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AGE-RELATED MACULAR DEGENERATION (AMD)

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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. Larger, ill-defined spots. Small well-defined spots.

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Presentation Transcript
slide1

AGE-RELATED MACULAR

DEGENERATION (AMD)

1. Drusen

2. Drusen and AMD

3. Atrophic AMD

4. Exudative AMD

  • Pigment epithelial detachment (PED)
  • Choroidal neovascularization (CNV)
slide2

Drusen

Histopathology

Hard

Soft

  • Larger, ill-defined spots
  • Small well-defined
  • spots
  • May enlarge and coalesce
  • Usually innocuous
  • Increased risk of AMD
slide3
``

FA of drusen

Degree of hyperfluorescence depends on:

  • Extent of overlying RPE atrophy (window defect)
  • Amount of staining
  • Lipid content
slide4

Drusen and AMD - progression

Exudative AMD

Atrophic AMD

slide5

Atrophic AMD

Progression

Initially drusen and non-specific RPE changes

Late RPE (geographic) atrophy

slide6

Atrophic AMD

Fluorescein angiogram

Management

Hyperfluorescence from RPE window defect

Low-vision aids if appropriate

slide7

Signs of Pigment epithelial detachment

Sub-RPE fluid may be clear or turbid

Circumscribed, dome-shaped elevation

slide8

FA of pigment epithelial detachment

No increase in size of lesion

Progressive increase in

hyperfluorescence

Early, well-defined

hyperfluorescence

slide9

ICG angiogram of pigment

epithelial detachment

Later, thin surrounding

hyperfluorescent ring

Early, well-defined

hypofluorescence

No increase in size of lesion

slide10

Possible subsequent course of PED

Spontaneous resolution

Geographic atrophy

CNV

RPE rip

slide11

Choroidal neovascularization (CNV)

  • Less common than atrophic AMD but more serious
  • Metamorphopsia is initial symptom
  • Most lesions are not visible clinically

Suspicious clinical signs

Subretinal blood or lipid

Pinkish-yellow subretinal lesion

with fluid

slide12

Angiographic classification of CNV

Well-defined (classical)

Occult

  • Extrafoveal > 200 m from centre of
  • FAZ
  • Poorly defined
  • Juxtafoveal < 200 m from centre of
  • FAZ
  • Obscured by PED, blood or exudate
  • Subfoveal - involving centre of FAZ
slide13

FA of classical CNV

Leakage into subretinal

space and around CNV

Late staining

Very early ‘lacy’ filling

pattern

slide14

ICG angiogram in PED with occult CNV

PED is hypofluorescent

CNV is hyperfluorescent (hot spot)

slide15

Possible subsequent course of CNV

Subretinal (disciform) scarring

Haemorrhagic sensory and

RPE detachment

Massive subretinal exudation

Exudative retinal detachment

slide16

Potential indications for laser treatment of CNV

  • Classic extrafoveal CNV on FA
  • Occult extrafoveal CNV on ICG

Pre-treatment FA of classic CNV

slide17

Technique of laser photocoagulation of CNV

  • Perimeter is treated with overlapping 200 m (0.2-0.5 sec) burns
  • Entire area is covered with high energy burns

Late staining around

margin is normal

Lack of leakage following successful treatment

slide18

Results of laser photocoagulation of CNV

  • Initial risk of severe visual loss reduced by over 50%
  • Frequent subsequent recurrence with subfoveal involvement

Recurrence of CNV several months after initially successful treatment

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