Research advance in geographic atrophy due to age-related macular degeneration / 国际眼科杂志(Guoji Yanke Zazhi)

Geographic atrophy(GA)is an intermediate and advanced stage of age-related macular degeneration(ARMD). Due to the complex pathogenesis of GA, there are no effective treatments at present, and eventually patients will lose central vision. Studies have shown that excessive activation of the complement system is closely related to the occurrence and progression of GA. This review will offer a summary of the clinical features, pathogenesis, the role of complement system in the pathology and the treatment progress of GA.

Research progress of medication treatment of dry age-related macular degeneration / 国际眼科杂志(Guoji Yanke Zazhi)

Age-related macular degeneration(ARMD)is one of the leading causes of irreversible visual impairment worldwide, and the number of patients is increasing with the aging of the population, with dry ARMD accounting for about 90% of cases. Effective treatments for dry ARMD are currently lacking, making it a prominent area of research. Pharmacotherapy, targeting pathogenic factors such as oxidative damage, inflammation, and vascular issues contributing to ARMD, is one of the main treatments and some drugs have been shown to slow the progression of ARMD. This article reviews drug treatments for dry ARMD, including antioxidant drugs, complement biological agents, non-steroidal anti-inflammatory drugs and immunosuppressants, vasodilators, neurotrophic drugs, as well as traditional Chinese medicine. It summarizes their mechanisms and recent clinical research to contribute valuable insights for the treatment of dry ARMD and the development of novel therapeutic agents.

Charles Bonnet syndrome in age-related macular degeneration - prevalence and clinical features in a Portuguese population / Síndrome de Charles Bonnet na degeneração macular relacionada à idade - prevalência e características clínicas numa população portuguesa

ABSTRACT Objective: Age-related macular degeneration (AMD) is the most prevalent cause of irreversible visual loss in the developed world. In late stages, it may lead to extremely low visual acuities, especially when associated with geographic atrophy or choroidal neovascularization. According to recent literature, Charles Bonnet syndrome (CBS) may be a rather common feature of late AMD. Methods: One hundred patients with late-stage age-related macular degeneration were actively asked whether they had symptoms of Charles Bonnet syndrome. Those that answered positively underwent a comprehensive questionnaire about the details of the visual hallucinations. Results: The following factors were significantly associated with Charles Bonnet syndrome: older age (+6.3 years; p=0.003), lower visual acuity in the better eye (Charles Bonnet Syndrome Group: 0.11; Non-Charles Bonnet Syndrome Group: 0.42; p=0.005) and female sex (Charles Bonnet Syndrome Group: 88%; Non-Charles Bonnet Syndrome Group: 43%; p=0.02). The visual hallucinations occurred mainly straight ahead (n=5), once per day (n=4), at no particular time (n=6), lasted some minutes (n=5), and disappeared after blinking (n=3) or looking away (n=3). The majority of patients lived alone (n=7), had not told anyone about the hallucinations (n=6), and associated the episodes with severe distress (n=5). Conclusion: Charles Bonnet syndrome was fairly prevalent in this late-stage age-related macular degeneration population. Our sample shows the importance of directly asking subjects about Charles Bonnet syndrome since they are often reluctant to admit to having visual hallucinations. Reassurance about its benignity is crucial to improve their quality of life.

RESUMO Objetivo: A doença macular ligada à idade (DMI) é a causa mais prevalente de perda visual irreversível nos países desenvolvidos. Em estadios avançados, esta doença pode levar a acuidades visuais extremamente baixas. De acordo com literatura recente, a Síndrome de Charles Bonnet (SCB) pode acontecer de forma relativamente comum na DMI tardia. Métodos: Cem doentes com degeneração macular da idade avançada foram interrogados ativamente sobre terem sintomas da síndrome de Charles Bonnet. Os que responderam de forma positiva foram submetidos a um questionário oral detalhado sobre os pormenores das alucinações visuais. Resultados: Os seguintes fatores foram significativamente associados à síndrome de Charles Bonnet: idade avançada (+6,3 anos; p=0,003), menor melhor acuidade visual corrigida no melhor olho (Grupo com Síndrome de Charles Bonnet: 0,11; Grupo sem Síndrome de Charles Bonnet: 0,42; p=0,005) e sexo feminino (Grupo com Síndrome de Charles Bonnet: 88%; Grupo sem Síndrome de Charles Bonnet: 43%; p=0,02). As alucinações visuais ocorriam principalmente em frente (n=5), uma vez por dia (n=4), em qualquer altura do dia (n=6), duravam alguns minutos (n=5) e desapareciam após pestanejo (n=3) ou desvio do olhar (n=3). A maioria dos doentes vivia sozinha (n=7), não tinha partilhado sua condição com ninguém (n=6) e associava os episódios a uma sensação angustiante (n=5). Conclusão: A síndrome de Charles Bonnet teve prevalência relativamente alta nessa população de degeneração macular da idade. Nossa amostra sublinha a importância de questionar diretamente sobre síndrome de Charles Bonnet, uma vez que os doentes se sentem muitas vezes relutantes em admitir alucinações visuais. A reafirmação da benignidade da situação é crucial para aumentar a qualidade de vida desses indivíduos.

Pseudodrusen reticulares y degeneración macular asociada a la edad / Pseudodrusen reticularis and age-related macular degeneration

Objetivo: Identificar la relación de los pseudodrusen reticulares con la degeneración macular asociada a la edad mediante imágenes tomográficas. Método: Estudio observacional, descriptivo y transversal en pacientes con pseudodrusen reticulares atendidos en consulta de retina a los que se les realizó tomografía de coherencia óptica espectral desde enero de 2009 hasta diciembre de 2014 en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer". La población estuvo constituida por 69 pacientes de 55 años y más con pseudodrusen reticulares en dichas imágenes. Resultados: Los pseudodrusen predominaron en pacientes con edades comprendidas entre los 70 y 79 años para un 49,3 por ciento. El sexo femenino fue el más numeroso con un 76,8 por ciento. De los 122 ojos con pseudodrusen, 86 presentaron algún signo de degeneración macular asociada a la edad representado por el 70,5 por ciento. El 58,1 por ciento de estos últimos tuvo la forma avanzada. La membrana neovascular tipo II fue la más frecuente con un 58,0 por ciento. El grosor coroideo se estimó disminuido en el 77,9 por ciento de los casos. Conclusiones: Los pseudodrusen reticulares mantienen una relación directa con la degeneración macular asociada a la edad e influyen en la progresión de esta(AU)

Objective: To identify the relationship of reticular pseudodrusen with age-related macular degeneration using tomographic imaging. Methods: An observational, descriptive and cross-sectional study was conducted in patients with reticular pseudodrusen seen in retina consultation who underwent spectral optical coherence tomography from January 2009 to December 2014 at the Cuban Institute of Ophthalmology "Ramón Pando Ferrer". The population consisted of 69 patients aged 55 years and older with reticular pseudodrusen in these images. Results: Pseudodrusen predominated in patients between 70 and 79 years of age (49.3 percent). The female gender was the most numerous with 76.8 percent. Out of the 122 eyes with pseudodrusen, 86 showed some sign of age-related macular degeneration (70.5 percent). Out of the latter, 58.1 percent had the advanced form. Type II neovascular membrane was the most frequent with 58.0 percent. Choroidal thickness was estimated decreased in 77.9 percent of cases. Conclusions: Reticular pseudodrusen maintain a direct relationship with age-related macular degeneration and influence its progression(AU)

Research advances of modern and traditional medicine on dry age-related macular degeneration / 国际眼科杂志(Guoji Yanke Zazhi)

@#Age-related macular degeneration(ARMD)is one of the main causes of irreversible visual impairment in the middle-aged and elderly people, which severely impacts the patient's life quality and poses a substantial health economic burden on society. There are two types of late ARMD in clinic: wet ARMD and dry ARMD. Anti-vascular endothelial growth factor drugs, as first-line clinical drugs for wet ARMD, achieved remarkable efficacy. For dry ARMD, however, effective therapies are in the air. This review focuses on the potential drugs, biological therapies and traditional Chinese medicines that made significant progresses in clinical trials for dry ARMD, including anti-inflammatory drugs(doxycycline and FHTR2163), anti-oxidants(risuteganib and elamipretide), complement inhibitors(APL-2 and zimura), visual cycle modulators(ALK-001), neuroprotective agents(brimonidine), stem cell transplantation(MA09-hRPE and BMMF), gene therapy(HMR59), and traditional Chinese medicine(saffron, curcumin, quercetin and resveratrol). The new drugs exhibited favorable clinical efficacy and broad application prospects, which would foster hope for improvement and treatment of ARMD.

Degeneração macular relacionada à idade: o potencial terapêutico das células-tronco / Age-related macular degeneration: the therapeutic potential of stem cells

Introdução: A degeneração macular relacionada à idade (DMRI) é uma patologia ocular crônico-degenerativa com perda progressiva e irreversível da visão central. Os avanços no campo da pesquisa das células-tronco têm voltado suas atenções para a aplicação da terapia celular com o intuito de regenerar tecidos oculares que são danificados por essa doença. A DMRI exsudativa possui terapia com anti-fator de crescimento endotelial vascular, e a DMRI seca ou atrófica, não possui terapia aprovada disponível. Objetivo: Avaliar o potencial terapêutico do uso de células-tronco no tratamento de DMRI seca por meio de estudos que demonstraram a segurança e eficácia de experimentos com injeções intravítreas de fração mononuclear da medula óssea contendo células CD34+. Métodos: Revisão da literatura em artigos entre 2009 e 2017, usando como base os bancos de dados Scielo, PubMed e Lilacs. Resultado: Estudos evidenciaram que o uso de injeções intravítreas de fração mononuclear da medula óssea contendo células-tronco CD34+ está associado com melhora significativa da acuidade visual e do limiar de sensibilidade macular. Ademais, a ausência de crescimento tumoral, desenvolvimento de neovascularização coroidal, a não associação com inflamação significativa e o não comprometimento da função visual demonstrou a segurança da utilização da terapia. Conclusão: Os avanços nos estudos demonstraram que o uso da terapia celular na DMRI atrófica acarreta melhora da visão, proporcionando melhor qualidade de vida. Por isso, verifica-se a necessidade do investimento em novas pesquisas para ampliar os testes e confirmar se esta abordagem de tratamento será realmente eficaz e bem tolerada. (AU)

Introduction: Age-related macular degeneration (AMD) is a chronic degenerative eye condition with progressive and irreversible loss of central vision. Advances in the field of stem cell research have focused on the application of cell therapy in order to regenerate eye tissues that are damaged by this disease. Exudative AMD has anti-vascular endothelial growth factor therapy, and dry or atrophic AMD has no approved therapy available. Objective: To evaluate the therapeutic potential of stem cell use in the treatment of dry AMD through studies demonstrating the safety and efficacy of experiments with intravitreal injections of mononuclear bone marrow fraction containing CD34 + cells. Methods: Literature review in articles between 2009 and 2017, using as basis the databases Scielo, PubMed and Lilacs. Results: Studies have shown that the use of intravitreal injections of mononuclear bone marrow fraction containing CD34 + stem cells is associated with significant improvement in visual acuity and macular sensitivity threshold. In addition, the absence of tumor growth, development of choroidal neovascularization, non-association with significant inflammation and non-impairment of visual function demonstrated the safety of therapy use. Conclusion: Advances in studies have shown that the use of cell therapy in atrophic AMD causes improved vision, providing better quality of life. Therefore, it is necessary to invest in new research to expand the tests and confirm if this treatment approach will be really effective and well tolerated. (AU)

Progress in the treatment of atrophic age-related macular degeneration / 中华眼底病杂志

Atrophic age-related macular degeneration (AMD) does not show obvious loss of visual function in the early stage,so it is not easy to be taken seriously.In the advanced stage,most of the patients suffered from macular area retinal map atrophy,which affected night vision and central vision.Drugs currently used in clinical or clinical trials to treat atrophic AMD include drugs for improving choroidal perfusion,reducing the accumulation of harmful substances,preventing oxidative stress injury,inhibiting inflammatory reactions,as well as neuroprotectants and lipid metabolism drugs.Stem cell transplantation for atrophic AMD is currently the most promising treatment.In theory,it is feasible to replace atrophic AMD with retinal photoreceptor cells and RPE cells derived from human stem cell differentiation.However,there are still many problems to be solved,such as how to improve the efficiency of directional differentiation of seed cells and how to ensure the safe and effective RPE cell transplantation and survival after transplantation.At present,several studies have found that multiple locus mutations are associated with atrophic AMD,so gene therapy also plays an important role in the development of the disease.

Multimodal imaging quantitative analysis of geographic atrophy in aged-related macular degeneration / 中华眼底病杂志

Objective To compare and quantitatively analyse the different characteristics of multimodal imaging of geographic atrophy (GA) in age-related macular degeneration (AMD).Methods The study included multimodel images of 32 eyes of 27 patients with GA secondary to AMD.There were 14 males (17 eyes) and 13 females (15 eyes).The age ranged from 64 to 83 years,with the mean age of (74.4±7.6) years.All eyes were examined by color fundus photography (CFP),fundus autofluorescence (FAF),fundus fluorescein angiography (FFA) and spectral domain optical coherence tomography (OCT).Using image J software,two trained ophthalmologists,operating in masked fashion,graded the area of lesions of CFP,FAF and FFA independently and compared the sizes of GA area.OCT was performed to confirm the border of lesion when FAF difficult to be determined.The results consistency of two ophthalmologists was analyzed by Bland-Altman.Results The results consistency was high of two ophthalmologists,with the variation range of FFA＜ FAF＜CFP.The GA area of CFP,FAF and FFA were (19.81 ±13.03),(21.50± 13.61),(23.10± 14.29) mm2.The difference of GA area between three multimodel images was statistically significant (F=0.466,P=0.629).Conclusion The mean size of GA measured by CFP,FAF and FFA showed no statistical difference.

Epidemiological profile of age-related macular degeneration patients in Federal University of Parana, Brazil / Perfil epidemiológico da degeneração macular relacionada à idade na Universidade Federal do Paraná, Brasil

ABSTRACT Objective: To evaluate the profile and severity of age-related macular degeneration (AMD) in ophthalmology ambulatory of Federal University of Parana in Curitiba, Parana, Brazil. Methods: This was a cross-sectional study with data collected among the 6155 outpatients ophthalmic appointments (november 2011 to november 2013). In this 6155 patients, a total of 346 patients had retinal diseases and were screened by two retinal specialists for signs of AMD. If present, they were submitted to a protocol including a new ophthalmic evaluation comprising visual acuity, tonometry, biomicroscopy, dilated fundus examination and optical coherence tomography (OCT). Results: A total of 6155 patients underwent ophthalmologic evaluation for several reasons. Three hundred and forty six patients had retinal diseases (incidence of 5.6%) and 68 of these (incidence of 19.6% in retinal patients) had AMD. The mean age of all patients was 53 years and in retinal patients was 60 years. In AMD patients mean age was 73 years. Ethnicity, body-mass index (BMI) and smoking habits were evaluated in the 68 patients diagnosed with AMD (34 exudative and 34 non-exudative) but none of those parameters were statistically significant comparing exudative and non-exudative forms. Conclusion: Most of the patients were European descendants. A higher proportion of advanced cases of AMD comparing with literature was found (50% of exudative form). Regarding ethnicity, iris color, smoking habit and BMI, there was no difference comparing exudative and non-exudative forms. These results may be compared to available AMD studies, since there is little information about AMD in Brazil.

RESUMO Objetivo: Avaliar o perfil epidemiológico e severidade da degeneração macular relacionada à idade (DMRI) no ambulatório de oftalmologia da Universidade Federal do Paraná (UFPR) em Curitiba, Paraná, Brasil. Métodos: Estudo transversal com dados coletados referentes as 6155 consultas oftalmológicas realizadas no período de novembro de 2011 a novembro de 2013. Destes, 346 pacientes possuíam doenças retinianas e foram avaliados por dois especialistas em retina à procura de sinais de DMRI. Os confirmados foram submetidos a um protocolo compreendendo acuidade visual, tonometria, biomicroscopia, oftalmoscopia indireta sob midríase e tomografia de coerência óptica (OCT). Resultados: Um total de 6155 pacientes foram submetidos à consulta oftalmológica na UFPR. Trezentos e quarenta e seis pacientes apresentaram doenças retinianas (incidência de 5.6%) e 68 destes (incidência de 19.6% dos pacientes com doenças de retina) apresentaram DMRI. A média de idade dos pacientes do ambulatório geral foi de 53 anos e em pacientes com doenças de retina foi de 60 anos. Pacientes com DMRI tinham em média 73 anos. Etnia, cor da íris, índice de massa corpórea (IMC) e tabagismo foram avaliados nos 68 pacientes diagnosticados com DMRI (34 exsudativa e 34 não exsudativa), mas nenhum dos parâmetros foram estatisticamente significantes. Conclusão: A maioria dos pacientes eram de origem europeia. Comparando com a literatura, uma maior proporção de casos avançados de DMRI (50% de forma exsudativa) foi encontrada. Em relação à etnia, tabagismo e IMC, não houve diferença entre pacientes com forma exsudativa e não exsudativa. Estes resultados podem ser comparados com estudos disponíveis, considerando a pouca informação referente a DMRI existente no Brasil.

Use of Fundus Autofluorescence Images to Evaluate the Progression of Geographic Atrophy: Two-Year Follow-Up Study

PURPOSE: We evaluated the progression of geographic atrophy (GA) based on fundus autofluorescence (FAF) pattern and atrophy size using the fundus camera in non-exudative age-related macular degeneration (ARMD). METHODS: We acquired FAF images in non-exudative ARMD patients over a 2-year period. According to The Fundus Autofluorescence in Age-related Macular Degeneration (FAM) study, FAF patterns of geographic atrophy were classified into 5 categories. Examiners quantified the areas of GA in FAF images and analyzed the progression of atrophy based on FAF pattern and atrophy size. RESULTS: In 86 non-exudative ARMD eyes, elderly patients had faster progression rate of GA. The growth rates of GA were 1.51 mm2/year in 'Diffuse', 1.49 mm2/year in 'Banded', 1.05 mm2/year in 'Patchy', 0.59 mm2/year in 'Focal' and 0.16 mm2/year in 'None' pattern groups. In addition, the growth rate was 0.38 mm2/year in which initial the GA area was smaller than 1 disc area. This was the slowest progression rate among all categories according to initial GA area. CONCLUSIONS: As a result of evaluating the progression of geographic atrophy using FAF over a 2-year period, the growth rate of GA was the fastest in the 'Diffuse' pattern group. Additionally, as the initial GA area became smaller, the progression of GA atrophy was slower (p < 0.002). Although limitations such as short follow-up period and measurement error of GA atrophy area using fundus photography were compensated, the results in the present study were similar to the outcomes of studies on progression of GA based on FAF pattern using the scanning laser ophthalmoscope over several years and the fundus camera for 1 year. In conclusion, the fundus camera is a useful tool for the prediction of long-term progression of GA in patients with non-exudative ARMD.

Age-related macular degeneration with choroidal neovascularization in the setting of pre-existing geographic atrophy and ranibizumab treatment. Analysis of a case series and revision paper / Avaliação da resposta da injeção intravítrea de ranibizumab em pacientes com neovascularização de coróide da degeneração macular relacionada à idade com atrofia geográfica extensa pré-existente e revisão da literatura

PURPOSE: To report the response of choroidal neovascularization (CNV) to intravitreal ranibizumab treatment in the setting of age-related macular degeneration (AMD) with extensive pre-existing geographic atrophy (GA) and a revision paper. METHODS: This is a revision paper and a retrospective case series of 10 eyes in nine consecutive patients from a photographic database. The patients were actively treated with ranibizumab for neovascular AMD with extensive pre-existing GA. Patients were included if they had GA at or adjacent to the foveal center that was present before the development of CNV. The best corrected visual acuity and optical coherence tomography (OCT) analysis of the central macular thickness were recorded for each visit. Serial injections of ranibizumab were administered until there was resolution of any subretinal fluid clinically or on OCT. Data over the entire follow-up period were analyzed for overall visual and OCT changes. All patients had been followed for at least 2 years since diagnosis. RESULTS: The patients received an average of 6 ± 3 intravitreal injections over the treatment period. Eight eyes had reduced retinal thickening on OCT. On average, the central macular thickness was reduced by 94 ± 101 µm. Eight eyes had improvement of one or more lines of vision, where as one eye had dramatic vision loss and one had no change. The average treatment outcome for all patients was -0.07 ± 4.25 logMAR units, which corresponded to a gain of 0.6 ± 4.4 lines of Snellen acuity. The treatment resulted in a good anatomic response with the disappearance of the subretinal fluid, improved visual acuity, and stabilized final visual results. CONCLUSION: The results of this case series suggest that the use of an intravitreal anti-vascular endothelial growth factor (VEGF) agent (ranibizumab) for CNV in AMD with extensive pre-existing GA is effective. Our results are not as striking as published results from large-scale trials of anti-VEGF therapy for subfoveal CNV, presumably due to the limitation in the baseline visual acuity caused by the underlying GA. The good anatomic response with the disappearance of the subretinal fluid, improved visual acuity, and stabilized final visual results were consistent with other ranibizumab studies.

Investigar os resultados da injeção intravítrea de Ranibizumab em pacientes com neovascularização de coróide da degeneração macular relacionada a idade, com atrofia geográfica extensa, pré-existente e revisão da literatura. MÉTODOS: Este é um artigo de revisão e também um estudo retrospectivo de 9 pacientes, 10 olhos com neovascularização de coróide da degeneração macular relacionada à idade, com atrofia geográfica extensa, pré-existente. Os pacientes incluídos apresentaram atrofia geográfica, envolvendo a fóvea ou adjacente, antes do desenvolvimento da neovascularização de coróide. A melhor correção visual e o exame de tomografia de coerência óptica (OCT) com analise da espessura macular foram registrados em cada visita. As injeções de ranibizumab intravítrea foram feitas até a resolução do líquido sub-retiniano pelo OCT e clinicamente. Todos os pacientes tinham seguimento de 6 meses do diagnostico a 2 anos, com média de 16 meses. RESULTADOS: 10 olhos de 9 pacientes incluídos receberam uma média de 6 ± 3 injeções intravítreas de ranibizumab, sendo que 8 apresentaram redução do espessamento macular pelo OCT. A mácula teve o espessamento reduzido entre 94 ± 101 microns, 8 olhos tiveram melhora de 1 ou mais linhas de visão, um olho teve acentuada diminuição da visão.e um outro não teve alteração. A media do resultado do tratamento em logMAR era -0,07 ± 4.25 correlacionando um ganho de visão na tabela de Snellen entre 0,6 ± 4.4linhas de visão. CONCLUSÃO: Estes resultados sugerem que o uso do Ranibizumab intravítreo para neovascularização de coróide da degeneração macular relacionada à idade em extensa atrofia geográfica pré-existente é efetivo. Existem, entretanto, dificuldades na avaliação da acuidade visual destes pacientes em virtude da extensa Atrofia Geográfica que apresentavam e sobre esta ainda as complicações da neovascularização de coróide, se comparados a casos em que a neovascularização de coróide não ocorre em atrofia geográfica pré-existente.

Intravitreal ranibizumab and bevacizumab therapy for choroidal neovascularization in age-related macular degeneration with extensive pre-existing geographic atrophy / Avaliação da resposta da injeção intravítrea de ranibizumab e bevacizumab em pacientes com neovascularização de coroide da degeneração macular relacionada à idade com atrofia geográfica extensa pré-existente

PURPOSE: To report the response of choroidal neovascularization to intravitreal ranibizumab or bevacizumab treatment in the setting of age-related macular degeneration with extensive pre-existing geographic atrophy of the retinal pigment epithelium. METHODS: This is a retrospective case series of 11 eyes in ten consecutive patients retrieved from a photographic database. The patients were treated with ranibizumab or bevacizumab for neovascular age-related macular degeneration with pre-existing geographic atrophy. Patients were included if they had geographic atrophy at or adjacent to the foveal center of at least 1 disc area in size that was present before the development of choroidal neovascularization. The best corrected visual acuity and optical coherence tomography analysis of the central macular thickness were recorded for each visit. Serial injections of ranibizumab or bevacizumab were administered until there was complete resolution of subretinal fluid on optical coherence tomography. Data over the entire follow-up period were analyzed for overall visual and optical coherence tomography changes. RESULTS: The patients received an average of 7 ± 3 intravitreal injections over the treatment period. Seven of 11 eyes had reduced retinal thickening on optical coherence tomography. On average, the central macular thickness was reduced by 72 ± 115 µm. Six of these 7 eyes had improvement of one or more lines of vision and one had no change. The average acuity change for all patients was -0.04 ± 0.46 logMAR units, which corresponded to a gain of 0.2 ± 4.4 lines of Snellen acuity. The treatment resulted in a good anatomic response with resolution of the subretinal fluid and overall stable visual acuity. CONCLUSIONS: The results of this case series suggest that the use of an intravitreal anti-vascular endothelial growth factor (VEGF) agent (ranibizumab or bevacizumab) for choroidal neovascularization in age-related macular degeneration with pre-existing geographic atrophy is effective. Our results are not as striking as published results from large-scale trials of anti-vascular endothelial growth factor therapy for subfoveal choroidal neovascularization, presumably due to the limitation in the baseline visual acuity caused by the underlying geographic atrophy. The favorable anatomic response with the resolution of subretinal fluid and stable acuity were consistent with other ranibizumab and bevacizumab studies.

OBJETIVO: Avaliação dos resultados da injeção intravítrea de ranibizumab e bevacizumab em pacientes com neovascularização de coróide da degeneração macular relacionada a idade, com atrofia geográfica extensa, pré-existente. MÉTODOS: Este é um estudo retrospectivo de 10 pacientes, 11 olhos com neovascularização de coroide da degeneração macular relacionada à idade, com atrofia geográfica extensa, pré-existente. Os pacientes incluídos apresentaram atrofia geográfica, envolvendo a fóvea ou adjacência, antes do desenvolvimento da neovascularização de coroide. A melhor correção visual e o exame de tomografia de coerência óptica com análise da espessura macular foram registrados em cada visita. As injeções de ranibizumab e bevacizumab intravítrea foram feitas até a resolução do líquido sub-retiniano pela tomografia de coerência óptica e clinicamente. Todos os pacientes tinham seguimento de 6 meses do diagnóstico a 2 anos, com média de 16 meses. RESULTADOS: Onze olhos de 10 pacientes incluídos receberam uma média de 7 ± 3 injeções intravítreas de ranibizumab e bevacizumab, sendo que 7 apresentaram redução do espessamento macular pelo tomografia de coerência óptica. A mácula teve o espessamento reduzido entre 72 ± 115 µm, 6 olhos tiveram melhora de 1 ou mais linhas de visão, um olho teve acentuada diminuição da visão e um outro não teve alteração. A média do resultado do tratamento em logMAR era -0,04 ± 0,46 correlacionando um ganho de visão na tabela de Snellen entre 0,2 ± 4,4 linhas de visão. CONCLUSÕES: Estes resultados sugerem que o uso do ranibizumab e bevacizumab intravítrea para neovascularização de coroide da degeneração macular relacionada à idade em extensa atrofia geográfica pré-existente é eficaz. Há, entretanto dificuldades na avaliação da acuidade visual destes pacientes em virtude da extensa atrofia geográfica que apresentavam e sobre esta ainda a neovascularização de coroide, se comparados a casos em que a neovascularização de coroide não ocorre em atrofia geográfica pré-existente.