Choroidal volume is reduced along aging. Choroidal perfusion is decreased by 37% in AMD (Grunwald JE1998) (1) Choroidal thickness is reduced by 50% (EDI-OCT study-Spaide RF 2009) (2) Vortex Veins Occlusion (VVO) might restaure choriocapillaris perfusion. (Hayreh SS 1982, experiments in the Rhesus monkey) (3) and (Bonnet M 1985, surgery in 17 human eyes with AMD) (4). The goal of the study was to evaluate the choroidal perfusion after VVO.

Material and Methods:

Video cine ICG angiograms were performed (SD OCT HRA2) in 4 eyes of 4 patients, before and after VVO . 2 eyes had geographic atrophy, 1 eye presented confluent retrofoveal drusen and 1 eye had pseudo vitelliform dystrophy.

Results:

(videos)

New venous drainage routes with visible pulsations were observed in all eyes. Dense vascular fillings were observed in areas previously hypo perfused. A New drainage was demonstrated in all eyes in the territory of a Vortex Veins that had not been occluded.

Conclusion:

VVO might be able to induce partial reversibility of the rheological disturbances in AMD. VVO might prove the only therapeutics currently available to delay the natural course of the disease in those cases where the vascular factor is a starter, and/or a leading factor.

Literature

(1) Grunwald JE, Hariprasad SM, Dupont JC, et al. Foveal choroidal blood flow in age-related macular degeneration. Invest Ophthalmol Vis Sci 1998;39: 385-90.)

(2) Spaide RF Age-related choroidal atrophy. Am J Ophthalmol 2009 May;147(5):801-10

(3) Hayreh SS, Chopdar A. Occlusion of the posterior ciliary artery. V. Protective influence of simultaneous vortex vein occlusion. Arch Ophthalmol 1982 Sept;100(9):1481-91.,

(4) Bonnet M. Occlusion of two vortex vein in the treatment of senile disciform macular degeneration. J Fr Ophtalmol 1985;8(12):779-783