Our
controlled case describes the drug possibility to stabilize
the exudative form of Age-related Macular Degeneration. The
new approach of selective destruction of choroidal neovascularization
(CNV) can be applied in patients with subfoveal lesions. Photodynamic
therapy (PDT) is based on the reaction of photoactivable drug
with the light of low-energy laser beam. So far only verteporfin
[Visudyne, Novartis] as sensitizer is marketed and laser with
wavelength of 689 nm is used. But it is questionable whether
to apply this very costly treatment to extremely old people.
An example of treatment of 90–year old woman with AMD
with classic form of CNV is presented. Her BCVA was 0.05 OD.
She underwent four session of PDT. At the last visit (eighteen
months after initial and ten months after last session of
PDT) the BCVA remained 0.05 OD. The patient is using a special
magnifying lens for reading achieving near vision of 0.32.
The presented example indicates the necessity of detailed
study of every case to promote the therapeutic decisions for
the benefit of progress in the field.
In
developed countries the Age-related Macular Degeneration (AMD)
is the most frequent cause of severe central visual loss among
people older than 65 years (1). There are two forms of AMD:
the dry and the wet. The slowly progressive dry (non-vascular)
form accounts for about 90% of all cases. It is characterized
by abnormalities of the retinal pigment epithelium (drusen,
atrophy, hypopigmentation or hyperpigmentation). The wet or
neovascular AMD (about 10% of all cases) is characterized by
choroidal neovascularisation (CNV) (1). New vessels from the
choriocapillaris proliferate through breaks in Bruch's membrane
under the retinal pigment epithelium and further grow into the
subretinal space. This process can lead to subretinal hemorrhage,
detachment of the retinal pigment epithelium and the neurosensory
retina. The formation of a fibrovascular scar follows. The wet
form is frequently devastating and in some cases vision may
be lost within a few weeks.
So far there is no treatment possibility for patients with the
dry form of AMD. For patients with the wet form there are two
possibilities: photocoagulation or photodynamic therapy (PDT).
Laser photocoagulation of CNV causes nonselective thermal tissue
destruction. It destroys not only surrounding choriocapillaris,
but also retinal pigment epithelium and adjacent photoreceptors.
This leads to an absolute scotoma at the area of treatment.
Thus only extrafoveal CNV can be treated by this method (2).
