Department of Interventional Neuroradiology, Instituto Medico ENERI, Buenos Aires, Argentina
Department of Interventional Neuroradiology, Instituto Medico ENERI, Buenos Aires, Argentina.
J Neurointerv Surg. 2022 Oct;14(10):968-972. doi: 10.1136/neurintsurg-2021-018222. Epub 2022 Jan 5.
There 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.
Based 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.
OA 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.
Feasibility 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.
心血管疾病和年龄相关性黄斑变性（AMD）的发生有很大的重叠。由于衰老和血管疾病导致的眼部微循环受损会导致视网膜功能障碍和视力丧失。干性 AMD 患者的脉络膜灌注减少，这被认为在视网膜色素上皮功能障碍、局灶性萎缩的发展速度以及新生血管形成中起作用。本研究旨在证明 AMD 与眼部血流受损有关，并表明 OA 血管成形术可能是晚期 AMD 的潜在治疗方法。
基于如上所述的眼动脉（OA）作为 AMD 治疗的解剖学靶标这一潜在可能性，发现了五名符合同情使用治疗条件的患者，这些患者的单眼或双眼均出现临床意义上的晚期 AMD，视力严重下降，包括在这项回顾性研究中。
所有病例均证实 OA 狭窄，或颈内动脉眼段的大量钙负荷导致 OA 的起源处狭窄。所有患者均随后成功进行了 OA 插管，但存在一定难度。主观的患者报告表明，所有患者在手术后都感觉到了受益；然而，一名患者的术后视力改善并未证实这种感知到的受益。
OA 血管成形术具有可行性和安全性，五名视力严重下降且渴望提高生活质量的患者受益。需要进行一项具有对照方案、影像学和方法学的临床试验来确认这些结果。
