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Файл:Ординатура / Офтальмология / Учебные материалы / Age-related Macular Degeneration Springer.pdf
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- •Preface to the Second Edition
- •Contents
- •List of Abbreviations
- •1: Epidemiology of AMD
- •Core Messages
- •1.1 Introduction
- •1.3 Frequency
- •1.3.1 Prevalence
- •1.3.2 Incidence
- •1.4 Natural Course
- •1.5 Genetic Factors
- •1.5.1 The Complement Pathway Genes
- •1.5.1.1 Complement Factor H (CFH)
- •1.5.1.3 Complement Component 3 (C3)
- •1.5.1.4 Complement Factor I (CFI)
- •1.5.2 The ARMS2 (10q26) Locus
- •1.5.3.1 Apolipoprotein E (APOE)
- •1.5.4 Candidate Gene Association Studies
- •1.6 Environmental Factors
- •1.6.1 Smoking
- •1.6.2 Antioxidants
- •1.6.3 Body Mass Index (BMI)
- •1.6.4 Hypertension
- •1.6.5 Cataract Surgery
- •1.7 Interaction Between Risk Determinants
- •1.7.1 Combined Effects of CFH Y402H and Other Genetic and/or Environmental Factors
- •1.7.2 Combined Effects of 10q26 SNPs and Other Genetic and/or Environmental Factors
- •1.7.4 Combined Effects of the APOE Gene and Other Genetic and/or Environmental Factors
- •References
- •2: Genetics
- •Core Messages
- •2.1 Introduction
- •2.2 Identifying Risk Factors of a Common Disease
- •2.3 Early Findings
- •2.4.1 Functional Implications
- •2.5.1 Functional Implications
- •2.7 Prospects of Genetics in AMD Therapy and Prevention
- •Summary for the Clinician
- •References
- •Core Messages
- •3.1 Introduction
- •3.2 Cause and Consequences of Ageing
- •3.3 Clinical Changes Associated with Retinal Ageing
- •3.4 Ageing of the Neural Retina
- •3.5 Ageing of the RPE
- •3.5.1 Changes in RPE Cell Density
- •3.5.2 Subcellular Changes in the RPE
- •3.5.3 Accumulation of Lipofuscin
- •3.5.4 Melanosomes and Pigment Complexes
- •3.5.7 Antioxidant Capacity of the RPE
- •3.6 Ageing of Bruch’s Membrane
- •3.7 The Association Between Ageing and AMD
- •Summary for the Clinician
- •References
- •Core Messages
- •4.1 Introduction
- •4.2 The Complement System
- •4.3 Evidence for Involvement of the Complement System in AMD Pathogenesis
- •4.4.2 Complement Gene Variants and AMD Subtypes
- •4.4.3 Complement Gene Variants and Progression of AMD
- •4.4.5 Variations of Complement Genes and Response to Treatment: Pharmacogenetics
- •4.5 Emerging Pharmacological Intervention Targeting Complement Dysregulation
- •Conclusions
- •Summary for the Clinician
- •References
- •5: Histopathology
- •Core Messages
- •5.1 Retinal Pigment Epithelium
- •5.1.1 Structure and Function of the Retinal Pigment Epithelium
- •5.1.3 Deposits in the RPE
- •5.2 Bruch’s Membrane
- •5.2.1 Structure of Bruch’s Membrane
- •5.2.3 Deposits in Bruch’s Membrane, Drusen
- •5.3 Choroidal Neovascularization
- •5.4 Detachment of the Retinal Pigment Epithelium
- •5.5 Geographic Atrophy of the RPE
- •Summary for the Clinician
- •References
- •6: Early AMD
- •Core Messages
- •6.1 Introduction
- •6.2 Drusen
- •6.2.3 Fluorescence Angiography and Optical Coherence Tomography
- •6.3 Focal Hypopigmentation and Hyperpigmentation of the Retinal Pigment Epithelium
- •6.4 Abnormal Choroidal Perfusion
- •Summary for the Clinician
- •References
- •Core Messages
- •7.1 Introduction
- •7.2.1 Decreased Visual Acuity
- •7.2.2 Visual Distortion
- •7.2.3 Visual Field Defects
- •7.2.4 Miscellaneous Symptoms
- •7.3 Signs of Choroidal Neovascularization
- •7.3.1 Hemorrhage
- •7.3.2 Macular Edema and Subretinal Fluid
- •7.3.3 Retinal Pigment Epithelial Detachment
- •7.3.4 Miscellaneous Signs
- •7.4 Common Testing Modalities to Diagnose Choroidal Neovascularization
- •7.4.1 Fluorescein Angiography
- •7.4.2 Indocyanine Green Angiography
- •7.4.4 Optical Coherence Tomography
- •Summary for the Clinician
- •References
- •8: Geographic Atrophy
- •Core Messages
- •8.1 Introduction
- •8.3 Histology and Pathogenesis of Geographic Atrophy
- •8.5 Spectral Domain Optical Coherence Tomography in Geographic Atrophy
- •8.7 Risk Factors
- •8.7.1 Genetic Factors
- •8.7.2 Systemic Risk Factors
- •8.7.3 Ocular Risk Factors
- •8.8 Development of CNV in Eyes with GA
- •8.9 Visual Function in GA Patients
- •8.9.1 Measurement of Visual Acuity
- •8.9.2 Contrast Sensitivity
- •8.9.3 Reading Speed
- •8.9.4 Fundus Perimetry
- •8.10 Perspectives for Therapeutic Interventions
- •8.10.2 Complement Inhibition
- •8.10.3 Neuroprotection
- •8.10.4 Alleviation of Oxidative Stress
- •8.10.5 Serotonin-1A-Agonist
- •8.10.6 Perspective
- •Summary for the Clinician
- •References
- •9: Fundus Imaging of AMD
- •Core Messages
- •9.1 Introduction
- •9.2 Color Photography
- •9.3 Monochromatic Photography
- •9.5 Optical Coherence Tomography
- •9.5.2 Coherence Length
- •9.5.3 Time Domain Optical Coherence Tomography
- •9.5.4 Frequency Domain Optical Coherence Tomography
- •9.5.5 Increasing Depth of Imaging
- •9.5.6 General Optical Coherence Tomographic Imaging Characteristics of the Macular Region
- •9.6 Fundus Angiography
- •9.6.1 Fluorescein Dye Characteristics
- •9.6.2 Indocyanine Green Dye Characteristics
- •9.6.3 Cameras Used in Fluorescence Angiography
- •9.6.4 Patient Consent and Instruction
- •9.6.5 Fluorescein Injection
- •9.6.6 Fluorescein Technique
- •9.6.7 Indocyanine Green Technique
- •9.7 Fluorescein Angiographic Interpretation
- •9.7.1 Filling Sequence
- •9.7.2 The Macula
- •9.8 Deviations from Normal Angiographic Appearance
- •9.10.1 Drusen
- •9.12 Neovascular AMD
- •9.13 Retinal Pigment Epithelial Detachments
- •9.14 Retinal Vascular Contribution to the Exudative Process
- •9.15 Follow-up
- •9.15.1 Thermal Laser
- •9.15.2 Photodynamic Therapy
- •9.15.3 Anti-VEGF Therapy
- •Summary for the Clinician
- •References
- •10: Optical Coherence Tomography
- •10.1 Introduction
- •Core Messages
- •10.4 OCT in Geographic Atrophy
- •10.5 OCT in Exudative AMD
- •Summary for Clinician
- •References
- •11: Microperimetry
- •Core Messages
- •11.1 Introduction
- •11.2.1 From Manual to Automatic Microperimetry
- •11.2.2 Automatic Microperimetry
- •11.2.3 Microperimetry: The Examination
- •11.2.4 Microperimetry: Test Evaluation
- •11.2.5 Other Microperimeter
- •11.3 Microperimetry in AMD
- •11.3.1 Early AMD
- •11.3.2 Geographic Atrophy
- •11.3.3 Neovascular AMD
- •11.3.4 Neovascular AMD: Treatment
- •Summary for the Clinician
- •References
- •Core Messages
- •12.1 Introduction
- •12.2 Antioxidants and Zinc
- •12.3 Beta-Carotene
- •12.4 Macular Xanthophylls
- •12.6 Vitamin E
- •12.7 Vitamin C
- •12.8 Zinc
- •12.10 AREDS2
- •Summary for the Clinician
- •References
- •Core Messages
- •13.1 Introduction
- •13.2 Basic Principles
- •13.2.1 Clinical Background
- •13.2.2 Laser Photocoagulation
- •13.2.3 Photodynamic Therapy
- •13.3 Treatment Procedures
- •13.3.1 Laser Photocoagulation
- •13.3.2 Photodynamic Therapy
- •13.4 Study Results
- •13.4.1 Laser Photocoagulation
- •13.4.1.1 Extrafoveal CNV
- •13.4.1.2 Subfoveal CNV
- •13.4.1.3 Meta-analysis
- •13.4.2 Photodynamic Therapy
- •13.4.2.1 Predominantly Classic
- •13.4.2.2 Occult with No Classic Neovascularization
- •13.4.2.3 Minimally Classic
- •13.5 Safety and Adverse Events
- •13.5.1 Laser Photocoagulation
- •13.5.2 Photodynamic Therapy
- •13.6 Variations
- •13.6.1 Laser Photocoagulation: Different Wavelengths
- •13.6.2 Photodynamic Therapy
- •13.6.3 Combination Treatments
- •13.7 Present Guidelines
- •13.7.1 Laser Photocoagulation
- •13.7.2 Photodynamic Therapy
- •13.8 Perspectives
- •Summary for the Clinician
- •References
- •Core Messages
- •14.1 Introduction
- •14.2 Vascular Endothelial Growth Factor (VEGF)
- •14.3 Targets Within the VEGF Pathway
- •14.3.1 Sequestration of Released VEGF
- •14.3.2 Inhibition of VEGF and VEGF Receptor Synthesis by Small Interfering RNA (siRNA)
- •14.3.3 Inhibition of the Intracellular Signal Cascade
- •14.3.4 Natural VEGF Inhibitors
- •14.4 New Methods of Drug Delivery
- •14.5 Combined Strategies
- •Summary for the Clinician
- •References
- •Core Messages
- •15.1 Introduction
- •15.1.1 Anti-VEGF Therapies for NV-AMD
- •15.2.1 How Should Neovascular AMD be Diagnosed?
- •15.2.4.1 Results with Continuous Monthly Treatment
- •15.2.4.2 How Should Treatment be Started?
- •15.2.4.3 What Flexible Approaches Are Reported?
- •Fixed Quarterly Injection Studies
- •Flexible Dosing Regimens: Two Approaches
- •Flexible Dosing Regimens: ‘As Needed’ Approach
- •Flexible Dosing Regimens: ‘Treat-and-Extend’ Approach
- •Summary for the Clinician
- •References
- •Core Messages
- •16.1 Introduction
- •16.3 Current Limitation of Therapy in the Treatment of Exudative AMD
- •16.4 Rationale for Combination Therapy in the Treatment of Exudative AMD
- •16.5 Clinical Data Examining Combination Therapy for Exudative AMD
- •16.5.3 Triple Therapy for Exudative AMD
- •16.5.4 Combination Therapy with Radiation
- •Summary for the Clinician
- •References
- •Core Messages
- •17.1 Introduction
- •17.2 Current Treatment Options for Dry AMD
- •17.3 Targeting the Cause of AMD
- •17.4 Preclinical and Phase I Drugs in Development for Dry AMD
- •17.4.1 Clinical Trial Endpoints in Dry AMD
- •Trimetazidine
- •17.4.2.2 Neuroprotection
- •Ciliary Neurotrophic Factor (CNTF/NT-501)
- •AL-8309B (Tandospirone)
- •Brimonidine Tartrate Intravitreal Implant
- •17.4.2.3 Visual Cycle Modulators
- •Fenretinide
- •17.4.2.4 Other
- •17.4.3 Drugs to Prevent Injury from Oxidative Stress and Micronutrient Depletion
- •17.4.4.1 Complement Inhibition at C3
- •17.4.4.2 Complement Inhibition at C5
- •Eculizumab
- •17.4.4.3 Complement Inhibition of Factor D
- •FCFD4514S
- •Iluvien
- •Glatiramer Acetate (Copaxone)
- •17.5 Summary
- •Summary for the Clinician
- •References
- •18: Surgical Therapy
- •Core Messages
- •18.1 Maculoplasty
- •18.2 Macular Translocation
- •18.3 Single Cell Suspensions
- •18.5 Indications for Surgery
- •18.5.1 Non-responder
- •18.5.2 Pigment Epithelium Rupture
- •18.5.3 Massive Submacular Bleeding
- •18.5.5 Macula Dystrophies
- •Summary for the Clinician
- •References
- •19: Reading with AMD
- •Core Messages
- •19.1 Introduction
- •19.2 Physiological Principles
- •19.3 Reading with a Central Scotoma
- •19.3.1.2 The Reading Visual Field Related to the Fundus (Fig. 19.4b)
- •19.3.1.3 The Reading Visual Field Related to the Text (Fig. 19.4c)
- •19.3.1.4 Eccentric Fixation Related to the Globe (Fig. 19.5)
- •19.3.3 Examination of Fixation Behaviour
- •19.3.4 Motor Aspects
- •19.4 Methods to Examine Reading Ability
- •19.5 Rehabilitation Approaches to Improve Reading Ability
- •Summary for the Clinician
- •References
- •20: Low Vision Aids in AMD
- •Core Messages
- •20.2 Effects of Visual Impairment in AMD
- •20.5 Optical Magnifying Visual Aids for Distance
- •20.5.1 Aids for Watching Television
- •20.8 Electronic Reading Instruments
- •20.9 Additional Aids
- •20.10 Noteworthy Details for the Provision of Low Vision Aids
- •20.11 Basic Information on Prescription
- •Summary for the Clinician
- •References
- •Index
94 |
A. Lommatzsch et al. |
|
|
a |
a |
RPE
RPE detachment
Basal membrane
ICL
EL
OCL
Choriocapillaris
b
RPE
RPE detachment |
Basal membrane |
ICL
EL
OCL
Choriocapillaris
b
Fig. 5.18 Sketches concerning the pathogenesis of pigment epithelial detachment (a) by Gass [53]: serous fluid derived from choroidal capillaries invades the lumen under the RPE and (b) by Bird and Marshall [100]: hydrophobic barrier by deposition of lipids in Bruch’s membrane; combination of stimulated growth for capillaries from choroid und resistance against the directed removal of fluid from RPE; ICL inner collagenous layer, EL elastic layer, OCL outer collagenous layer
cause the accumulation of fluid in PED, whereby the respective fluid proportion contributed may vary.
5.5Geographic Atrophy of the RPE
Geographic atrophy of the RPE is caused by expansive destruction of RPE cells and consecutive regression of drusen accompanied by choroidal atrophy and regression of the sensory neural retina. The combination of cellular age processes and an excessive lipofuscin accumulation is blamed for causing the subsequent cell death of the RPE cells. A slow progression is characteristic.
It is still unclear if the neovascular (wet) and the non-neovascular (dry) form of AMD have different etiologies. Some findings may support different causes, i.e., dry AMD is associated with hypertension [123].
Geographic atrophy is characterized by the development of areas with degenerated RPE and regressed neural retina with intact Bruch’s membrane and without any new subretinal blood vessels. Geographic
Fig. 5.19 Geographic atrophy (a) demonstrated in the fundus by ophthalmoscopy and (b) as seen in autofluorescence imaging
atrophy is suggested to be the natural end stage of advanced AMD.
The distance of cells to their supplying vessels in the adult organism is optimized to ensure ideal oxygen and nutrient maintenance. Therefore, even small changes in the choroidal blood flow underlying the macular area may induce signal cascades leading to neovascularization or degeneration [97]. In addition to age, epidemiological studies revealed smoking as a risk factor for AMD, especially for the dry form with geographic atrophy [124].
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