Strahlentherapie okkulter choroidaler NeoVaskularisationen (CNV) bei altersabhängiger Makuladegeneration (AMD)

Radiosurgery using the Leksell Gamma Knife (LGK) applied to ophthalmologic indications is a specific area where the eye target has a very eccentric location, since the eye can move, its fixation is required and the patient is generally treated in a prone position. It was demonstrated that the LGK is sufficiently accurate to be used for ophthalmic radiosurgery. Current spectrum of treated indications includes uveal melanomas, eye metastases, advanced glaucoma, age-related macular degeneration (ARMD), hemangioblastoma, angioreticuloma, pseudotumors and vegetative pain. The results for uveal melanomas are recognized and the value of the LGK in the treatment of glaucoma and ARMD seems promising after initial studies. Gamma Knife radiosurgery of the ciliary body leads to a significant alleviation of pain and reduction in intraocular pressure in advanced glaucoma. The latency of the treatment effect is relatively short. In the majority of patients with ARMD, both ultrasonography and fluorescein angiography demonstrated a regression of the neovascular complex or stabilization after LGK radiosurgery. A number of rare ophthalmologic indications have also been treated by the Gamma Knife in our Center with more or less prominent therapeutic responses.

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Current and Future Treatment Options for Nonexudative and Exudative Age-Related Macular Degeneration

Comer

Ciulla

Criswell

et al. 2004

Drugs & Aging

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Age-related macular degeneration (AMD) is the leading cause of irreversible visual loss in the industrialised world. Although relatively simple to diagnose through direct visualisation augmented with rapid sequence fluorescein angiography, treatment has presented a far greater challenge because the true aetiology of AMD is largely unknown. Within the past decade, researchers have introduced many new, potentially promising treatment and prevention options in an attempt to minimise the damage imparted from AMD. They capitalise on many of the theoretical and known factors contributing to AMD progression. A high-dose of an orally administered combination of the antioxidants ascorbic acid (vitamin C), tocopherol (vitamin E) and beta-carotene, in addition to copper and zinc, is the only widely accepted preventive therapy. Thermal laser photocoagulation and verteporfin photodynamic therapy are the only standard treatment options available based on large scale, randomised, prospective, placebo-controlled trials; however, efficacy is limited and only a minority of patients who present with AMD are eligible for these treatments. Many other preventive and treatment options are in all phases of clinical studies and expected to change the entire approach to AMD management in the near future. For example, alternative antioxidants, drusen ablation, apheresis and HMG-CoA reductase inhibitors have shown promise in some studies by preventing or slowing the progression of certain forms of AMD. In addition, alternative photodynamic therapies, low-intensity laser, antiangiogenic medications, radiation treatment and surgery have demonstrated the ability, albeit to differing degrees, to inhibit or possibly even reverse the severe vision loss often associated with AMD characterised by choroidal neovascularisation.

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Strahlentherapie okkulter choroidaler NeoVaskularisationen (CNV) bei altersabhängiger Makuladegeneration (AMD)

Abstract: Our results do not support the general use of radiation therapy in patients with occult choroidal neovascularisation secondary to AMD. However, the controlled multicenter studies might provide a better basis for a general recommendations.

Cited by 3 publications

References 1 publication

Treatment of age-related macular degeneration

Treatment of age-related macular degeneration

Radiosurgery in Ocular Disorders: Clinical Applications

Current and Future Treatment Options for Nonexudative and Exudative Age-Related Macular Degeneration

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