Macular Degeneration: Scheider A

Scheider A, Gündisch O, Kampik A. · Universitätsaugenklinik, Munich, Germany. · Graefes Arch Clin Exp Ophthalmol. · Pubmed #9951635 No free full text.

Abstract: BACKGROUND: The surgical extraction of subfoveal choroidal new vessels (CNV) is one of several possibilities to treat subfoveal CNV or haemorrhages in age-related macular degeneration (ARMD). METHODS: Prospective study, follow-up 3-6 months. Clinical and angiographic differentiation of three subgroups: (1) subfoveal well-defined CNV (24 eyes); (2) subfoveal ill-defined CNV with or without well-defined components (10 eyes); (3) submacular haemorrhages (20 eyes). RESULTS: The mean and median visual acuity and the proportion of eyes with > or = 20/200 vision increased slightly in group 1 and decreased slightly in group 2; the differences were not significant. Group 3 demonstrated mean improvement but was heterogeneous, depending on the site and type of underlying CNV. The proportion of eyes with 3 or more lines of improvement after 3 months was 35.3% (7/17), 10% (1/10) and 38.9% (7/18) respectively. The proportion of eyes with a loss of 3 or more lines after 3 months was 5.9% (1/17), 20% (2/10) and 5.6% (1/18) respectively. The recurrence rate was 29.2% (7/24), 8.3% (1/11) and 25% (5/20). Intraoperative complications were iatrogenic central tears in 7.3% (4/55), peripheral tears in 14.5% (8/55) and peripheral retinal detachment in 3.6% (2/55). A postoperative retinal detachment was observed in 2 of 55 eyes (3.6%). All these complications could be managed without ill effect. CONCLUSION: Subfoveal surgery might preserve remaining retinal function in eyes with well-defined CNV. However, subgroups of the MPS subfoveal laser trials with comparable initial visual acuity demonstrated postoperative functional stabilisation and similar recurrence rates in well-defined CNV. Though selected cases of submacular haemorrhage did profit from surgery, TPA-assisted gas injection will probably be a better alternative. Unfortunately, surgery for ill-defined CNV, found in the vast majority of eyes with exudative ARMD, seems to worsen the natural course. Surgery has to be combined with restoration of Bruch's membrane before it can become a possible therapeutic option in ARMD.

Pauleikhoff D, Scheider A, Wiedmann P, Gelisken F, Scholl HP, Roider I, Mohr A, Zlateva G, Xu X. · Augenabteilung am St. Franziskus-Hospital, Münster, Deutschland. · Ophthalmologe. · Pubmed #18709375 No free full text.

Abstract: BACKGROUND: Approximately 35,000 cases of neovascular age-related macular degeneration (AMD) occur annually in Germany. The neovascular form of AMD (NV-AMD) is responsible for severe vision loss associated with the disease in 90% of the cases. This study was conducted to assess the humanistic and economic burden of NV-AMD in the German population. METHODS: A cross-sectional, observational study of subject self-reported functional health, well-being, and disease burden among elderly subjects with (n=83) and without (n=93) NV-AMD in Germany was conducted. Patients participated in telephone surveys involving the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25), the EuroQol (EQ-5D), the Hospital Anxiety and Depression Scale (HADS), and also reported history of falls, fractures, and healthcare resource utilization. Furthermore, the healthcare utilization and unit costs for the NV-AMD patients were calculated. RESULTS: The mean age of NV-AMD patients was 77.2 years and 64% were female. NV-AMD patients reported significantly worse vision-related function and overall well-being than controls (adjusted mean scores: NEI-VFQ-25 overall scale: 51.3 vs 96.3; p<0.0001) and significantly more depression symptoms than controls (HADS depression: 6.2 vs. 2.7; p<0.0001). NV-AMD patients also reported that the need for assistance with daily activities was more than 10 times greater compared to controls (26.5% vs. 2.2%; p<0.0001) and the prevalence of falls was 3 times that of the control group (13.3% vs 4.3%; p=0.031). Annual NV-AMD costs per patient were <euro> 9871, 6 times that of elderly patients without NV-AMD (<euro> 1559). Of the NV-AMD costs one-half were direct non-medical-related costs (assistance of ADL or social benefit) and one-third were direct medical costs. CONCLUSIONS: NV-AMD is associated with decreased functional abilities and quality of life, which result in an increase in healthcare resource utilization. Consequently, costs were higher for NV-AMD patients compared to controls. These findings emphasize the need for new NV-AMD treatments that will prevent vision loss and progression to blindness, and lessen the ensuing economic burden. Sponsored by Pfizer Inc. New York, US.

Müller S, Ehrt O, Gündisch O, Eckl-Titz G, Scheider A. · Augenklinik der Universität München. · Ophthalmologe. · Pubmed #10734740 No free full text.

Abstract: BACKGROUND: SLO microperimetric examination after the extraction of choroidal neovascular membranes (CNV) in age-related macular degeneration (AMD) shows absolute scotoma in the area of pigment epithelial loss. Laser treatment also causes complete functional loss. The functional results of these two methods should be compared before the surgical procedure is expanded. METHODS AND PATIENTS: Five eyes of five patients with large subfoveal well-defined CNV were treated by photocoagulation following the MPS criteria. Functional results were compared with similar phenotypes from a group of 78 patients operated upon. Before and after the treatment visual acuity was tested following the ETDRS criteria. The need for magnification for reading was tested using the ZEISS charts. Fundus-controlled microperimetry was performed using the scanning laser ophthalmoscope (Rodenstock) to detect deep and relative scotomata. RESULTS: The recurrence rate (OP 2/5; ALK 1/5) was normal regarding the small number of patients. Visual results are slightly better in patients operated on (mean: pre 0.08; 6 weeks 0.09; 3 month 0.13; last 0.13) than in laser-treated patients (mean: pre 0.06; 6 weeks 0.07; 3 months 0.08; last 0.12). Deep scotoma can be reduced with surgical extraction of the CNV (mean factor: 6 weeks 0.6; last control 0.8) while laser treatment of the margins enlarges the scotoma (mean factor: 6 weeks 2.3; last control 2.2). CONCLUSIONS: Because of the minimal functional advantages of the surgical procedure we do not think it is the method of first choice. For both methods the treatment of well-defined CNV increases the possibility of low-vision rehabilitation.

Gandorfer A, Scheider A. · Augenklinik der Ludwig-Maximilians-Universität München, Germany. · Retina. · Pubmed #10696759 No free full text.

This publication has no abstract.

Ehrt O, Scheider A, Gündisch O, Eckl-Titz G, Rittweger T, Kampik A. · Augenklinik der Ludwig-Maximilians-Universität München. · Ophthalmologe. · Pubmed #10479891 No free full text.

Abstract: The follow-up of central scotomas and fixation--next to visual acuity--are important parameters for the evaluation of new therapies in AMD. PATIENTS AND METHODS: Twenty-three patients (age 67 to 91 years) with subfoveal CNV had SLO fundus-controlled perimetry before and 6-8 weeks after surgical removal of the CNV. The size and location of deep (0 dB) and relative (12 dB) scotomas were measured. Stability and location of fixation were analyzed. RESULTS: Fifty-six percent of patients gained (10% lost) more than 2 lines of VA; 52% of deep scotomas decreased in size (26% increased). No relative scotoma increased, but 63% decreased, some remarkably. Most scotomas had steeper borders postoperatively. Five of 7 patients were able to fixate again. Fixation moved slightly more peripheral in 4 patients and was otherwise unchanged. None of 7 patients whose fixation was close to their fovea preoperatively lost that fixation. CONCLUSION: Subfoveal surgery may stabilize the course of subfoveal CNV in AMD at 6 weeks follow-up. In some patients the major benefit can be a reduction of relative scotoma due to reattachment of the retina. As the location of fixation changes little with surgery and is typically located within the area of relative scotoma, visual function can improve.