoperative visual acuity did not confirm that perceived benefit for one of the patients.ConclusionsFeasibility and safety of the OA angioplasty were demonstrated, and a benefit perceived in five patients with profound vision loss and a desire to achieve improved quality of life. A clinical trial with controlled schedule, imaging, and methodologies is needed to confirm these results.

Doppler ultrasound features of ophthalmic artery in diabetic retinopathy in a Nigerian Teaching Hospital

Background: Diabetes mellitus is a metabolic disease characterized by elevated blood glucose level due to impaired insulin secretion, insulin action or both with diabetic retinopathy being the most common microangiopathic complication. A comparative, cross- sectional study aimed at evaluating Doppler blood flow indices in the ophthalmic artery in diabetic retinopathy and non-retinopathy patients when compared to normal controls in a Nigerian tertiary hospital.Methods: Data were collected over 7 months (April 2017-October 2017) in Lagos University Teaching Hospital, Idi-Araba Lagos, Nigeria. Sixty-five diabetic retinopathy patients, 65 diabetic patients without retinopathy and 65 non-diabetic controls had their ophthalmic artery Doppler indices assessed for comparison.Results: The end diastolic velocity (EDV) of the ophthalmic arteries in the diabetic patients were significantly lower than those of control group (EDV=5.84±2.59 cm/s, p<0.001 bilaterally). In diabetic patients with retinopathy, the end diastolic velocity of the ophthalmic arteries was significantly lower than those of diabetic patients without retinopathy (EDV=5.84±2.59 cm/s right eye, EDV=5.75±2.39 left eye, p<0.001 bilaterally). The resistivity index (RI) of the ophthalmic arteries was significantly higher in both diabetic patients with retinopathy and those without retinopathy compared to control group (RI=0.92±0.07 right eye, p=0.044 right eye, p<0.001 left eye) with resistivity index of diabetic retinopathy respondents significantly higher than the diabetic patients with no retinopathy.Conclusions: The study showed that Doppler is a useful screening parameter in identifying eyes at risk of developing sight threatening proliferative disease in diabetic patients. Significant differences exist in ophthalmic artery Doppler flow indices of diabetics with retinopathy compared to the healthy controls.