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NEUROENDOCRINOLOGY LETTERS

NEL Vol.23 No.4, August 2002

CLINICAL CASE STUDY
Treatment of macular degeneration

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1. Khavinson 'Epitalon in Retinitis Pigmentosa'
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2002; 23:370–372
pii: NEL230402A12
PMID: 12195243

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Treatment of macular degeneration
(A controlled case)

Petr Soucek & Ilona Cihelková

The Eye Department, University Hospital, Prague, Czech Republic.

Key words:
Age-related macular degeneration; choroidal neovascularization; verteporfin; photodynamic therapy; fluorescein angiography; optical coherence tomography

Submitted: July 11, 2002
Accepted: July 13, 2002

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Novartis pdf [678kb]


ABSTRACT

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).

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