12th Vitreoretinal Symposium Frankfurt – Marburg 2009

Scientific programm: Abstract

3rd scientific session: Age Related Macular Degeneration

23. Exudative AMD - Three Injections and how to Proceed?

Jörg C. Schmidt¹, S. Mennel² (¹Duisburg, ²Marburg)

Background: The treatment of exudative age-related macular degeneration (AMD) with severe decrease of visual acuity within a short period of time still represents a big challenge. Anti-VEGF treatment is not sufficient enough for several cases and some do not respond to repeated injections.
Patients and method: Today, intravitreal injection of anti-VEGF drug for every four weeks within the first three months and further injetions corresponding to the effect or recurrence of exudations and change of visual acuity represents the treatment of choice.
Results: Anti-VEGF shows promising results in the treamtent of exudative AMD maintaining visual acuity or even to increase visual function. Intra- and subretinal fluid resolves and leakage is reduced or stopped. However, in about 30% of cases the disease does not respond to repeated treatment. Additionally, complications like subretinale hemorrhage or RPE tear may occur. Several of those eyes that do not adequatly respond to anti-VEGF therapy presents vitreous adhesion at the retina or even vitreoretinal traction at the macula. In these cases pars plana vitrecomy offers a treatment to release traction and if necessary to remove subretinal membranes as an alternative treamtent.
Discussion: Intravitreal application of anti-VEGF represents an effective and easy treatment for exudative AMD in most of the cases. If there is no response to this treamtent option, alternative strategies as pars plana vitrectomy and membrane peeling should be discussed. In paticular when no response could be demonstrated for the first eye and progression is present in the second eye.