Macular Degeneration – Treatment of AMD

Age or senile macular degeneration, also known as AMD or SMD, is a condition that, as the name calls it, is directly influenced by age and affects the area of maximum visual acuity of the retina, macula. This is manifested by altering the central visual quality.

This disease is painless, it never leads to loss of vision, but it is invaliding because the person with this condition can not read, does not see well on TV anymore, can not look at photos anymore. For example, looking at a person’s face instead of a face he sees a black or gray spot.

In many cases, the disease progresses slowly, so slow that the person in question does not realize the alteration of sight, it is not mandatory to appear at the same time in both eyes. But there are cases when the disease progresses very quickly and often affects the sight of both eyes.

Types of Macular Degeneration

An easier, dry and moist form. Drought-like disease progresses slowly, in stages, while wet AMD evolves rapidly, without stages. Studies show that wet disease is less frequent, about 15%, and the dry one in the remaining 85%, the problem is that dry SMD can turn anytime in wet form, however, this is not a must.

Causes

The causes of the disease are not exactly known, but it seems to be due to blood circulation disorders that occur to some people after a certain age. It is believed that the risk factors are smoking, race (white race is more exposed to this disease), obesity, high blood pressure, sex (women have a higher risk) and, last but not least, family history. The incidence is higher among people over 65 years of age. Studies show that as life expectancy is on the rise, the number of people with AMD will increase.

Healthy diet, exercise, not smoking is believed to help prevent the disease. No other methods of preventing the disease are known.

Some of the first signs of the disease are blurred vision, straight lines are perceived crooked, disturbed central vision. It is important that after a certain age, annual ophthalmic medical checks are carried out in specialized medical centers to try to prevent, slow down the evolution, or treat illnesses that can often occur without too many signs. The ophthalmic consultation should include visual acuity testing, intraocular pressure measurement, pupil dilatation for a fundus exam, visual field examination, and AMD should include the Amsler test.

Treatment

The treatment consists of an intravitreal injection of an anti-VEGF substance, which aims to improve the state of the retina, to improve the patient’s vision and to stop the progression of the disease.

Depending on the case, it is decided how many sessions are needed. The starting dose is 3 injections / eye. In some cases, treatment can be customized.

The treatment is done in the operating room under local anesthesia and does not require hospitalization.

Investigations, complications and recommendations

The investigations necessary for the diagnosis and follow-up of AMD evolution are retinal scan, retinal photograph and A.F.G..
For this surgery, blood tests and cardiology tests are not required.

Complications (fortunatelly very rare):

• Inflammation, infection, endophthalmitis, choroid or retinal detachments
• Infections
• Endophthalmitis
• Choroid detachments
• Retinal detachment
• Intraocular or conjunctival haemorrhage
• Treatment inefficiency

Postoperative recommendations:

• exposure to dust, wind is forbidden
• swimming (pool, lake, sea) is forbidden for 30-50 days
• during the first 2 weeks after surgery it is recommended to get help when washing your head to avoid water entering the eye
• eye make up is forbidden for 3 weeks
• rubbing your eyes is forbidden (should be avoided for 3-4 months)
• local trauma, intense physical efforts are forbidden, especially in the first 6-8 months

Mandatory postoperative checks are: first day after the surgery, one month after the last infusion, then twice a year. Depending on the case, these dates may change..

The patient is informed during the preoperative consultation about complications, risks, results..

For any question or information contact one of our assistants.

Details of intravitreal injection of Avastin (bevacizumab) – Notification from 2012:

*taken from National Agency for Medicines and Medical Devices

The Romanian Ophthalmology Society and the Romanian Society Retina, following a newscast on ProTv on March 4, 2012, make the following clarifications about the intraocular use of bevacizumab, commercial name Avastin, with the note that they have nothing to do with the case from Iasi, of Dr. Narcisa Ianopol, that we fully reject:

• The use of this substance in intravitreal administration has been practiced worldwide since 2005
• The use of this substance in ophthalmology is made “off-label”, in addition to the therapeutic indication specified by the manufacturer, but with the consensus of ophthalmologists. All international ophthalmic fora have validated the use of intraocular Avastin and have launched studies that have confirmed the efficacy and safety profile of the substance
• It is mandatory for the patient to be properly informed and to give his written consent on a written form for the condition he suffers, the existing therapeutic possibilities, the indication of treatment with the substance in question, alternatives to this therapeutic option, prognosis with or without treatment, side effects and side effects of the drug, potential complications
• The main indication of the use of Avastin in intraocular injection was age-related macular degeneration, a neovascular form, with a wider range of retinal diseases in which Avastin demonstrated efficacy (macular edema of diabetes mellitus and venous occlusion retinal, proliferative retinopathies, neovascular secondary glaucoma, relapsed central serum corioretinopathy, etc.)
• The actual injection is necessary to be done under strict aseptic conditions in the operator block, observing all working conditions specific to intraocular surgery
• Ophthalmologists who practice this therapy must have good knowledge of retinal pathology, while having the competence of overspecialization / vitreoretin surgery is a guarantor of professional training in this segment.
  We believe that the use of bevacizumab injected intravitrean is effective and safe under conditions of observation of treatment guidelines, surgical techniques and professional conduct rules for “off-label” medication