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DOI: 10.1055/s-2001-15888
Georg Thieme Verlag Stuttgart · New York
Traitements «evidence based medecine» de la DMLA exsudative (photocoagulation laser et therapie photodynamique)
Therapy of age related macular degeneration - evidence based medicine with laser photocoagulation and photodynamic therapyPublication History
Publication Date:
31 December 2001 (online)
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Altersbedingte Makuladegeneration - Behandlung nach evidence based medicine mit Laserkoagulation und photodynamischer Therapie
Hintergrund Die altersbedingte Makuladegeneration (AMD) ist bei über 50 Jahre alten Individuen die häufigste Ursache eines uni- oder bilateralen Visusverlustes. Die exsudative Form, durch eine Neovaskularisationsmembran charakterisiert, bedingt die meisten Fälle einer legalen Blindheit. In diesem Artikel wird der aktuelle Wissenstand über die AMD vorgestellt.
Methode Übersichtsartikel, der die relevante Literatur berücksichtigt.
Ergebnisse Während mehr als 10 Jahren war die Laserkoagulation der Neovaskularisationsmembranen die einzige anerkannte Therapie, die einen Einfluss auf den Visusverlust hat und war ebenfalls der einzige „evidence based medecine”-Therapieansatz. Seit 1999 besteht eine neue Therapieoption, die Photodynamische Therapie, deren Wirksamkeit nachgewiesen werden konnte.
Schlussfolgerung Die Laserkoagulation und die Photodynamische Therapie sind die einzigen Behandlungen, die nach den Kriterien der „evidence based medecine” bei der Therapie der Neovaskularisationsmembranen wirksam sind.
Introduction Age related macular degeneration (AMD) is actually the leading cause of severe visual acuity loss in people over 65 in the Western World. Most of the visual loss is due to choroidal neovascularization (CNV).
Methods Review of the literature.
Results For more then 10 years laser photocoagulation was the only proven treatment for selected cases of AMD according to the evidence based medecine criteria. In 1999 photodynamic therapy was proven to be efficient for the treatment of predominantly classic subfoveal CNV.
Conclusion Laser photocoagulation and photodynamic therapy constitute therefore the only evidence based medecine treatment available for CNV in AMD.
Schlüsselwörter
Altersbedingte Makuladegeneration - Photodynamische Therapie - Laserkoagulation - transpupillare Thermotherapie
Key words
Age related macular degeneration - photodynamic therapy - laser photocoagulation - transpupillary thermotherapy - choroidal neovascularization
Références
- 01 Laatikainen L, Hirvela H. Prevalence and visual consequences of macular changes in a population aged 70 years and older. Acta Ophthalmol Scand. 1995; 73 (2) 105-110
- 02 Klein R, Klein B E, Jensen S C, Meuer S M. The five-year incidence and progression of age-related macular degeneration. The Beaver Dam Eye Study. Ophthalmology. 1997; 104 7-21
- 03 Macular Photocoagulation Study Group. Argon laser photocoagulation for neovascular maculopathy: five years results from randomized clinical trials. Arch Ophthalmol. 1991; 109 1109-1114
- 04 Macular Photocoagulation Study Group. Subfoveal neovascular lesions in age-related macular degeneration: guidelines for evaluation and treatment in the Macular photocoagulation Study. Arch Ophthalmol. 1991; 109 1242-1257
- 05 Macular Photocoagulation Study Group. Five-years follow-up of fellow eyes of patients with age-related macular degeneration and unilateral extrafoveal choroidal neovascularization. Arch Ophthalmol. 1993; 111, 9 1189-1199
- 06 Macular Photocoagulation Study Group. Laser photocoagulation of subfoveal neovascular lesions of age related macular degeneration; updated findings from two clinical trials. Arch Ophthalmol. 1993; 111 1200-1209
- 07 Macular Photocoagulation Study Group. Laser photocoagulation for juxtafoveal choroidal neovascularization: five-jyear results from randomized clinical trials. Arch Ophthalmol. 1994; 112 500-509
- 08 Macular Photocoagulation Study Group. Visual outcome after laser photocoagulation for subfoveal choroidal neovascularization secondary to age-related macular degeneration: the influence of initial lesion size and initial visual acuity. Arch Ophthalmol. 1994; 112 480-488
- 09 Miller J W, Schmidt-Erfuhrt U, Sickenberg M, Gragoudas E S, Bressler N M, Zografos L et al. Photodynamic therapy of choroidal neovascularization due to AMD using verteporfin. Results of a single treatment in a phase I and II study. Arch Ophthalmol. 1999; 117 1161-1173
- 10 Schmidt-Erfurth U, Miller J W, Sickenberg M, Laqua H, Barbazetto I, Gragoudas E S et al. Photodynamic therapy with verteporfin for choroidal neovascularization caused by age-related macular degeneration. Results of retreatments in a phase 1 and 2 study. Arch Ophthalmology. 1999; 117 1177-1187
- 11 Treatment of Age Related Macular Degeneration with Photodynamic Therapy Study Group (writing committee member). Verteporfin (VisudyneTM) therapy of subfoveal choroidal neovascularization in Age-Related Macular Degeneration. One Year Results of Two Randomized Clinical Trials-TAP Report #1. Arch Ophthalmology. 1999; 117 1329-1345
- 12 Donati G, Kapetanios A D, Pournaras C J. Principles of treatment of choroidal neovascularization in age related macular degeneration with photodynamic therapy. Seminars in Ophthalmology. 1999; 14, 1 2-10
- 13 Coscas G, Soubrane G, Ramahefasolo C, Fardeau C. Perifoveal laser treatment of subfoveal choroidal new vessels in age-related macular degeneration: results of a randomized clinical trial. Arch Ophthalmol. 1991; 109 1258-1265
- 14 Coscas G, Soubrane G. Photocoagulation des néovaisseaux sousrétiniens dans la dégénéréscence maculaire sénile par laser à argon. Résultats de l'étude randomisée de 60 cas. Bull Mém Soc Fr Ophtalmol. 1983; 94 149-154
- 15 Macular Photocoagulation Study Group. Persistent and recurrent neovascularization after krypton laser photocoagulation for neovascular lesions of age-related macular degeneration: results of a randomized clinical trial. Arch Ophthalmol. 1990; 108 825-831
- 16 Soubrane G, Coscas G, Francais C, Koenig F. Occult subretinal new vessels in age-related macular degeneration: natural history and early laser treatment. Ophthalmology. 1990; 97 649-657
- 17 Macular Photocoagulation Study Group. Occult choroidal neovascularization: Influence on visual outcome in patients with age-related macular degeneration. Arch Ophthalmol. 1996; 114, 4 400-412
- 18 Bressler N, Maguire M G, Murphy P L, Alexander J, Margherio R, Schachat A P et al. Macular scatter («grid») laser treatment of poorly demarcated subfoveal choroidal neovascularization in age-related macular degeneration. Arch Ophthalmol. 1996; 114 1456-1464
- 19 Soubrane G, Barreau E, Algan M, Coscas G. Photocoagulation disséminée dans le cas de néovaisseaux sous-rétiniens occultes: résultats à long terme. Bull Soc Ophthalmol. 1994; 4 375-378
- 20 Yannuzzi L, Slakter J, Sorensen J, Guyer D, Orlock D. Digital indocyanine green videoangiography and choroidal neovascularization. Retina. 1992; 12 191-223
- 21 Guyer D R, Yannuzzi L A, Slakter J S et al. Indocyanine green videoangiography of occult choroidal neovascularization. Ophthalmology. 1994; 101 1727-1737
- 22 Guyer D R, Yannuzzi L A, Ladas I, Slakter J S, Sorenson J A, Orlock D. Indocyanine green guide laser photocoagulation of focal spots at the edge of plaques of choroidal neovascularization. Arch Ophthalmol. 1996; 114 693-697
- 23 Wolf S, Remky A, Elsner A E, Arend O, Reim M. Indocyanine green videoangiography in patients with age-related maculopathy-related retinal pigment epithelial detachments. Ger J Ophthalmol. 1994; 3 224-227
- 24 Lim J, Aarberg T M, Capone A, Sternberg P. Indocyanine green angiography-guided photocoagulation of choroidal neovascularaization associated with retinal pigment epithelial detachment. Am J Ophthalmol. 1997; 123 524-532
- 25 Donati G, Kapetanios A D, Pournaras C J. ICG-guided laser photocoagulation of juxtafoveal and extrafoveal occult choroidal neovascularization. Graefe's Clin Exp Ophthalmol. 1999; on press
- 26 Donati G, Kapetanios A D, Pournaras C J. La photocoagulation au laser des néovaisseaux occultes guidée par l'angiographie au vert d'indocyanine: une étude pilote. J Fr Ophtalmol. 2000; 23, 1 45-51
- 27 Bressler N M, Frost L A, Bressler S B, Murphy R P, Fine S L. Natural course of poorly defined choroidal neovascularization associated with macular degeneration. Arch Ophthalmol. 1988; 106 1537-1542