Effects of photodynamic therapy on subfoveal blood flow in neovascular age-related macular degeneration patients.

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 microm (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.

Cavernous sinus fistula treated through the transvenous approach: report of four cases.

PURPOSE: To describe transvenous embolization in four patients with indirect dural carotid cavernous fistulas (CCFs) via the inferior petrosal sinus (IPS) or superior ophthalmic vein (SOV), and their clinical outcomes. METHODS: The CCF approach was performed after retrograde venous catheterization from the femoral vein to the cavernous sinus via the IPS (n=1) or SOV (n=3). SOV catheterization was possible without surgical intervention. All patients presented initially with typical clinical signs of CCF. Patients treated via the SOV presented with thrombosis of the IPS. RESULTS: Catheterization and embolization were successful in all patients, with complete angiographic occlusion of the fistula. No early or late complications occurred. All patients presented with favorable clinical outcomes and complete recovery of ocular symptoms. CONCLUSION: Retrograde transvenous embolization of CCF via the IPS, or SOV if the IPS is thrombosed, is a safe procedure with a good clinical outcome.