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OPHTHALMOLOGY MACULA DEGENERATION. MBChB 4 Prof P Roux 2012. AGE-RELATED MACULAR DEGENERATION (AMD). 1. Drusen. 2. Drusen and AMD. 3. Atrophic AMD. 4. Exudative AMD. Pigment epithelial detachment (PED). Choroidal neovascularization (CNV). Drusen. Histopathology. Hard. Soft. - PowerPoint PPT Presentation
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OPHTHALMOLOGYMACULA DEGENERATION
MBChB 4Prof P Roux
2012
AGE-RELATED MACULAR DEGENERATION (AMD)
1. Drusen
2. Drusen and AMD
3. Atrophic AMD
4. Exudative AMD• Pigment epithelial detachment (PED)• Choroidal neovascularization (CNV)
DrusenHistopathology
• Small well-defined spots• Usually innocuous
• Larger, ill-defined spots• May enlarge and coalesce
SoftHard
• Increased risk of AMD
FA of drusen
• Amount of staining • Lipid content
Degree of hyperfluorescence depends on:• Extent of overlying RPE atrophy (window defect)
``
Drusen and AMD - progression
Atrophic AMD Exudative AMD
Atrophic AMD
Initially drusen and non-specific RPE changes
Late RPE (geographic) atrophy
Progression
Atrophic AMD
Hyperfluorescence from RPE window defect Low-vision aids if appropriate
ManagementFluorescein angiogram
Signs of Pigment epithelial detachment
Sub-RPE fluid may be clear or turbid Circumscribed, dome-shaped elevation
FA of pigment epithelial detachment
Early, well-defined hyperfluorescence
Progressive increase in hyperfluorescence
No increase in size of lesion
ICG angiogram of pigment epithelial detachment
Later, thin surrounding hyperfluorescent ring
No increase in size of lesion Early, well-defined hypofluorescence
Possible subsequent course of PED
Spontaneous resolution Geographic atrophy
CNV RPE rip
Choroidal neovascularization (CNV)• Metamorphopsia is initial symptom• Most lesions are not visible clinically
Suspicious clinical signs
Pinkish-yellow subretinal lesion with fluid
Subretinal blood or lipid
• Less common than atrophic AMD but more serious
• Extrafoveal > 200 m from centre of FAZ• Juxtafoveal < 200 m from centre of FAZ
Angiographic classification of CNV
Well-defined (classical)
• Subfoveal - involving centre of FAZ
• Poorly defined
• Obscured by PED, blood or exudate
Occult
Late staining
FA of classical CNV
Leakage into subretinal space and around CNV
Very early ‘lacy’ filling pattern
CNV is hyperfluorescent (hot spot) PED is hypofluorescent
ICG angiogram in PED with occult CNV
Subretinal (disciform) scarring
Massive subretinal exudation
Possible subsequent course of CNV
Haemorrhagic sensory and RPE detachment
Exudative retinal detachment
Potential indications for laser treatment of CNV• Classic extrafoveal CNV on FA• Occult extrafoveal CNV on ICG
Pre-treatment FA of classic CNV
• Perimeter is treated with overlapping 200 m (0.2-0.5 sec) burns• Entire area is covered with high energy burns
Technique of laser photocoagulation of CNV
Lack of leakage following successful treatmentLate staining around margin is normal
Treatment
• Anti VEGF intravitreal injection monthly x3– Avastin– Lucentis
• Triamcinolone intravitreal injection every 3-6 months
Amsler grid for follow up
Amsler grid
Prevention for patients with Drusen
• Anti oxidants, vitamins and minerals• Ocuvite with Lutein• Eye Rx
• Healthy diet of veggies and fruits• Stop smoking • Treat hypercholesterolemia
Prevention for general public
• Healthy diet of veggies and fruits• Stop smoking • Treat hypercholesterolemia