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OPHTHALMOLOGY MACULA DEGENERATION

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.

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OPHTHALMOLOGY MACULA DEGENERATION

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  1. OPHTHALMOLOGYMACULA DEGENERATION MBChB 4 Prof P Roux 2012

  2. AGE-RELATED MACULAR DEGENERATION (AMD) 1. Drusen 2. Drusen and AMD 3. Atrophic AMD 4. Exudative AMD • Pigment epithelial detachment (PED) • Choroidal neovascularization (CNV)

  3. Drusen Histopathology Hard Soft • Larger, ill-defined spots • Small well-defined • spots • May enlarge and coalesce • Usually innocuous • Increased risk of AMD

  4. `` FA of drusen Degree of hyperfluorescence depends on: • Extent of overlying RPE atrophy (window defect) • Amount of staining • Lipid content

  5. Drusen and AMD - progression Exudative AMD Atrophic AMD

  6. Atrophic AMD Progression Initially drusen and non-specific RPE changes Late RPE (geographic) atrophy

  7. Atrophic AMD Fluorescein angiogram Management Hyperfluorescence from RPE window defect Low-vision aids if appropriate

  8. Signs of Pigment epithelial detachment Sub-RPE fluid may be clear or turbid Circumscribed, dome-shaped elevation

  9. FA of pigment epithelial detachment No increase in size of lesion Progressive increase in hyperfluorescence Early, well-defined hyperfluorescence

  10. ICG angiogram of pigment epithelial detachment Later, thin surrounding hyperfluorescent ring Early, well-defined hypofluorescence No increase in size of lesion

  11. Possible subsequent course of PED Spontaneous resolution Geographic atrophy CNV RPE rip

  12. 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

  13. 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

  14. FA of classical CNV Leakage into subretinal space and around CNV Late staining Very early ‘lacy’ filling pattern

  15. ICG angiogram in PED with occult CNV PED is hypofluorescent CNV is hyperfluorescent (hot spot)

  16. Possible subsequent course of CNV Subretinal (disciform) scarring Haemorrhagic sensory and RPE detachment Massive subretinal exudation Exudative retinal detachment

  17. Potential indications for laser treatment of CNV • Classic extrafoveal CNV on FA • Occult extrafoveal CNV on ICG Pre-treatment FA of classic CNV

  18. 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

  19. Treatment • Anti VEGF intravitreal injection monthly x3 • Avastin • Lucentis • Triamcinolone intravitreal injection every 3-6 months

  20. Amsler grid for follow up

  21. Amsler grid

  22. 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

  23. Prevention for general public • Healthy diet of veggies and fruits • Stop smoking • Treat hypercholesterolemia

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