Management of Deep Retinal Capillary Ischemia by Electromagnetic Stimulation and Platelet-Rich Plasma: Preliminary Clinical Results
To investigate the efficacy of retinal electromagnetic stimulation and sub-tenon autologous platelet-rich plasma in the treatment of deep retinal capillary ischemia.
The study included 28 eyes of 17 patients aged 15–76 years (mean 37.9 years) who had deep retinal capillary ischemia. Patients who had acute-onset paracentral scotoma in the last 1 month were included in the study between January 2018 and January 2019. The diagnosis of deep retinal capillary ischemia was based on clinical history and typical findings of optical coherence tomography angiography. The eyes were divided into three groups: group 1 (n = 7 eyes) received electromagnetic stimulation alone; group 2 (n = 7 eyes) received electromagnetic stimulation and sub-tenon autologous platelet-rich plasma injection; group 3 had no intervention and served as a control group (n = 14 eyes). The patients underwent ten sessions of electromagnetic stimulation in groups 1 and 2. Sub-tenon autologous platelet-rich plasma injection was performed immediately after the first, fifth, and tenth sessions of electromagnetic stimulation in group 2. The deep retinal capillary density and best corrected visual acuity changes were investigated before and after treatment at the first month.
The mean 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 (group 2), the mean deep retinal capillary density was 46.9% before the treatment and 56.5% after the treatment; this increase was also statistically significant (p = 0.01). Statistically significant best corrected visual acuity improvement (p = 0.01) could be achieved only in group 2. The combined treatment was significantly superior (p < 0.01) to treatment with only electromagnetic stimulation regarding 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 mean deep retinal capillary density and best corrected visual acuity.
Treatment of the underlying cause is a priority in the treatment of deep retinal capillary ischemia. However, in the acute period, local ischemia treatment is necessary to prevent permanent retinal damage and scotomas. In mild cases, only electromagnetic stimulation, which is non-invasive and easy to use, might have a beneficial effect on deep retinal capillary density. In more severe cases, sub-tenon fresh autologous platelet-rich plasma injection together with electromagnetic stimulation may be more effective in the treatment of local ischemia of the retina in order to augment the response.
The Rapid Service Fees were funded by the Ankara University Tecnopolis Institute.
Clinical Trial Registration
titck.gov.tr identifier, 2018-136.
KeywordsAcute macular neuroretinopathy Deep retinal capillary ischemia Electromagnetic stimulation Magnovision Ophthalmology Paracentral acute middle maculopathy Platelet-rich plasma
We thank the participants of the study.
No funding or sponsorship was received for this study and the Rapid Service Fees were funded by the Ankara University Tecnopolis Institute. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis.
All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.
Medical Writing Assistance
Medical writing and editorial assistance was provided by Ali Hariri from the American Manuscript Editors Company, which was funded by the authors.
Compliance with Ethics Guidelines
Ethics committee approval for the transcranial electromagnetic stimulation study was obtained from the Ankara University Faculty of Medicine Clinical Research Ethics Committee (17-1177-18) as well as and Review Board of the Drug and Medical Device Department within the Turkish Ministry of Health (2018-136). These committees had already approved the aPRP work (12-595-16 and 16-AKD-30). The study was performed in accordance with the tenets of the 1964 Declaration of Helsinki. Written informed consent was obtained from the patients prior to enrollment.
Emin Özmert and Umut Arslan have nothing to declare.
The datasets generated during and/or analysed during the study are available from the corresponding author on reasonable request.
- 24.Armulik A. Endothelial/pericyte interactions. Circ Res. 2005;97(6):512–23. https://doi.org/10.1161/01.res.0000182903.16652.d7.CrossRefGoogle Scholar
- 25.Benjamin LE, Hemo I, Keshet E. A plasticity window for blood vessel remodelling is defined by pericyte coverage of the preformed endothelial network and is regulated by PDGF-B and VEGF. Development. 1998;125:1591–8.Google Scholar
- 26.Arslan U, Özmert E, Demirel S, Örnek F, Şermet F. Effects of subtenon-injected autologous platelet-rich plasma on visual functions in eyes with retinitis pigmentosa: preliminary clinical results. Graefes Arch Clin Exp Ophthalmol. 2018;256(5):893–908. https://doi.org/10.1007/s00417-018-3953-5.CrossRefGoogle Scholar
- 28.Zhang N, Xing M, Wang Y, Tao H, Cheng Y. Repetitive transcranial magnetic stimulation enhances spatial learning and synaptic plasticity via the VEGF and BDNF–NMDAR pathways in a rat model of vascular dementia. Neuroscience. 2015;311:284–91. https://doi.org/10.1016/j.neuroscience.2015.10.038.CrossRefGoogle Scholar
- 32.Nikolaeva NV, Bolotova NV, Kamenskikh TG, Raĭgorodskiĭ IuM, Kolbenev IO, Luk’ianov VF. Transcranial magnetotherapy for the correction of initial manifestations of diabetic retinopathy in children. Vopr Kurortol Fizioter Lech Fiz Kult. 2009;3:25–8.Google Scholar
- 34.Heintz PH, Sandoval DJ, Chambers GD, Adolphi NL. Biological effects of magnetic resonance imaging. In: Kelsey CA, Heintz PH, Sandoval MS, et al., editors. Radiation biology of medical imaging. Hoboken: Wiley; 2018. p. 281–95.Google Scholar
- 36.Colafrancesco V, Coassin M, Rossi S, Aloe L. Effect of eye NGF administration on two animal models of retinal ganglion cells degeneration. Ann 1st Super Sanita. 2011;47:284–9.Google Scholar
- 38.Lambiase A, Mantelli F, Sacchetti M, Rossi S, Aloe L, Bonini S. Clinical applications of NGF in ocular diseases. Arch Ital Biol. 2011;149:283–92.Google Scholar
- 46.Bagattini C, Mazzi C, Savazzi S. Waves of awareness for occipital and parietal phosphenes perception. Neuropsychologia. 2015;70:114–25. https://doi.org/10.1016/j.neuropsychologia.2015.02.CrossRefGoogle Scholar
- 49.Drakon AK, Elfimov MA, Illarionov VE, Ivanova II, Portnov VV. Contemporary potential of nonmedical treatment in ophthalmology. Med Tr Prom Ekol. 2016;2:6–11.Google Scholar