Abstract
Aim
To assess the short-term changes in choroidal blood flow (ChBF) after photodynamic therapy (PDT) in patients with neovascular age-related macular degeneration (AMD).
Methods
Fourteen patients with exudative AMD were included after a complete ophthalmological examination, fluorescein and indocyanine green angiography and optical coherence tomography. Subfoveal ChBF was assessed using laser Doppler flowmetry (LDF) in both treated (n=14) and nontreated contralateral (n=8) eyes, 1 h and 1 week after PDT. Ocular perfusion pressure was calculated.
Results
The detection sensitivity of the LDF measurements at 2-min intervals before PDT in treated eyes was 7.4% for volume, 6.3% for velocity, and 10.4% for ChBF. The initial mean visual acuity was 0.68±0.3 logMar. Macular thickness at baseline as measured by OCT3 was at median (interquartile range), 326.5 μm (188–367). At 1 h and 7 days after PDT, a significant increase in velocity (15.8 and 24.4%, respectively) and a significant decrease in volume (11 and 17.9%, respectively) were noted in treated eyes. Choroidal blood flow and ocular perfusion pressure (OPP) remained similar during follow-up. No significant change in flow parameters was reported in untreated eyes.
Conclusion
The LDF technique provides feasible and reliable measurements of blood flow parameters before and after PDT in a selective population of patients with exudative AMD. The prognostic value of these early blood flow parameter changes also needs to be assessed.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Buch H, Nielsen NV, Vinding T, Jensen GB, Prause JU, la Cour M . 14-year incidence, progression, and visual morbidity of age-related maculopathy: the Copenhagen City Eye Study. Ophthalmology 2005; 112 (5): 787–798.
Smith BT, Joseph DP, Grand MG . Treatment of neovascular age-related macular degeneration: past, present and future directions. Curr Opin Ophthalmol (Review) 2007; 18 (3): 240–244.
Gelisken F, Lafaut BA, Inhoffen W, Voelker M, Grisanti S, Bartz-Schmidt KU . Clinicopathological findings of choroidal neovascularisation following verteporfin photodynamic therapy. Br J Ophthalmol 2004; 88 (2): 207–211.
Schmidt-Erfurth U, Laqua H, Schlotzer-Schrehard U, Viestenz A, Naumann GO . Histopathological changes following photodynamic therapy in human eyes. Arch Ophthalmol 2002; 120 (6): 835–844.
Michels S, Schmidt-Erfurth U . Sequence of early vascular events after photodynamic therapy. Invest Ophthalmol Vis Sci 2003; 44 (5): 2147–2154.
Husain D, Kramer M, Kenny AG, Michaud N, Flotte TJ, Gragoudas ES et al. Effects of photodynamic therapy using verteporfin on experimental choroidal neovascularization and normal retina and choroid up to 7 weeks after treatment. Invest Ophthalmol Vis Sci 1999; 40 (10): 2322–2331.
Geiser M, U Diermann, Riva CE . Compact laser Doppler choroidal flowmeter. J Biomed Opt 1999; 4 (4): 459–464.
Bonner RF, Nossal R . Principles of laser doppler flowmetry. In: Shepherd AP, Öberg PA (eds). Developments in Cardiovascular Medicine: Laser Doppler Blood Flowmetry. Kluwer Academic Publishers: Boston, 1990, pp 73–92.
Aveline B, Hasan T, Redmond RW . Photophysical and photosensitizing properties of benzoporphyrin derivative monoacid ring A (BPD-MA). Photochem Photobiol 1994; 59 (3): 328–335.
Bill A, Nilsson SF . Control of ocular blood flow. J Cardiovasc Pharmacol 1985; 7 (Suppl 3): S96–S102. (review).
Kubicka-Trzaska A . Macular microcirculation blood flow in patients with age related macular degeneration treated with photodynamic therapy and transpupillary thermotherapy. Klin Oczna 2007; 109 (4–6): 138–141.
Gugleta K, Orgul S, Flammer I, Gherghel D, Flammer J . Reliability of confocal choroidal laser Doppler flowmetry. Invest Ophthalmol Vis Sci 2002; 43 (3): 723–728.
Lovasik JV, Kergoat H, Riva CE, Petrig BL, Geiser M . Choroidal blood flow during exercise-induced changes in the ocular perfusion pressure. Invest Ophthalmol Vis Sci 2003; 44 (5): 2126–2132.
Longo A, Geiser MH, Riva CE . Posture changes and subfoveal choroidal blood flow. Invest Ophthalmol Vis Sci 2004; 45 (2): 546–551.
Pournaras CJ, Logean E, Riva CE, Petrig BL, Chamot SR, Coscas G et al. Regulation of subfoveal choroidal blood flow in age-related macular degeneration. Invest Ophthalmol Vis Sci 2006; 47 (4): 1581–1586.
Figueroa M, Schocket LS, DuPont J, Metelitsina TI, Grunwald JE . Long-term effect of laser treatment for dry age-related macular degeneration on choroidal hemodynamics. Am J Ophthalmol 2006; 141 (5): 863–867.
Grunwald JE, Hariprasad SM, DuPont J, Maguire MG, Fine SL, Brucker AJ et al. Foveolar choroidal blood flow in age-related macular degeneration. Invest Ophthalmol Vis Sci 1998; 39 (2): 385–390.
Grunwald JE, Metelitsina TI, Dupont JC, Ying GS, Maguire MG . Reduced foveolar choroidal blood flow in eyes with increasing AMD severity. Invest Ophthalmol Vis Sci 2005; 46 (3): 1033–1038.
Metelitsina TI, Grunwald JE, DuPont JC, Ying GS . Effect of niacin on the choroidal circulation of patients with age related macular degeneration. Br J Ophthalmol 2004; 88 (12): 1568–1572.
Metelitsina TI, Grunwald JE, DuPont JC, Ying GS . Effect of Viagra on the foveolar choroidal circulation of AMD patients. Exp Eye Res 2005; 81 (2): 159–164.
Michels S, Hansmann F, Geitzenauer W, Schmidt-Erfurth U . Influence of treatment parameters on selectivity of verteporfin therapy. Invest Ophthalmol Vis Sci 2006; 47 (1): 371–376.
Costa RA, Farah ME, Cardillo JA, Calucci D, Williams GA . Immediate indocyanine green angiography and optical coherence tomography evaluation after photodynamic therapy for subfoveal choroidal neovascularization. Retina 2003; 23 (2): 159–165.
Ozdemir H, Karacorlu SA, Karacorlu M . Early optical coherence tomography changes after photodynamic therapy in patients with age-related macular degeneration. Am J Ophthalmol 2006; 141 (3): 574–576.
Riva CE, Harino S, Petrig BL, Shonat RD . Laser Doppler flowmetry in the optic nerve. Exp Eye Res 1992; 55 (3): 499–506.
Uhlmann S, Friedrichs U, Eichler W, Hoffmann S, Wiedemann P . Direct measurement of VEGF-induced nitric oxide production by choroidal endothelial cells. Microvasc Res 2001; 62 (2): 179–189.
Schmidt-Erfurth U, Schlotzer-Schrehard U, Cursiefen C, Michels S, Beckendorf A, Naumann GO . Influence of photodynamic therapy on expression of vascular endothelial growth factor (VEGF), VEGF receptor 3, and pigment epithelium-derived factor. Invest Ophthalmol Vis Sci 2003; 44 (10): 4473–4480.
Grunwald JE, Iannaccone A, DuPont J . Effect of isosorbide mononitrate on the human optic nerve and choroidal circulations. Br J Ophthalmol 1999; 83 (2): 162–167.
Luksch A, Polak K, Beier C, Polska E, Wolzt M, Dorner GT . Effects of systemic NO synthase inhibition on choroidal and optic nerve head blood flow in healthy subjects. Invest Ophthalmol Vis Sci 2000; 41 (10): 3080–3084.
Acknowledgements
This study was supported by a grant from University Hospital of Grenoble, France (CHU de Grenoble, Innovations Hospitalières 2005).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Vinh Moreau-Gaudry, V., Geiser, M., Romanet, J. et al. Effects of photodynamic therapy on subfoveal blood flow in neovascular age-related macular degeneration patients. Eye 24, 706–712 (2010). https://doi.org/10.1038/eye.2009.130
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/eye.2009.130
