ABSTRACT
OBJECTIVE: Age related macular degeneration (ARMD) in its neovascular form is a serious disease which produces legal blindness in many patients with poor prognosis if left untreated. We intend to establish a clinical guide with the different therapeutic options that exist nowadays, which may help the ophthalmologists in their clinical practice. METHODS: A group of medical retina experts selected by SERV have evaluated the results of different published studies with the drugs currently available, obtaining an evidence-based consensus. Some recommendations have been established for diagnosis, treatment and monitoring of patients with neovascular ARMD. RESULTS: The intravitreal injection of ranibizumab at a dosage of 0.5 mg produces significant improvement of visual acuity in subfoveal lesions, according to data obtained from studies with the highest level of evidence. It should be considered as a first choice drug. The use of bevacizumab, a drug with not approved indication for intraocular use, nor for the treatment of neovascular ARMD can reach a result which is closer to the ones obtained with ranibizumab than to those obtained with photodynamic therapy (PDT) and pegaptanib. The use of intravitreal pegaptanib sodium in intravitreal injection at a dosage of 0.3 mg as a treatment for subfoveal lesions can obtain similar results to the TFD, but with a wider range of injuries. CONCLUSION: The results of the evidence-based studies are a good guide for the treatment of this disease.
Subject(s)
Wet Macular Degeneration/diagnosis , Wet Macular Degeneration/therapy , Algorithms , HumansABSTRACT
Objetivo: La Degeneración Macular Asociada a laEdad (DMAE) en su forma húmeda supone unagrave enfermedad que condiciona ceguera legal enmuchos pacientes y con mal pronóstico si no es tratada.Pretendemos establecer una guía de actuaciónclínica con las diferentes opciones terapeúticas queexisten en el momento actual, que puedan ayudar aloftalmólogo en su práctica clínica.Métodos: Un grupo de expertos en retina médicaseleccionados por la SERV han evaluado los resultadosde los diferentes estudios publicados con losfármacos actualmente disponibles, llegando a un consenso basado en la evidencia. Se han establecidounas recomendaciones para el diagnóstico, tratamientoy seguimiento de los enfermos con DMAEhúmeda.Resultados: La inyección intravítrea de ranibizumaba la dosis de 0,5 mg permite obtener mejoríassignificativas de la agudeza visual en lesiones subfoveales,según los datos obtenidos de estudios conmáximo nivel de evidencia. Debe ser consideradocomo el fármaco de primera elección. El empleo debevacizumab, fármaco sin indicación aprobada parauso intraocular, ni para el tratamiento de la DMAEhúmeda, puede aportar un beneficio más próximo alos resultados obtenidos con el ranibizumab que alos obtenidos con la terapia fotodinámica (TFD) yel pegaptanib. El uso de pegaptanib sódico eninyección intravítrea a la dosis de 0,3 mg como tratamientode lesiones subfoveales permite obtenerresultados parecidos a la TFD, pero en un abanicomás amplio de lesionesConclusiones: Los resultados de los estudios basadosen la evidencia constituyen una buena guía deactuación en el tratamiento de esta enfermedad(AU)
Objective: Age related macular degeneration(ARMD) in its neovascular form is a serious diseasewhich produces legal blindness in many patientswith poor prognosis if left untreated. We intend toestablish a clinical guide with the different therapeuticoptions that exist nowadays, which may helpthe ophthalmologists in their clinical practice.Methods: A group of medical retina experts selectedby SERV have evaluated the results of differentpublished studies with the drugs currently available,obtaining an evidence-based consensus. Somerecommendations have been established for diagnosis, treatment and monitoring of patients with neovascularARMD.Results: The intravitreal injection of ranibizumabat a dosage of 0.5 mg produces significant improvementof visual acuity in subfoveal lesions, accordingto data obtained from studies with the highestlevel of evidence. It should be considered as a firstchoice drug. The use of bevacizumab, a drug withnot approved indication for intraocular use, nor forthe treatment of neovascular ARMD can reach aresult which is closer to the ones obtained with ranibizumabthan to those obtained with photodynamictherapy (PDT) and pegaptanib. The use of intravitrealpegaptanib sodium in intravitreal injection at adosage of 0.3 mg as a treatment for subfoveallesions can obtain similar results to the TFD, butwith a wider range of injuries.Conclusion: The results of the evidence-based studiesare a good guide for the treatment of this disease(AU)
