1Michalk F., 1Werner D., 2Harazny J., 2Michelson G., 1Daniel W. G.

1II. Medical Clinic (Cardiology), Östliche Stadtmauerstr. 29; 2Eye Clinic, Schwabachanlage 6, Friedrich-Alexander-University, 91054 Erlangen, Germany

Objective: Intraaortic counterpulsation is an established therapy for coronary ischemia. Aim of this study was the assessment of the effects of the newer external counterpulsation on retinal ischemia in patients with retinal artery occlusion (RAO) or branch retinal artery occlusion (BRAO).
Methods: External counterpulsation devices (EECP, Vasomedical, Westbury, USA) operate by ECG-triggered diastolic compression of the vessels of the lower extremities. 10 patients suffering from RAO or BRAO (age of infarction: 2.8 ± 1.3 d) were treated by counterpulsation for two hours, interrupting previous medical therapy for this time. Before, immediately after and 48 h after EECP retinal capillary perfusion was measured by scanning-laser-doppler-flowmetry (in arbitrary units, AU) using the Heidelberg Retina Flowmeter. 7 further patients (age of infarction: 2.2 ± 1.8 d) without treatment by EECP were measured as controls using the same time intervals. Retinal areas were classified into three groups according to their initial perfusion (severely reduced perfusion: <100 AU, moderately reduced perfusion: 100-200 AU, nearly normal perfusion: >200 AU).
Results: The increase of perfusion was significantly higher after EECP compared with the non-counterpulsation-treated controls (100% vs 6 %, p<0.05) in retinal areas with severe ischemia. The table shows changes of perfusion in comparison to baseline measurement (** p < 0.01, * p < 0.05):

Conclusion: Reperfusion of ischemic retinal tissue after RAO/BRAO was significantly accelerated by two hours of EECP. The most distinct increase of reperfusion was in the retinal areas with initially severe ischemia.

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