Surgical Treatment of Age-Related Macular Degeneration

Abstract

Choroidal neovascularization (CNV) and geographic atrophy (GA) are serious and potentially devastating complications of age-related macular degeneration (AMD), a leading cause of blindness in the developed world. While anti-vascular endothelial growth factor (VEGF) therapies have emerged as the current standard treatment of choice for choroidal neovascularization, the requirement for indefinite injections places a tremendous burden on physicians and patients, and may have disappointing outcomes in hemorrhagic neovascular AMD. No superior agents exist to treat large subretinal hemorrhage and geographic atrophy. Over the years, several vitreoretinal surgical approaches have been developed to treat macular degeneration, and these surgical options may still play a role in the management of specific complications of AMD. This review summarizes the principles, techniques, and results of surgical treatments for neovascular and non-neovascular age-related macular degeneration, with emphasis on submacular surgery for removal of CNV, full and limited macular translocation, retinal pigment epithelium, and choroid transplants as well as treatment of thick subretinal hemorrhage.

Stem cells as source for retinal pigment epithelium transplantation

“…As functional recovery depends on photoreceptor rescue by implanted healthy RPE cells, it will be critical to treat patients early in the disease process and before extensive damage occurs. Although success rates are not high, case numbers low and no long-term follow-up is available, the positive outcomes described in some patients treated with macular translocation and RPE patch grafts confirmed that replacement of diseased RPE can improve vision and thus are encouraging the development of new cell-replacement therapeutic approaches(Ong and da Cruz, 2012;Skaf and Mahmoud, 2011). Developing a safe therapy with RPE cells might become useful in the treatment of many of the retinal degenerative diseases affecting the RPE-photoreceptor complex.…”

Intravitreal Recombinant Tissue Plasminogen Activator and Sulphur Hexafluoride Gas for Submacular Haemorrhage Displacement in Age-Related Macular Degeneration: Looking behind the Blood

“…Another possible approach to the management of SMH is submacular surgery as a first therapeutic option, without any prior gas displacement of blood. In fact, although the Submacular Surgery Trial [30] could not demonstrate any benefit from the simple removal of CNV and blood in eyes with predominantly haemorrhagic CNV secondary to AMD, diverse surgical approaches such as FMT and autologous RPE-choroid patch grafting, which are able to restore the RPE-choroid complex underneath the macula, have been found to preserve macular function and improve vision in selected cases [16,17,31,32]. However, it is most likely that the majority of patients affected by AMD with an acute SMH might benefit from early displacement by rtPA and gas injection followed by the continuation of anti-VEGF treatment.…”

Ten Years of Knowledge of Nano-Carrier Based Drug Delivery Systems in Ophthalmology: Current Evidence, Challenges, and Future Prospective

“…Age-related macular degeneration (AMD) is a major cause of blindness in the developed world and choroidal neovascularization (CNV) and geographic atrophy are serious and potentially devastating complications of the disease. 117 Many studies have shown that nano-carrier DDSs have potential to treat AMD ( Table 4 ). However, these studies are still in the preliminary stage.…”