黄酮对眼部血流量和脉络膜新生血管的作用

目的:观察黄酮对兔眼部血流量和大鼠脉络膜新生血管(CNV)的作用。方法:在体研究中,我们采用彩色微球技术测定黄酮对兔眼部血流量的影响。预先给予5g/L黄酮滴眼液(3次/d),1wk后用激光诱导大鼠CNV的生成,在2和4wk末,采用荧光血管造影(FA)测量CNV面积。离体研究中,采用MTT法检测黄酮对人脐静脉内皮细胞(HUVECs)存活率的影响。结果:黄酮显著的增加了兔眼部血流量,抑制了由激光诱导的CNV的生成。离体研究结果表明,黄酮抑制了HU-VEC的增生。结论:黄酮能够增加眼部血流量,并且抑制CNV的生成。     

Effect of flavone on the ocular blood flow and formation of choroidal neovascularization

AIM: To investigate the effect of flavone on ocular blood flow in rabbit eyes and the formation of choroidal neovascularization (CNV) in rat model of age-related macular degeneration (AMD). METHODS: In in vivo studies, colored microsphere technique was used to determine the ocular blood flow in ocular hypertensive rabbit eyes. The rat eyes were treated with 0.5% flavone eye drops 3 times a day for 1 week before and 4 weeks after laser-induced injury of Bruch's membrane. The development of CNV was determined by fluorescein angiography (FA) performed on the 2nd and 4th after injury. In in vitro studies, the effect of flavone on the viability of human umbilical vein endothelial cells HUVECs was measured by MTT assay. RESULTS: The ocular blood flow in rabbit eyes was significantly increased after flavone instillation. Flavone significantly inhibited the formation of laser induced CNV. In vitro results showed that flavone inhibited the proliferation of HUVECs. CONCLUSION: Flavone could increase ocular blood flow and inhibit the formation of CNV.     

Quercetin inhibits choroidal and retinal angiogenesis in vitro

Background Quercetin is a natural substance found abundantly in grapes, red wine and other food products. In this study, we examined the effect of quercetin on choroidal and retinal angiogenesis in vitro using rhesus choroids-retina endothelial cell line (RF/6A). Methods RF/6A cells were cultured in Dulbecco’s Modified Eagle’s Medium (DMEM) containing 10% fetal bovine serum. Then cells were treated with different concentrations (from 0 to 100 μM) of quercetin. The cell proliferation was assessed using choromogenic methylthiazol tetrazolium bromide (MTT) dye after 24, 48 and 72 hours. Cell migration after 24-hour incubation with quercetin was investigated by wound assay. Following exposure to the various concentrations of quercetin for 24 hours, tube formation on matrigel by endothelial cells was also analyzed. Apoptosis was measured by flow cytometry using annexin V-FITC and propidium iodide staining. Results Quercetin inhibits endothelial cell proliferation in a dose-dependent fashion; 10.1%, 42.6% and 65.2% inhibition on treating with 10, 50 and 100 μM Quercetin respectively. The migration and tube formation of RA/6A cells were also significantly inhibited by quercetin in a dose-dependent manner. Flow cytometric analysis showed that the percentages of apoptotic cells were slightly increased only in 100 μM quercetin-treated cells. Conclusions Our results show that quercetin inhibits choroidal and retinal angiogenesis in vitro. Further studies are ongoing to evaluate this drug as a potential candidate for the treatment of choroidal or retinal neovascularization.     

Foveolar choroidal circulation and choroidal neovascularization in age-related macular degeneration

PURPOSE: To investigate in a longitudinal study whether foveolar choroidal blood flow changes are associated with the development of choroidal neovascularization (CNV) in AMD. METHODS: Relative foveolar choroidal blood velocity (ChBVel), volume (ChBVol), and flow (ChBFlow) were assessed in 135 patients with AMD, at baseline and then annually with laser Doppler flowmetry. All study eyes had visual acuity of 20/40 or better and no CNV at the time of enrollment. Comparison of foveolar choroidal circulatory measurements at baseline and their change before the development of CNV was made between eyes that had CNV and those that did not. RESULTS: CNV developed in 28 eyes during the study. Baseline average foveolar ChBVol and ChBFlow in these eyes were 24% (P < 0.0001) and 20% (P = 0.0007) lower than that observed in the 165 eyes in which CNV did not develop. In the eyes with CNV, foveolar ChBVol and ChBFlow decreased by 9.6% and 11.5% before the formation of CNV, whereas in the eyes that did not, they increased by 6.7% (P = 0.006) and 2.8% (P = 0.004), respectively. Eyes with lower baseline foveolar ChBFlow were more likely (risk ratio = 3.47, 95% CI: 1.24-8.70) to show visual loss of three or more lines than were eyes with a higher baseline ChBFlow (P = 0.005). CONCLUSIONS: The development of CNV and visual loss are associated with lower choroidal circulatory parameters at baseline. In addition, the results suggest that decreases in the foveolar choroidal circulation precede the development of CNV in AMD and may play some role in its development.     

Reduced foveolar choroidal blood flow in eyes with increasing AMD severity

PURPOSE: In an earlier study, the authors reported that foveolar choroidal blood flow (ChBFlow) decreases in patients with AMD and drusen. To explore further the choroidal circulatory changes in patients with AMD, the relationship between ChBFlow and fundus features associated with increased risk of choroidal neovascularization (CNV) were investigated. METHODS: The study included 26 control eyes of 17 normal subjects and 163 eyes with early AMD characteristics of 123 patients with AMD. The AMD study eyes were divided into three groups according to increasing risk for development of CNV: (1) drusen > or =63 microm, no RPE hyperpigmentary changes in the study eye, and no CNV in the fellow eye; (2) drusen > or =63 microm, RPE hyperpigmentary changes in the study eye, and no CNV in the fellow eye; and (3) eyes with CNV in the fellow eye. Laser Doppler flowmetry was used to assess relative foveolar choroidal blood velocity (ChBVel), volume (ChBVol), and flow (ChBFlow). Differences in the mean circulatory parameters were assessed by analysis of variance (ANOVA) and test of linear trend. RESULTS: Mean ChBVel, ChBVol, and ChBFlow decreased with increased risk for CNV (linear trend, P < 0.05). The lowest circulatory parameters were observed in the eyes with the highest risk for CNV development. Trends for ChBVel and ChBFlow were still significant after adjustment for multiple factors. CONCLUSIONS: There is a systematic decrease in choroidal circulatory parameters with an increase in the severity of AMD features associated with risk for the development of CNV, suggesting a role for ischemia in the development of CNV.     

Pigment epithelium-derived factor is deficient in the vitreous of patients with choroidal neovascularization due to age-related macular degeneration

PURPOSE: Pigment epithelium-derived growth factor (PEDF) is a potent inhibitor of angiogenesis that is found in the normal eye. The purpose of this study is to report decreased levels of PEDF in the vitreous of eyes with choroidal neovascularization (CNV) due to age-related macular degeneration (AMD). DESIGN: Prospective case-control study. METHODS: In a prospective case-control study, undiluted vitreous was collected from nine eyes of nine patients with CNV due to AMD and from an age-matched control group of 12 eyes of 12 patients with retinal disorders not involving neovascularization. Vitreous PEDF and vascular endothelial growth factor (VEGF) concentrations were determined by Western blot analyses and enzyme-linked immunosorbent assay (ELISA), respectively. Angiogenic activities of the vitreous samples were assessed in vitro using an endothelial cell chemotaxis assay. RESULTS: In vitreous samples from nine eyes with CNV due to AMD the mean +/- SD PEDF level was 2.8 ng/microl +/- 1.3 ng/microl. In vitreous samples from 12 age-matched control eyes the mean +/- SD PEDF level was 16.4 ng/microl +/- 7.1 ng/microl. The difference between the two groups was statistically significant (P =.00003). No significant difference in vitreous VEGF concentration was seen between CNV/AMD samples and control samples (P =.23). All CNV/AMD vitreous samples induced endothelial cell migration in vitro. No sample from age-matched non-age-related macular degeneration controls could induce endothelial cell migration, and 11 of 12 were able to block VEGF-induced migration in vitro. This inhibitory activity required active PEDF. CONCLUSION: The vitreous of patients with CNV due to AMD contained lower levels of PEDF and lacked the antiangiogenic activity of vitreous from age-matched controls. This suggests that loss of PEDF creates a permissive environment for CNV patients with AMD.     

Pulsatile ocular blood flow of choroidal neovascularization in asymmetric age-related macular degeneration after transpupillary thermotherapy

PURPOSE: A previous study has shown that the pulsatile ocular blood flow (POBF) in eyes with asymmetric age-related macular degeneration (AMD) differs. Whereas eyes with drusen have higher POBF than contralateral eyes with disciform scarring, the POBF of eyes with drusen is lower relative to contralateral eyes with choroidal neovascularization (CNV). This study was designed to assess whether the POBF of eyes with CNV changes after transpupillary thermotherapy (TTT), using the contralateral eyes with drusen or scarring without TTT as controls. METHODS: In total, 26 patients with CNV in one eye and drusen or scarring in the other were enrolled in this prospective case series. Eyes with CNV were treated with TTT. POBF was measured monthly in both eyes of each subject. RESULTS: Before TTT, the POBF of eyes with CNV was 1179+/-317 microl/min. After TTT, the POBF of CNV eyes had decreased at 1 month (1015+/-273 microl/min, P=0.002) and 2 months (945+/-398 microl/min, P=0.011) of follow-up, but had rebounded at 3 months (P=0.441) and 6 months (P=0.084). CONCLUSIONS: These findings suggest that TTT decreases the pulsatile choroidal blood flow in eyes with CNV in patients with asymmetric AMD and the effects persist for 2 months. POBF may be used as a modality to monitor the therapeutic effects of CNV in asymmetric exudative AMD.     

Color Doppler imaging of choroidal circulation in patients with asymmetric age-related macular degeneration

We aimed at evaluating the possible role of choroidal perfusion abnormalities in the development of choroidal neovascularisation (CNV) in patients with age-related macular degeneration (AMD). Twenty-six patients who had non-exudative AMD in the first eye and CNV secondary to AMD in the fellow eye were enrolled. Blood flow velocities, vessel pulsatilities and resistivities were measured from ophthalmic artery, nasal and temporal posterior ciliary arteries using colour Doppler imaging. Systolic and diastolic velocities were lower in eyes with CNV for all vessels, except for the systolic velocity of the nasal posterior ciliary artery (p >0.05). Pulsatility and resistivity indices were higher in eyes with CNV for all vessels. This difference was statistically significant for the resistivity index of the nasal and temporal posterior ciliary arteries (p = 0.032 and p = 0.021, respectively) and the pulsatility index of the nasal posterior ciliary artery (p = 0.035). We have shown that in patients with AMD choroidal blood flow is more impaired in the eyes with CNV than in the fellow eyes.     

Effect of Z,E-butylidedephthalide on experimental choroidal neovascularization in rat and ocular blood flow in rabbits

To investigate the effect of Z,E-butylidedephthalide (Bdph)on laser-induced experimental choroidal neovasculari- zation (CNV) in rat model and choroid blood flow in rabbits' eyes. · METHODS: Male Brown Norway rats were treated with Nd:YAG laser to break Bruch's membrane. 30mg/kg and 15mg/kg Bdph were given daily through intraperitoneal injection for 4 weeks after laser treatment. Fluorescein angiography (FA) and choroidal flat mount were used to measure the development of CNV. Female New Zealand white rabbits' eyes were instilled with 10g/L Z,E-BdPh solution, and ocular blood flow was measured with colored microsphere technique. · RESULTS: The intensity of fluorescein leakage, indicating the ocular lesion, decreased significantly in group Bdph 30mg/kg and 15mg/kg, as compared to the control at P <0.01. The area of neovascularization checked by FA in both groups of Bdph, at 30mg/kg and 15mg/kg decreased significantly compared to the control group at P <0.05. On the choroid flat mount, the areas of CNV were also smaller in both Bdph groups than that in control group. One percent drug solution instilled into rabbits' eyes could improve the choroid blood flow at 30 and 60 minutes after drug instillation (P <0.05). · CONCLUSION: Z,E-butylidedephthalide can inhibit the development of CNV in the rat eyes and increase the choroid blood flow in the rabbit eyes. These results suggest that Z,E-butylidedephthalide may be a good agent for the treatment of age-related macular degeneration (AMD).     

Pulsatile ocular blood flow in asymmetric exudative age related macular degeneration

BACKGROUND/AIMS: Decreased perfusion or increased vascular resistance of the choroidal vessels had been proposed as the vascular pathogenesis for age related macular degeneration (AMD). This study planned to answer the question whether pulsatile ocular blood flow (POBF) was different in patients with asymmetric exudative AMD between eyes with drusen, choroidal neovascularisation (CNV), or disciform scar. METHODS: 37 patients with asymmetric exudative AMD were enrolled in this observational case series study. POBF were measured in both eyes of each subject. Eyes with high myopia, anisometropia, recent laser treatment, and glaucoma were excluded. RESULTS: After adjusting for ocular perfusion pressure, intraocular pressure, and pulse rate, multivariate regression analysis with generalised estimating equation showed POBF was significantly higher in eyes with CNV (1217 (SD 476) microl/min) than the contralateral eyes with drusen (1028 (385) microl/min) (p = 0.024). Eyes with disciform scar had lower POBF than the contralateral eyes with drusen (999 (262) microl/min and 1278 (341) microl/min, respectively, p<0.001). There was no significant correlation between the POBF and the lesion size of the CNV. CONCLUSION: The POBF in eyes with drusen was lower than their fellow eyes with CNV, but higher than their fellow eyes with disciform scar. This finding suggests that haemodynamic differences between fellow eyes in individuals are relevant to the development of CNV and the formation of disciform scar. Further studies on the follow up patients might shed light on the pathogenesis of exudative AMD.     

Impaired expression of thrombospondin-1 in eyes with age related macular degeneration

AIMS: This study investigated the expression and localisation of thrombospondin-1 (TSP-1), a known anti-angiogenic extracellular matrix protein, in normal aged control human eyes and eyes with age related macular degeneration (AMD). METHODS: Immunohistochemical analysis with mouse anti-human TSP-1 antibody and mouse anti-human CD 34 antibody, as a blood vessel marker, was performed on frozen sections from macular and peripheral blocks of aged control donor eyes (n = 12; mean age 78.8 years), and eyes with AMD (n = 12; mean age 83.9 years). Pigment in retinal pigment epithelium (RPE) and choroidal melanocytes was bleached. Three independent observers scored the immunohistochemical reaction product. RESULTS: In the macular region, TSP-1 expression was observed intensely in Bruch's membrane and weakly in RPE basement membrane, choriocapillaris, and the wall of large choroidal blood vessels in the aged control eyes. In eyes with AMD, TSP-1 immunoreactivity was significantly lower in all structures except RPE basement membrane (p<0.01). There was significantly lower TSP-1 in the far periphery than the equator and submacular regions in all eyes. TSP-1 immunoreactivity was low in choroidal neovascularisation (CNV), but it was high and diffuse in adjacent scar tissue. CONCLUSION: These findings suggest that decreased TSP-1 in Bruch's membrane and choroidal vessels during AMD may permit the formation of CNV.     

Peroxisome proliferator-activated receptor-gamma ligands inhibit choroidal neovascularization

PURPOSE: To determine the antiangiogenic effects of peroxisome proliferator-activated receptor (PPAR)-gamma agonists on ocular cells involved in the pathogenesis of choroidal neovascularization (CNV) in vitro and on experimental laser photocoagulation-induced CNV in vivo. METHODS: PPAR-gamma expression in human retinal pigment epithelial (RPE) cells and bovine choroidal endothelial cells (CECs) was determined using an RNase protection assay and Western blot analysis. Two PPAR-gamma ligands, troglitazone (TRO) and rosiglitazone (RSG; 0.1-20 microM), were used to assess effects on RPE and CEC proliferation and migration and CEC tube formation in response to vascular endothelial growth factor (VEGF). The effects of intravitreal injection of TRO on laser photocoagulation-induced CNV lesions in rat eyes (15 experimental, 15 control, nine burns per eye) and cynomolgus monkey eyes (two experimental, two control, seven paramacular burns per eye) was assessed by fluorescein angiography and histologic evaluation. RESULTS. PPAR-gamma1 was expressed in both RPE and CEC. PPAR-gamma ligands significantly inhibited VEGF-induced migration and proliferation in both cell types and tube formation of CEC in a dose-response manner. CNV in rats was markedly inhibited by intravitreous injection of TRO (P < 0.001). Lesions showed significantly less fluorescein leakage and were histologically thinner in the TRO-treated animals. Similar findings were present in the TRO-treated lesions in two monkey eyes. The drug showed no apparent adverse effects in the adjacent retina or in control eyes. CONCLUSIONS: The inhibition of VEGF-induced choroidal angiogenesis in vitro, and CNV in vivo by PPAR-gamma ligands suggests the potential application of these agents in the large group of patients with age-related macular degeneration complicated by CNV.     

老年黄斑变性的药物治疗

在美国等发达国家中，老年黄斑变性(AMD)是65岁以上人群最主要的致盲原因。迄今为止，老年黄斑变性的治疗方法很有限。目前的治疗方法可以分为两大类：物理治疗和药物治疗。前者曾受到广泛关注却效果不显著，而后者近来发展迅速。药物治疗包括：光动力学治疗、激素、血管内皮生长因子VEGF的抑制药物、细胞外间质的修饰药物、基因治疗、营养补充和脉络膜血流促进药物等。光动力学治疗是某些特定类型的新生血管型AMD唯一有效的治疗方法。Anecortave acetate(一种人工合成的激素)球旁注射可以稳定患者的视力达6mo。玻璃体腔注射VEGF的拮抗药物，也能稳定患者的视力3mo。在AMD的早期就可发现脉络膜血流的改变。血管压力的增加是AMD重要的血流动力学改变，它导致了脉络膜毛细血管血流减少。经过一系列反应，最终导致视网膜色素上皮细胞变性、Bruch膜断裂、脉络膜新生血管形成、老年黄斑变性、失明。因此改善脉络膜血流的药物可能阻止AMD的发展和恶化。虽然这些药物还多处于试验阶段，但还是很有希望来发现治疗AMD的药物，从而阻止其发展。     

Effects of naringenin on ocular blood flow and choroidal neovascularization in experimental animals

AIM: To investigate the effects of naringenin on laser- induced experimental choroidal neovascularization (CNV) in rat models, ocular blood flow and retinal function recovery after ischemic insults in rat eyes. METHODS: Male Brown Norway rats were treated to break the Bruch's membrane. Naringenin 10g/L (20mg/kg) was given once per day through intraperitoneal injection for 4 weeks after laser treatment. The development of CNV was determined by fluorescein angiography (FA) performed on week 2 and 4. The colored microsphere technique and electroretinography method were used for the study of ocular blood flow and retinal function recovery, respectively. RESULTS: The choroidal blood flow in elevated intraocular pressure (IOP) rabbit eyes was significantly increased by 10g/L naringenin solution as compared to control group (P < 0.05). The retinal function recovery after ischemic insults in rat eyes indicated significant increase of b-wave recovery in treated group, as compared to control group (P <0.05). The intensity of fluorescein leakage from the photocoagulated lesions significantly decreased in treated group, compared to the control group (75.8%-95.0%, P <0.01). CONCLUSION: Naringenin could prevent the development of CNV on laser-induced experimental rat models, increase the choroidal blood flow in elevated IOP rabbit eyes and be beneficial on retinal function recovery in ischemic rat eyes.     

Targeted delivery of anti-angiogenic agent TNP-470 using water-soluble polymer in the treatment of choroidal neovascularization.

PURPOSE: The conjugation of drugs with water-soluble polymers such as poly(vinyl alcohol) (PVA) tends to prolong the half-life of drugs and facilitate the accumulation of drugs in tissues involving neovascularization. The purpose of this study was to evaluate the effect of TNP-470-PVA conjugate on the proliferation of endothelial cells in vitro and on experimental choroidal neovascularization (CNV) in vivo. METHODS: TNP-470 was conjugated in PVA by a dimethylaminopyridine-catalyzed reaction. The effects of TNP-470-PVA and free TNP-470 on the proliferation of human umbilical vein endothelial cells (HUVECs) and bovine retinal pigment epithelial cells (BRPECs) were evaluated by the tetrazolium-based colorimetric assay (XTT assay). Experimental CNV was induced by subretinal injection of gelatin microspheres containing basic fibroblast growth factor, into rabbits. Thirty rabbits were intravenously treated either with TNP-470-PVA (n = 8), free TNP470 (n = 5), free PVA (n = 5), or saline (n = 12) daily for 3 days, 2 weeks after implantation of gelatin microspheres. Fluorescein angiography was performed to detect the area with CNV, and the evaluation was made by computerized measurement of digital images. These eyes were also examined histologically. To observe the accumulation of conjugate, 3 rabbits with CNV received rhodamine B isothiocyanate-binding PVA (RITC-PVA), and the lesion was studied 24 hours later by fluorescein microscopy. RESULTS: The TNP-470-PVA inhibited the growth of HUVECs, similar to that of free TNP-470. The BRPECs were less sensitive to TNP-470-PVA than were the HUVECs. TNP-470-PVA significantly inhibited the progression of CNV in rabbits (P = 0.001). Histologic studies at 4 weeks after treatment demonstrated that the degree of vascular formation and the number of vascular endothelial cells in the subretinal membrane of the eyes treated with TNP-470-PVA were less than those of the control eyes. RITC-PVA remained in the area with CNV 24 hours after administration. CONCLUSIONS: These results suggest that TNP-470-PVA inhibited the proliferation of HUVECs more sensitively than that of BRPECs, and the targeted delivery of TNP-470-PVA may have potential as a treatment modality for CNV.     

吸烟对年龄相关性黄斑变性发生和发展的影响

年龄相关性黄斑变性(AMD)的视力损失多由视网膜色素上皮细胞的凋亡和光感受器的退化引起。主动、被动吸烟会增加AMD发病率及向晚期AMD进展的风险,并且影响湿性AMD的治疗效果。吸烟可引起脉络膜血管收缩、血管阻力增加、血管内皮功能障碍、脉络膜和神经节细胞复合体变薄,导致脉络膜和视网膜血管反应性受损。香烟中的尼古丁可导致血...     

D-Timolol和L-Timolol对大鼠脉络膜新生血管及内皮细胞的作用

目的:老年黄斑变性患者存在脉络膜血流灌注障碍.据此,我们推测血管活性药物,由于能减小脉络膜血流的阻力,可能会防止脉络膜新生血管的发展.D-Timolol和L-timolol是应用于心血管和青光眼治疗的降血压药物.本文旨在评价二者对激光诱发的大鼠脉络膜新生血管模型和人脐静脉内皮细胞(HUVEC)的作用.方法:雄性Brown Norway大鼠,麻醉下行Nd:YAG激光击穿Bruch膜.激光后,予D-Timo lo l和L-Timolol每日一次腹腔注射4wk.2wk末及4wk末时行荧光造影检查.观察不同浓度D-Timolol和L-Timolol对体外培养的HUVEC细胞增殖和黏附的影响.结果:在激光诱发的大鼠脉络膜新生血管模型中,予D-Timolol腹腔注射1 5mg/(Kg·d),可减少荧光渗漏的位点,至对照组的83%.而L-Timolol对脉络膜新生血管的形成没有影响,即使注射更高的治疗剂量20mg/(kg·d).D-Timolol 300mg/L可抑制内皮细胞的生长.L-Timolol在1 000mg/L可以显著抑制细胞的增殖,但在相对低的浓度300mg/L,则没有发现明显的抑制作用.在HUVEC细胞黏附的观察中,两者均未有显著的影响.结论:D-Timolol可减少激光诱发的脉络膜新生血管的形成,也能抑制血管内皮细胞的增殖.而L-Timolol在同样的浓度不影响内皮细胞的增殖,也不能影响大鼠脉络膜新生血管的形成.这两种同分异构体对动物模型和培养细胞的不同作用,可能对探索脉络膜新生血管的治疗有新的意义.     

年龄相关性黄斑变性黄斑部循环改变与脉络膜新生血管形成

目的探讨年龄相关性黄斑变性(age-relatedmaculardegeneration,AMD)黄斑部循环改变与脉络膜新生血管(choroidalneovascularization,CNV)形成的关系。方法对12例(24眼)首诊为萎缩型AMD,在随访中转变为渗出型AMD(16眼)的眼底荧光素血管造影(fundusfluorescenceangiography,FFA)及吲哚青绿血管造影(indocyaninegreenangiography,ICGA)图像进行回顾性分析,对比观察脉络膜循环变化。结果24只萎缩型AMD黄斑区脉络膜毛细血管层均有局限性灌注不良,16眼(67%)CNV在原脉络膜毛细血管灌注不良区域内生成。结论脉络膜灌注不良是CNV形成的主要原因。     

Macular microcirculation blood flow in patients with age related macular degeneration treated with photodynamic therapy and transpupillary thermotherapy

PURPOSE: To assess the macular retinal and choroidal microcirculation blood flow in patients with exudative age related macular degeneration before and after photodynamic therapy (PDT) or transpupillary thermotherapy (TTT) with Doppler laser scanning (HRF--Heidelberg retinal flowmeter). MATERIAL AND METHODS: Thirty patients with exudative age-related macular degeneration were included in a prospective study. The diagnosis was established based on ophthalmic examination and fluorescein angiography results. In all cases the subfoveal choroidal neovascularization (CNV) was present. Control group consists of the fellow eyes with early stage of AMD (19 eyes) or with disciform scar (11 eyes). In 15 eyes with active CNV PDT was performed and in remaining 15--TTT. In all cases the macular blood flow was measured with Heidelberg retina flowmeter (HRF) before therapy and then 1 week, 4 weeks and 10-12 weeks after treatment. RESULTS: At the baseline examination in a group of eyes with active CNV the mean values of macular blood flow were significantly higher comparing to the fellow eyes and reached respectively: 678.6 +/- 125.0 AU and 298.4 +/- 79.2 AU (p=0.001). Four weeks after treatment all eyes showed the reduction of macular blood flow comparing to the baseline values (p=0.001). Ten to twelve weeks after laser therapy in all cases the increased macular blood flow was detected comparing to the previous examination (p=0.01). During the follow-up period the macular blood flow in the fellow eyes were significantly lower than in treated eyes. CONCLUSIONS: The measurement of macular blood flow using Doppler scanning laser (HRF--Heidelberg retinal flowmeter) may act as a non-invasive and useful diagnostic tool in assessment of CNV activity in patients with exudative age-related degeneration before and after PDT or TTT.     

Decreased arterial dye-filling and venous dilation in the macular choroid associated with age-related macular degeneration

PURPOSE: To compare the angioarchitecture of choroidal arteries and veins in patients with age-related macular degeneration (AMD) to the angioarchitecture of age-matched normal subjects using indocyanine green (ICG) angiography. METHODS: ICG angiography was performed in 35 consecutive AMD patients and 18 normal age-matched volunteers with a fundus ICG camera. ICG video images, including the arterial and venous phases, were quantitatively analyzed using image analyzing software. RESULTS: In patients with AMD, the choroidal arterioles are dilated, fewer, run a straighter course, and possess fewer bifurcations. The number of choroidal arteries and the macular fluorescent intensity in the arterial phase of choroidal filling was significantly less in patients with AMD as compared to age-matched normal controls (P = 0.008). The mean and maximum caliber of choroidal veins in the macula was dilated in AMD eyes than in age-matched normal control eyes (P < 0.001). There was no statistically significant difference in arterial dye filling or venous caliber observed in AMD eyes, with or without choroidal neovascular membrane (CNV). CONCLUSION: Choroidal arterial perfusion in the macula was significant decreased in eyes with AMD with and without CNV, and was associated with choroidal venous dilation. These observations implicate poor choroidal perfusion of the macula in the pathogenesis of AMD.