Über die medikamentöse Prävention und die präventive Behandlung der altersbedingten Makuladegeneration (AMD) durch die günstige Beeinflussung der Gefäßendotheldysfunktion (ED)

Fischer, Tamás

doi:10.1055/s-2004-813577

Cited by 5 publications

(1 citation statement)

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“…In the genesis and later development of age-related macular degeneration (AMD), endothelial dysfunction (ED) has a crucial role (Fischer, 2004;Lip et al, 2001;. Vascular endothelium regulates retinal arteriolar tone, circulation in the ophthalmic and ciliary arteries, that is, the eye including ophthalmic microcirculation.…”

Section: Novel Considerations About the Etiopathogenesis And Pathophymentioning

confidence: 99%

Is the age-related macular degeneration (AMD) vascular disease, part of vasculopathy, respectively? Novel considerations on AMD arising from the newest pathophysiological, clinical and clinical- pharmacological observations (Preliminary Communication)

Fischer¹

2012

J. Neurosci. Behav. Health

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In the genesis and later development of age-related macular degeneration (AMD), endothelial dysfunction (ED) has a crucial role. AMD-risk factors, which play a decisive role in AMD, are in a close connection, correlate with, and often are identical wih the risk factors (RFs) of cardiovascular diseases (CVDs), so that it can reasonably be presumed that the two conditions have a similar pathogenesis. These risk factors, which seem essentially different, lead to chronic vascular injury based on the same mechanism of action: by inducing oxidative stress (OS). ED itself is a consequential-consecutive phenomenon (OS→ED!), and is a clinico-pathophysiologically important connecting link between harm(s)/noxa and vascular injury (harm [noxa] → oxidative stress (OS) → endothelial activation (EA), endothelial dysfunction (ED), respectively → vacular injury, vascular disease). Disordered function of endothelium in the vessels supplying the affected ocular structures with blood (ED) have a key role in the genesis and development of age-related macular degeneration. Changes in blood vessels including those in choroids may be triggered by several repeated and/or prolonged mechanical, physical, chemical, microbiological, immunologic, and genetic influences/impacts/noxa (in fact, the risk factors!), against which protracted response 1 **) (increased ROS formation → oxidative stress → endothelial activation/dysfunction → aftermath of EA/ED) may develop, and in consequence of this, (chronic) vascular damage (functional and then structural alteration [remodelling] of the blood vessel), pathological consecutive changes ending in AMD, ultimately, may develop (choriocapillaris degenerates in exudative AMD, choriocapillaris degeneration precedes retinal pigment epithelial atrophy in wet AMD). All this goes to show that AMD may be a local manifestation of systemic (vascular) disease, undoubtedly. AMD is the disease of the aging body. Normal aging processes can lead to structural and blood flow changes that can predispose patients to AMD. Advancing age is a privotal and independent risk factor for vascular disease as can be understood from the fact that aging individuals often demonstrate dysfunctional blood vessel repair after vascular injury and aging per se, in the absence of other risk factors is associated with oxidative/nitrosative stress and inflammatory changes in the phenotype of blood vessels (primary abnormalities in ocular perfusion worsen with age, secondarily causing dysfunction of the retinal pigment epithelial cells, predisposing eyes to AMD), these changes together with individual's (environmental) risk factors set the stage for the development Fischer 43 of AMD. Regarding therapy/preventive treatment/prevention of AMD: (I) Non-medicinal (preventive) treatment such as lifestyle modifications of AMD patients (modifying lifestyles behavours of diet, smoking and physical activity) is of indispensable importance; they influence strongly and very beneficially the established vascular risk factors and also advantageously affect ...

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Section: Novel Considerations About the Etiopathogenesis And Pathophymentioning

confidence: 99%

Is the age-related macular degeneration (AMD) vascular disease, part of vasculopathy, respectively? Novel considerations on AMD arising from the newest pathophysiological, clinical and clinical- pharmacological observations (Preliminary Communication)

Fischer¹

2012

J. Neurosci. Behav. Health

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A possible strategy for the prevention and preventive therapy of age-related macular degeneration based on recent pathophysiological and clinical observations

Fischer¹

2009

Clinical and Experimental Medical Journal

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A new possible strategy of prevention and preventive treatment of age-related macular degeneration

Fischer¹

2008

Orvosi Hetilap

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The beneficial effect achieved by the treatment of endothelial dysfunction in chronic cardiovascular diseases is already an evidence belonging to the basic treatment of the disease. Given the fact that the vascular system is uniform and consubstantial both physiologically, pathophysiologically and in terms of therapy, and that it plays a key role in age-related macular degeneration (AMD)--a disease leading to tragic loss of vision with its etiology and therapy being unknown--endothelial dysfunction should be treated. The pleiotropic effects of ACE-inhibitors, AR-blockers and statins help to restitute the balance between vasodilators and vasoconstrictors in endothelial dysfunction caused by oxidative stress, the balance of growth factors and their inhibitors, pro- and anti-inflammatory substances and prothrombotic and fibrinolytic factors, inhibit the formation of oxidative stress and its harmful effects; while aspirin with its pleiotropic effects acting as an antiaggregation substance on platelets helps to set the endothelial layer back to its normal balance regarding its vasodilating, antithrombotic, antiadhesive and anti-inflammatory functions; trimetazidine as an adjuvant agent helps to normalize, to restore the disturbed metabolism of the retinal tissue functioning insufficiently, in the end. For the above reasons it is suggested that, as a part of long term primary and/or secondary prevention, the following groups of patients with AMD receive--taking into consideration all possible side effects--ACE-inhibitor and/or AR blocker and statin and aspirin treatment, and trimetazidine as adjuvant medicine 1. those without maculopathy but being above the age of 50 and having risk factors inducing endothelial dysfunction; 2. those, who already developed AMD in one eye as a prevention in the second, unaffected eye; and 3. those patients who developed AMD in both eyes in order to ameliorate or merely slow the progression of the disease. Besides, it is advisory to eliminate AMD risk factors inducing oxidative stress with consecutive endothelial dysfunction.

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Über die medikamentöse Prävention und die präventive Behandlung der altersbedingten Makuladegeneration (AMD) durch die günstige Beeinflussung der Gefäßendotheldysfunktion (ED)

Cited by 5 publications

References 0 publications

Is the age-related macular degeneration (AMD) vascular disease, part of vasculopathy, respectively? Novel considerations on AMD arising from the newest pathophysiological, clinical and clinical- pharmacological observations (Preliminary Communication)

Is the age-related macular degeneration (AMD) vascular disease, part of vasculopathy, respectively? Novel considerations on AMD arising from the newest pathophysiological, clinical and clinical- pharmacological observations (Preliminary Communication)

A possible strategy for the prevention and preventive therapy of age-related macular degeneration based on recent pathophysiological and clinical observations

A new possible strategy of prevention and preventive treatment of age-related macular degeneration

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