Management of deep retinal capillary ischemia
Introduction
Transcription of the article from Springer Healthcare Limited published on June 16, 2019.
A study was conducted regarding the effectiveness of retinal electromagnetic stimulation and platelet-rich plasma in the treatment of deep retinal capillary ischemia.
Methods
The study included 28 eyes from 17 patients aged 15 to 76 years (mean age of 37.9 years) who had deep retinal capillary ischemia.
Patients with an acute-onset paracentral scotoma in the last month were enrolled in the study between January 2018 and January 2019.
The diagnosis of deep retinal capillary ischemia was based on clinical history and typical findings from optical coherence tomography angiography.
Subjects were divided into three groups:
- Group 1 (n = 7 eyes) received electromagnetic stimulation alone.
- Group 2 (n = 7 eyes) received electromagnetic stimulation and an injection of autologous platelet-rich sub-tenon plasma.
- Group 3 had no intervention and served as a control group (n = 14 eyes).
Patients underwent ten sessions of electromagnetic stimulation in Groups 1 and 2.
An injection of autologous platelet-rich sub-tenon plasma was performed immediately after the first, fifth, and tenth sessions of electromagnetic stimulation in Group 2.
Changes were assessed before and after treatment during the first month.
Results
The average deep retinal capillary density was 52.0% before electromagnetic stimulation and 56.1% after ten sessions of application in Group 1.
This improvement was statistically significant (p = 0.01).
In the combined treatment group, the average deep retinal capillary density was 46.9% before treatment and 56.5% after treatment; this increase was also statistically significant (p = 0.01).
Statistically significant improvement in best-corrected visual acuity (p = 0.01) could only be achieved in Group 2.
Combined treatment was significantly superior (p < 0.01) to treatment with only electromagnetic stimulation in terms of best-corrected visual acuity and deep retinal capillary density.
In the control group (Group 3), there was no statistically significant change (p = 0.09) in the average deep retinal capillary density and best-corrected visual acuity.
Conclusions
In conclusion, addressing the underlying cause is a priority in the treatment of deep retinal capillary ischemia.
However, in the acute period, localized treatment of ischemia is necessary to prevent permanent retinal damage and scotomas.
In mild cases, only non-invasive and easy-to-use electromagnetic stimulation may have a beneficial effect on deep retinal capillary density.
In more severe cases, a sub-tenon autologous platelet-rich plasma injection combined with electromagnetic stimulation may be more effective in the treatment of localized retinal ischemia to enhance the response.
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