Age-related macular degeneration after retinal detachment surgery

We studied a group of 157 patients who had retinal detachment surgery in one eye with successful anatomical reattachment and a fellow eye without a retinal detachment. In a group of 7 out of 8 patients who had a retinal detachment that included the macula and who underwent surgery, we found that the development of macular degenerative changes was much less pronounced in the operated eye than in the fellow, control eye. In a group of 3 patients who had retinal detachment without macular involvement, the appearance of macular degenerative changes appeared to be rather symmetric in the operated and in the fellow eye. The presence of a circling buckle did not appear to have an influence on the ARMD changes. It appears that the presence of a macular detachment is a factor in modifying the natural history of age-related macular degeneration. The diminution of signs of ARMD could be related to a degree of atrophy in the retinal pigment epithelium occurring after a retinal detachment with the macula off.     

Age-related macular degeneration

Age-related macular degeneration (AMD) is a major cause of visual loss. The atrophic form is more frequent but accounts for only 20% of severe visual loss. The neovascular form accounts for 80% of severe visual loss. The Macular Photocoagulation Study demonstrated that prompt argon laser photocoagulation can significantly reduce the risk of severe visual loss for patients with neovascular membranes outside the fovea. For patients with both atrophic and neovascular forms of AMD, low vision aids may be of great benefit.     

Age-related macular degeneration

Age-related macular degeneration (AMD) is the leading cause of irreversible severe visual loss in the United States in people over 50 years of age. The nonexudative stage includes hard drusen (associated with localized dysfunction of the retinal pigment epithelium [RPE]), soft drusen (associated with diffuse dysfunction of the RPE), and geographic (areolar) atrophy. These fundus changes may predispose the eye to develop the neovascular/exudative stages of AMD. Most patients who develop severe visual loss from AMD have this exudative stage. Treatment for AMD has been shown to be effective for only a small proportion of patients who have a well-defined choroidal neovascular membrane (CNVM) more than 200 microns from the foveal center. Even in successfully treated cases, severe visual loss is postponed only for about 18 months because of the high rate of recurrent CNVMs that extend into the fovea. Thus, despite recent breakthroughs in laser treatment for AMD, most patients who develop the exudative form of AMD will develop central visual impairment. At the present time, the only available treatments for the majority of patients who develop the exudative form of AMD are low vision aids. Investigators are currently evaluating whether treatment is effective for membranes within 200 microns of the foveal center. Future studies need to be directed toward further understanding of the pathogenesis, treatment and prevention of the blinding complications of AMD.     

Age-related macular degeneration and genetics

Age related macular degeneration (AMD) is the main cause of blindness after age 55 in western countries. These last past years, several lines of evidence such as familial aggregation or twin studies suggested a genetic component in AMD. However, the late onset of the disease and the fact that AMD is a polygenic and multifactorial disease are the main limiting factors for linkage studies. Gene candidate strategy allowed the exclusion of several genes (VMD2, RDS, TIMP3) and lead to the implication of two genetic factors: the apoE gene (involved in the transport of lipids) and the ABCR gene (involved in Stargardt macular dystrophy). Concerning the apoE gene, a lower frequency of the epsilon 4 alleles carriers was observed in the exudative AMD population compared with controls, supporting the idea of a role of the apoE gene in exudative AMD with drusen. These results, together with ultrastructural studies, suggest that allele epsilon 4 is a protective factor for drusen and thus for AMD. For the ABCR gene, several studies and a large multicentric study definitively show that some heterozygous mutations are predisposing factors for AMD, in a polygenic and multifactorial model.     

Age-related macular degeneration and apoptosis

Several studies suggest that apoptosis might play a major role in age-related macular degeneration. Apoptosis in retinal pigment epithelium cells undergoing severe oxidative stress has been reported and could therefore be involved in the pathogenesis of AMD. The processes of drusen formation seem to be similar to the processes described in apoptosis. Moreover, apoptosis appears to be involved in the early outgrowth of choroidal neovascular membranes as well as in the development of fibrotic scars at a later stage. Targeting apoptotic pathways should therefore be considered as a possible treatment approach for AMD.     

Age-related macular degeneration in Inuit

PURPOSE: To describe a specific Greenlandic type af age-related macular degeneration (AMD) - the Retinochoroidal Atrophy (RCA). METHODS: 135 referred patients in East Greenland were examined in 1997. A colour and a redfree fundus photograph of an 87-year-old Greenlandic woman illustrates the clinical picture of RCA (retinochoriodal atrophy). RESULTS: Of 135 examined patients 22 had AMD. 23 eyes in 12 patients had RCA, which was the most common type af AMD in this Greenlandic investigation. The clinical picture of RCA is peripapillary and central retinochoroidal atrophy and sclerosis resembling a recumbent Russian matúshka doll. The mean age of the 12 patients with RCA was 74.4+/-8.7 years. They were all severely visually handicapped with a visual acuity < or =6/60. CONCLUSION: A specific type of Greenlandic AMD called RCA is described. No epidemiological conclusions can be drawn from this investigation.     

Age-related macular degeneration and its management

Age-related macular degeneration is a major cause of vision loss in older individuals. The clinical picture and pathogenesis of age-related macular degeneration is reviewed. Present treatment modalities for subretinal vascularization in exudative-type macular degeneration and their limitations are discussed. The role of low-vision aids in providing magnification for reading vision is described. The role of intraocular lens implantation is discussed, as well as the newly developed intraocular lens which, with the addition of a plus-lens, functions as a Galilean telescope to provide magnification for near vision.     

Age-related macular degeneration in Chinese-Canadians.

BACKGROUND: Ethnicity has long been suspected to play a role in the risk of macular degeneration as well as its neovascular complications. We carried out a study to determine the prevalence of retinal diseases in Chinese-Canadians presenting for fluorescein angiography compared to a matched group of Canadians of European origin. METHODS: We reviewed 20,000 consecutive fluorescein angiograms obtained between December 1987 and November 1993 at a tertiary referral centre for ophthalmic care in Vancouver. All patients identified by name as being of Chinese ancestry were identified and matched to a patient of European ancestry. The two groups were compared in regard to the prevalence of specific retinal diseases, including age-related macular degeneration (AMD). RESULTS: Among the first 10,000 fluorescein angiograms, 417 patients of Chinese ancestry were identified, of whom 61 (14.6%) had the primary diagnosis of AMD. The rate among the patients of European ancestry was 30.4% (127/417) (odds ratio [OR] 2.12, 95% confidence interval [CI] 1.79 to 2.56) (p < 0.001). A total of 88 ethnic Chinese patients were identified among the subsequent 10,000 angiograms. Pigment epithelial detachments were more than twice as common in the overall group of ethnic Chinese patients as in their counterparts of European ancestry (OR 2.6, 95% CI 0.7 to 10.1). Choroidal neovascularization was 1.6 times more common in the latter group (95% CI 0.98 to 2.8). INTERPRETATION: The findings support the growing clinical observations of a lower prevalence of AMD in nonwhite populations in addition to an increased prevalence of pigment epithelial detachments in ethnic Chinese patients.     

Age-related macular degeneration and optic disk morphology

PURPOSE: To assess the relationship between age-related macular degeneration and appearance of the optic disk. METHOD: By morphometric evaluation of wide-angle color fundus photographs, 143 patients with age-related macular degeneration were compared with 33 normal subjects and with 83 diabetic patients. RESULTS: Size and shape of the optic disk and size of parapapillary atrophy did not vary significantly (P > .12) between the study groups. CONCLUSIONS: Age-related macular degeneration is not associated with special features in the appearance of the optic disk. Parapapillary atrophy, large or small optic disk, and abnormal disk shape are neither risk factors nor protective factors of age-related macular degeneration.     

Age-related macular degeneration: new perspectives

Age-related macular degeneration (ARMD) is a major source of legal blindness in individuals older than 50 years. Even though recent reports suggest that genetics plays an important role, its pathogenesis remains puzzling and the risk factors for its occurrence are not completely established. Vitamin and mineral supplementation reduced the risk of development of choroidal neovascularization (CNV) or progression to the most advanced stages of age-related macular degeneration. Photodynamic therapy (PDT) and antiangiogenic therapy have proved to be very useful for the treatment of choroidal neovascularization associated to age-related macular degeneration, by reducing the risk of vision loss and, occasionally, by a temporary improvement of vision. Only a small subset of patients may benefit from other treatment modalities, such as laser photocoagulation, surgical removal of choroidal neovascularization and transpupillary thermotherapy (TTT). Strategies to control and treat age-related macular degeneration may progress quickly as more is learned about its pathophysiology and the molecular events that contribute to the disease expression.     

Age-related macular degeneration and vitreous hemorrhage.

Age-related macular degeneration led to vitreous hemorrhage (VH) in six eyes of four patients. Macular involvement was bilateral in three patients and fluorescein angiography performed before VH showed extensive subretinal hemorrhage in the macular region in all eyes. We examine the possible causal mechanisms of VH resulting from age-related macular degeneration. Local risk factors, as outlined in our series by fluorescein angiography, are discussed and systemic risk factors are considered. Three out of the six eyes underwent pars plana vitrectomy for removal of intravitreal blood, and had severe inflammatory reactions in the postoperative period. In the three non-operated eyes spontaneous reabsorption of VH was observed at the end of follow-up.     

Age-related macular degeneration and risk of stroke

Age-related macular degeneration (ARMD) and stroke are common causes of disability in subjects over 40 years of age. The etiology of ARMD remains unknown and numerous epidemiological studies have suggested a relationship between vascular risk factors and ARMD. A direct relationship between stroke and ARMD has also been suggested. An update on the association between ARMD and stroke is discussed in this article.     

Age-related macular degeneration: from neovascular to atrophic

A 72-year-old man with age-related neovascular macular degeneration and recurrent episodes of macular subretinal exudation showed a spontaneous change to geographic atrophy of the macula over a period of six years. The evolution of the macular changes from exudative to atrophic illustrates the difficulty of the retrospective classification of age-related macular degeneration.