Intravitreal therapy (treatment of the macula)

Age-related macular degeneration (AMD) primarily affects the elderly.

Although it rarely causes complete loss of vision, impaired central vision significantly affects the quality of life.

Timely identification, quality diagnostics and prompt therapy have a significant impact on the progression of the disease.

AMD treatment depends on the form of the disease.

In case of the dry form of AMD, various antioxidant substances are prescribed. The most common are vitamins C and E, zinc, lutein and numerous other multivitamin preparations intended for macular diseases. Clinical studies have shown that they cannot repair the damage, but can slow down the progression of the disease.

In case of the wet form of AMD, if the damage is far enough from the centre of the macula (fovea), the photocoagulation laser is used. This type of treatment is guided by fluorescein angiography (FAG), which specifically marks the ”stray” blood vessels. This is only the first part of the combined procedure, which is the best form of treatment for this condition.

The second and more important part of macular disease treatment is the intravitreal (in the eye) administration of a medication from the group of synthetic antibodies against vascularization factors. The ”stray” blood vessels additionally damage the macula by releasing exudate and fluid from their poor-quality walls. Anti-VEGF therapy (anti-vascular endothelial growth factor) strengthens the intercellular connections and makes them impermeable, repairing the poor construction of the walls of the newly-formed “stray” blood vessels, and preventing the creation of endothelial cells, the building material of blood vessels.

The intravitreal (intraocular) method of application ensures that the medication is administered in a sufficient concentration and with the greatest effectiveness. Intraocular injections are used to treat many eye diseases, most commonly for the treatment of macular edema in diabetic retinopathy, retinal vein occlusion, inflammatory diseases and the wet form of age-related macular degeneration. This is the preferred method of application for the latest medication intended for the treatment of the wet form of age-related macular degeneration, helping prevent the growth of new blood vessels in the eye (anti-VEGF). Corticosteroids (triamcinolone acetonide and others), intended for treating the edema and the inflammatory changes in the retina, are also administered in this way.

Some of the medications in the anti-VEGF group are:

Avastin® (bevacizumab) is a drug primarily used in the treatment of colon cancer, where the non-selective blockage of growth of new blood vessels stops tumour growth. In the last few years, Avastin has been widely used throughout the world for the treatment of the wet form of macular degeneration, and new indications, such as diabetic retinopathy, are also being introduced. Since ocular use represents a so-called “off-label use”, the patient must be fully acquainted with the risks of such use and sign an informed consent before the drug is administered. An advantage of this drug is its price, which is significantly lower than the prices of other drugs.

Macugen® (pegaptanib) selectively blocks the endothelial growth factors of blood vessels in the eye. Its primary indication is the wet form of age-related macular degeneration and it is approved for use in such cases by the US FDA. Its selective action provides far greater safety of application in patients with an increased risk of cardiovascular disease.

Kenalog® (triamcinolone acetonide) is a corticosteroid administered intravitreally to reduce macular edema in diabetic retinopathy, vascular occlusions, the wet form of age-related macular degeneration, in combination with anti-VEGF drugs or laser therapy, for treating certain inflammatory diseases of the eye, and other less common conditions.

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