Treatment of Macular Degeneration with Sildenafil: Results of a Two-Year Trial

Overview

Journal Ophthalmologica

Publisher Karger

Specialty Ophthalmology

Date 2018 Apr 26

PMID 29694963

Citations 14

Authors

D Jackson Coleman

Winston Lee

Stanley Chang

Ronald H Silverman

Harriet O Lloyd

Suzanne Daly

Stephen H Tsang

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate PDE5/6 inhibition with sildenafil to reduce choroidal ischemia and treat age-related macular degeneration.

Methods: Sildenafil was prescribed to treat participants with macular degenerations or macular dystrophies measured by spectral-domain optical coherence tomography, color fundus photography, enhanced depth imaging, and best-corrected visual acuity.

Results: No change in calcified drusen was noted. Vitelliform-type soft drusen were not substantially changed. A participant with Best vitelliform macular dystrophy had a significant improvement in vision as well as in photoreceptor and ellipsoid layers.

Conclusions: Our research supports sildenafil as a safe treatment for age-related and vitelliform macular degenerations. Thickened Bruch's membrane reduces the beneficial effect of perfusion increase, but all eyes appear to benefit from PDE6. Notably, maintenance or improvement in the photoreceptor layer may be the most significant result of sildenafil and is consistent with PDE6 inhibition. Thus, sil-denafil treatment of macular degeneration offers significant potential for vision retention and recovery.

Citing Articles

Color Doppler Imaging, Endothelin-1, Corneal Biomechanics and Scleral Rigidity in Asymmetric Age-Related Macular Degeneration.

Finzi A, Ottoboni S, Cellini M, Corcioni B, Gaudiano C, Fontana L Clin Ophthalmol. 2024; 18:2583-2591.

PMID: 39281979 PMC: 11401527. DOI: 10.2147/OPTH.S479225.

Chronic sildenafil citrate use decreases retinal vascular endothelial growth factor expression in diabetic rats: a pilot study.

Sorour O, Nassar E, Sarhan N, El-Anwar N, Elkholy R, Tahoon D Int J Retina Vitreous. 2023; 9(1):42.

PMID: 37460929 PMC: 10351124. DOI: 10.1186/s40942-023-00480-x.

Multimodal imaging in Best Vitelliform Macular Dystrophy: Literature review and novel insights.

Bianco L, Arrigo A, Antropoli A, Berni A, Saladino A, Vilela M Eur J Ophthalmol. 2023; 34(1):39-51.

PMID: 36972471 PMC: 10757402. DOI: 10.1177/11206721231166434.

Chronic Central Serous Chorioretinopathy with Pigment Epithelium Detachment Treated with Sildenafil: A Case Report.

Finzi A, Valsecchi N, Tassi F, Cellini M, Fontana L Case Rep Ophthalmol. 2023; 13(3):692-699.

PMID: 36845460 PMC: 9944586. DOI: 10.1159/000524992.

Optical Coherence Tomography-Based Choroidal Structural Analysis and Vascularity Index in Best Vitelliform Macular Dystrophy.

Wei X, Roy R, Saurabh K, Sen P, Bhende M, Shelke K Ophthalmol Ther. 2022; 11(6):2141-2152.

PMID: 36153433 PMC: 9587204. DOI: 10.1007/s40123-022-00567-y.

References

Chen J, Fitzke F, Pauleikhoff D, Bird A . Functional loss in age-related Bruch's membrane change with choroidal perfusion defect. Invest Ophthalmol Vis Sci. 1992; 33(2):334-40. View

Lin M, Kim S, Zhang L, Tsai Y, Tsang S . Rod metabolic demand drives progression in retinopathies. Taiwan J Ophthalmol. 2017; 5(3):105-108. PMC: 5602704. DOI: 10.1016/j.tjo.2015.06.002. View

Chew E, Clemons T, Agron E, Sperduto R, SanGiovanni J, Davis M . Ten-year follow-up of age-related macular degeneration in the age-related eye disease study: AREDS report no. 36. JAMA Ophthalmol. 2014; 132(3):272-7. PMC: 11551520. DOI: 10.1001/jamaophthalmol.2013.6636. View

Chalam K, Sambhav K . Optical Coherence Tomography Angiography in Retinal Diseases. J Ophthalmic Vis Res. 2016; 11(1):84-92. PMC: 4860994. DOI: 10.4103/2008-322X.180709. View

Bird A . Doyne Lecture. Pathogenesis of retinal pigment epithelial detachment in the elderly; the relevance of Bruch's membrane change. Eye (Lond). 1991; 5 ( Pt 1):1-12. DOI: 10.1038/eye.1991.2. View

Cordell W, Maturi R, Costigan T, Marmor M, Weleber R, Coupland S . Retinal effects of 6 months of daily use of tadalafil or sildenafil. Arch Ophthalmol. 2009; 127(4):367-73. DOI: 10.1001/archophthalmol.2009.36. View

Flower R, von Kerczek C, Zhu L, Ernest A, Eggleton C, Topoleski L . Theoretical investigation of the role of choriocapillaris blood flow in treatment of subfoveal choroidal neovascularization associated with age-related macular degeneration. Am J Ophthalmol. 2001; 132(1):85-93. DOI: 10.1016/s0002-9394(01)00872-8. View

Hayreh S . Ischemic optic neuropathy. Prog Retin Eye Res. 2008; 28(1):34-62. DOI: 10.1016/j.preteyeres.2008.11.002. View

Urs R, Ketterling J, Silverman R . Ultrafast Ultrasound Imaging of Ocular Anatomy and Blood Flow. Invest Ophthalmol Vis Sci. 2016; 57(8):3810-6. PMC: 5015817. DOI: 10.1167/iovs.16-19538. View

10.

Laties A . Vision disorders and phosphodiesterase type 5 inhibitors: a review of the evidence to date. Drug Saf. 2009; 32(1):1-18. DOI: 10.2165/00002018-200932010-00001. View

11.

Kim D, Silverman R, Chan R, Khanifar A, Rondeau M, Lloyd H . Measurement of choroidal perfusion and thickness following systemic sildenafil (Viagra(®) ). Acta Ophthalmol. 2012; 91(2):183-8. PMC: 3528845. DOI: 10.1111/j.1755-3768.2011.02305.x. View

12.

Okawa H, Sampath A, Laughlin S, Fain G . ATP consumption by mammalian rod photoreceptors in darkness and in light. Curr Biol. 2008; 18(24):1917-21. PMC: 2615811. DOI: 10.1016/j.cub.2008.10.029. View

13.

Galie N, Ghofrani H, Torbicki A, Barst R, Rubin L, Badesch D . Sildenafil citrate therapy for pulmonary arterial hypertension. N Engl J Med. 2005; 353(20):2148-57. DOI: 10.1056/NEJMoa050010. View

14.

Kurihara T, Westenskow P, Gantner M, Usui Y, Schultz A, Bravo S . Hypoxia-induced metabolic stress in retinal pigment epithelial cells is sufficient to induce photoreceptor degeneration. Elife. 2016; 5. PMC: 4848091. DOI: 10.7554/eLife.14319. View

15.

Harris A, Kagemann L, Ehrlich R, Ehrlich Y, Lopez C, Purvin V . The effect of sildenafil on ocular blood flow. Br J Ophthalmol. 2008; 92(4):469-73. DOI: 10.1136/bjo.2007.131789. View

16.

Friedman E, Oak S . Choroidal microcirculation in vivo. Bibl Anat. 1965; 7:129-32. View

17.

Grunwald J, Siu K, Jacob S, Dupont J . Effect of sildenafil citrate (Viagra) on the ocular circulation. Am J Ophthalmol. 2001; 131(6):751-5. DOI: 10.1016/s0002-9394(00)00944-2. View

18.

Marmor M, Kessler R . Sildenafil (Viagra) and ophthalmology. Surv Ophthalmol. 1999; 44(2):153-62. DOI: 10.1016/s0039-6257(99)00079-x. View

19.

Kurtulan E, Gulcu A, Secil M, Celebi I, Aslan G, Esen A . Effects of sildenafil on ocular perfusion demonstrated by color Doppler ultrasonography. Int J Impot Res. 2004; 16(3):244-8. DOI: 10.1038/sj.ijir.3901189. View

20.

Vance S, Imamura Y, Freund K . The effects of sildenafil citrate on choroidal thickness as determined by enhanced depth imaging optical coherence tomography. Retina. 2010; 31(2):332-5. DOI: 10.1097/IAE.0b013e3181eef0ae. View