Ophthalmic artery angioplasty improves choroidal thickness in subjects with geographic atrophy

Abstract

Purpose : The causal relationship between choroidal perfusion and the onset and progression of AMD remains unproven. However, the retinal pigment epithelium and outer retina are dependent on choroidal perfusion and involved in AMD, so it’s reasonable to assume that choroidal perfusion plays an important role. In this open-label study (NCT05091476) using ophthalmic artery (OA) angioplasty in the treatment of patients with geographic atrophy (GA) secondary to AMD, we investigated the relationship between ocular perfusion and choroidal thickness.

Methods : Patients ≥60 years old with ETDRS best-corrected visual acuity <56 letters (<20/80) due to GA were identified with OA stenoses and underwent an OA angioplasty per protocol. Spectral-domain optical coherent tomography imaging (SD-OCT, Spectralis; Heidelberg, Germany) was used to capture subfoveal choroidal thickness (SFChT). Horizontal 9mm horizontal line scans (ART=100) were obtained. The vertical subfoveal choroidal thickness (SFChT) measurements were from the hyperreflective line of Bruch’s membrane to the hyperreflective line of the choroid-scleral interface using the Heidelberg software caliper tool. All masked baseline measurements were performed by one of three ophthalmologist investigators with subsequent measurements for each subject made by the same investigator. The SFChT measurements were collected preoperatively and at weeks 1 and 4. A two-tailed, paired analysis was used to derive p-value.

Results : The first six consecutively treated subjects completed their week-4 visits and are reported here. Mean (SD) baseline SFChT was 138.5 (84.39), increasing to 155.8 (91.10), then 153.8 (88.36) at weeks 1 and 4, respectively (Figure 1). There was a statistically significant increase in SFChT (P=0.004) between baseline and week-4. Individual changes ranged from 9.92% – 22.73% and 5.37% – 22.73% at weeks 1 and 4, respectively (Figure 2); however, all subjects demonstrated increased SFChT over baseline.

Conclusions : In this small case series, preliminary evidence suggests that balloon angioplasty of the OA improved SFChT in subjects with GA secondary to AMD through postoperative week-4. Longer follow-up and additional patients are needed to determine if balloon angioplasty is a viable strategy to increase OA blood flow and choroidal perfusion.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.