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Ophthalmol Case Rep 2017 Volume 1 Issue 1
August 21-23, 2017 | Toronto, Canada EYE AND VISION3rd International Conference on
Age related macular degeneration is a common cause
of blindness, evident with many clinical distinct signs,
such as sub retinal neovascular membrane (SRNM), causing
metamorphosis and visual acuity loss; there are several
treatment options, to reduce its devastating visual effects.
The treatment of SRNM in the past, was solely relied upon
laser photocoagulation of the membrane, reducing the
risks of visual loss when treated without much delay. On
the other hand, if the membrane treated was located in
the foveal area, the outcome was bad despite treatment,
because most of the times the photoreceptors and other
retina cells were damaged in the macular area. Laser used to
be applied in the macula, and despite the reason was to halt
the process of membrane evolution, the patient lost visual
acuity immediately after the foveal laser, but MPS (Macular
Photocoagulation Study) studies realised that within a
couple of years the contrast sensitivity got better rather if the
lesion was not treated. Of course nowadays we do not laser
the fovea. Other recent studies that come on the way until
today show how the involvement of pharmacology and the
numerouslabsmaycontributetothesuccessofthetreatment.
Treatmens such as PDT (Photodynamic Therapy) with the
use of verteporfin (visudyne), which was used together with
the PDT treatment protocol for stimulating the action of the
drug through this non thermal laser pathway acted shrinking
the size and inhibiting the spreading and growth of the
membrane; another option applied was TTT (Transpupillary
Thermotherapy), with non thermal laser, played a role
towards the treatment of the membrane; last but not least
on the list was surgical treatment was attempted, with the
use of special cannulas underneath the retina to actually
remove the subretinal membranes; macular translocation,
withdrawing the membrane area from the macular center,
rotating good retina do override the retinal pigment
epithelium, but bad results and outcomes contributed to
the discontinuation of these procedures. Clinical research
on pharmacology and the ARMD pathogenesis came up with
the targeted cause of these lesions that is VEGF (vascular
endothelial growth factor), responsible for the membrane
formation and the process of angiogenesis. Development
of pharmacological treatment for the membrane came
to the most evolving drugs used in ophthalmology today,
ranging from pegaptanib sodium (Macugen), FDA approved,
to the off label bevacizumab (Avastin), largely employed.
Ranibizumab (Lucentis) is largely also used for the treatment
of the disease, and Aflibercept (Eyelid) was approved for
several diseases, many drugs also included in protocols for
diseases different from ARMD. Corticosteroids were far
more developed these days for the treatment of ARMD, to
mention triamcinolone acetate, Ozurdex (dexametasone
implant), and Illuvien (fluocinolone acetone) these last two
mentioned drugs being delivered as intravitreal implant
different from the others mentioned, delivered as injections.
Other drugs are in the way of development. Several studies
concerning the use of intraocular anti-VEGF (anti-vascular
endothelial growth factor) drugs proved to show great
results and membrane shrinking to the point of complete
resolution. Usually many of those studies show that after
one year duration treatment, and some protocols advise
monthly injections, the treatment could be performed as
necessary, with larger intervals between sessions. Other
drugs are still under investigation and development, but we
already have had good results with the approved worldwide
medication for the moment.
Speaker Biography
Hudson Nakamura is a Medical Specialist in Ophthalmology and specialized in Retina
and Vitreous. Completed School of Medicine at the Federal University of Goiás – UFG
and residency from the Base Hospital of the Federal District - Brasília - DF. Presently
member of American Academy of Ophthalmology, Brazilian Council of Ophthalmology,
Canadian Society of Ophthalmology and also the member of most prestigious society
ARVO - The Association for Research in Vision and Ophthalmology United States.
Currently working as a professor in department of Retina and Vitreous Course of
Medical Residency in Ophthalmology at the Bank of Goias Eye Foundation. Is also
working as Specialist in vitreoretinal disease Fellowship - University of Toronto Canada,
Specialist in Ophthalmology - University of Toronto Canada, Specialist in vitreoretinal
disease Fellowship - Brazilian Center for Eye Surgery.
e:
The new treatments for Age Related Macular Degeneration: The role of antiangiogenic agents and
evolution and their safety in the modern world
Hudson de Carvalho Nakamura
Goias Bank of Eyes Foundation, Brazil