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Vivian S Vuong, Steven Tran, Justin V Migacz, Iwona Gorczynska, David Cunefare, Sina Farsiu, Glenn Yiu; Effect of Sildenafil Citrate on Choroidal Thickness in Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2017;58(8):13.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate choroidal vascular compliance in age-related macular degeneration (AMD) by measuring choroidal thickness changes after a single-dose of oral sildenafil citrate.
Enhanced-depth optical coherency tomography (EDI-OCT) images were evaluated from 18 eyes of 9 adults with neovascular AMD in one eye and non-neovascular AMD in the other, at 1 and 3 hours after oral administration of 100mg sildenafil citrate. One patient also underwent OCT angiography(OCTA) of both eyes. Choroidal thickness was measured at the fovea and at 0.5mm intervals up to 1.5mm nasal and temporal to the fovea. One-way analysis of variance with Dunnett’s post-tests were used to compare choroidal thickness changes after sildenafil treatment.
The mean age of subjects was 76.2±6.5 years. Baseline choroidal thickness was 172.35μm±54.47μm and 192.62μm±92.15μm for eyes with non-neovascular and neovascular AMD, respectively. In eyes with neovascular AMD, choroidal thickness increased by 10.1%(19.35μm,P=0.005) at 1 hour and 11.5%(21.93μm,P=0.046) at 3 hours after oral sildenafil. In eyes with non-neovascular AMD, choroid thickness increased by 6.7%(11.61μm,P=0.059) and 11.9%(20.64μm,P=0.002) at 1 and 3 hours. There was no significant difference in choroidal thickness measurements between fellow eyes with non-neovascular versus neovascular AMD after oral sildenafil at any time point (P=0.198–0.560). Eyes with reticular pseudodrusen and geographic atrophy showed less choroidal thickening at 3 hours (P=0.019 and P=0.050), but number of prior anti-VEGF injections (P=0.148 at 1 hour,P=0.717 at 3 hours) did not impact choroidal response to sildenafil. OCTA showed up to 37% and 31% increase in choroidal vascular diameter within both Haller’s and Sattler’s layer in eyes with neovascular and non-neovascular AMD, respectively.
Sildenafil citrate increases choroidal thickness in both neovascular and non-neovascular AMD. Eyes with non-neovascular AMD demonstrate a slower rate of increase, particularly in the presence of reticular pseudodrusen and geographic atrophy, suggesting that reduced choroidal vascular compliance may play a role in the pathogenesis of some forms of AMD.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
OCTA images of choroidal thickness measurements at baseline and 3 hours after a single-dose of oral sildenafil citrate in an eye with (A) non-neovascular AMD and (B) the fellow eye with neovascular AMD. Yellow boxes indicate corresponding areas.
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