Age Related Macular Degeneration (AMD) & latest Treatment with Intraviteal injections of LUCENTIS & AVASTIN (anti VEGF). Exudative age related macular degeneration (wet ARMD) continues to be a common blinding retinal disorder. Laser treatment for wet ARMD often is not possible or worsens the patient’s vision. Unfortunately, the majority of leakages are occult or poorly defined choroidal neovascular membranes (CNVM) which are located under the center of the macula. These lesions respond the poorest to traditional laser therapy. The new treatments of anti-VEGF for exemple LUCENTIS or AVASTIN, might have a great benefit to patients with leakage located directly under the macula. So far, Dr. T.S. Melki has performed over 500 of these injections (2007).
Limited Retinal Translocation can move the retina inferiorly so that small classic (well defined) submacular CNVM can be moved “out” of the central macula prior to laser. Retinal surgeons now have the technical capability to perform translocation surgery. The CNVM can then be treated post-operatively while hopefully preserving the central macula. Limited retinal translocation is a reasonable procedure to consider for small classic submacular CNVM in a attempt to prevent further vision loss. Significant complications can occur following retinal translocation surgery.
Photodynamic Therapy (PDT) will allow for the treatment of subfoveal CNVM with less damage to the overlying retina. Hopefully, patients will experience less vision loss following PDT treatment. PDT requires the injection of a photosensitive dye prior to laser therapy. The preliminary results for PDT are encouraging when the majority of the leakage is classic (well defined). Unfortunately, in the same clinical trial, PDT was not proven visually beneficial in patients when the majority of the lesion was occult (poorly defined). Dr. T.S. Melki currently (2007) rarely offers this therapy option.
Transpupillary Thermotherapy (TTT) is an alternative therapy for patients with occult (poorly defined) subfoveal leakage. TTT utilizes the diode laser with an enlarged spot size and extended treatment time to treat subfoveal CNVM with less overlying retinal damage. TTT avoids the use and expense of the dye used in PDT. The preliminary results for TTT indicate the ability to stabilize vision loss in the majority of patients treated. TTT is already FDA approved. A large clinical trial of TTT is currently being organized. We are currently utilizing TTT in our offices for patients with otherwise untreatable subfoveal occult leakage.