Angiogenesis 2023: Using ophthalmic artery angioplasty to treat AMD

A team of investigators reported that ophthalmic artery angioplasty could prove to be a safe and novel treatment with subjective evidence of efficacy for patients diagnosed with age-related macular degeneration (AMD).

A team of investigators reported that ophthalmic artery angioplasty could prove to be a safe and novel treatment with subjective evidence of efficacy for patients diagnosed with age-related macular degeneration (AMD).

Pedro Lylyk, MD, and colleagues from the Instituto Medico Eneri-Clinica Sagrada Familia, ENERI, Buenos Aires, and the Centro Oftalmológico Dr. Daniel Charles S.A, Buenos Aires, Argentina, reported their results at Bascom Palmer’s 2023 Angiogenesis, Exudation, and Degeneration meeting in Miami.

The rationale for this treatment approach, they explained, is that compromised ocular microcirculation due to aging and vascular disease in AMD contributes to retinal dysfunction and visual loss; decreased choroidal perfusion is evident in eyes with dry AMD.

The researchers conducted a study to evaluate if a dysfunctional ophthalmic artery contributes to decreased retinal perfusion in eyes with AMD. A 7T magnetic resonance imaging instrument and a custom-built 32-channel head receive-array coil with a birdcage transmit coil non-invasively captured hemodynamic data from both arteries.

Five patients with late-stage AMD, i.e., geographic atrophy or a history of choroidal neovascularization, were treated under compassionate use. The patients had a best-corrected visual acuity (BCVA) of 20/400 or worse. Patients also underwent computed tomography to precisely locate the ophthalmic artery origin and its relationship with an atheroma plaque nearby or in the artery.

The investigators reported that balloon angioplasty was successfully performed in all patients.

“Subjective patient reports indicated all patients perceived a benefit after the procedure; however, improved postoperative VA did not confirm that perceived benefit for 1 patient,” they commented.

The mean preoperative BCVA was 20/710 and improved to 20/383 at 1 week postoperatively, for a mean gain of nearly 3 lines. The improvement remained stable through month 6 postoperatively.

In commenting on their results, they said that the ophthalmic arteries of these patients with AMD had a significant decrease in the lumen diameter (p = 0.006) and volumetric flow rates (p = 0.041), and an increased resistive index (p < 0.001), which measures dynamic flow properties, compared to age-matched controls without AMD.

“These findings indicate that the changes in or around the ophthalmic artery may contribute to decreased retinal perfusion in patients with AMD and present a potential treatment target in a patient population for whom there are no therapeutic options,” the investigators said.

In addition to safety and subjective efficacy, the investigators pointed out, the OA is a viable target to increase blood flow to the eye, restore retinal perfusion, and perhaps disrupt the disease process of AMD. They suggested that specific devices for this treatment should be developed.