University of Zagreb. School of Medicine. Chair of Ophthalmology and Optometry.
Abstract
Senilna makularna degeneracija je vodeći uzrok sljepoće starijeg stanovništva u razvijenim zemljama svijeta. Prvenstveno rezultira gubitkom centralnoga vida. Degenerativne promjene vezane uz oba oblika bolesti (vlažnu i suhu formu) zbivaju se u centralnom dijelu mrežnice, makuli, a točna etiopatogeneza još uvijek nije poznata. Suhi ili atrofični oblik obilježen je abnormalnostima retinalnog pigmentnog epitela i prisutnošću druza. Kod vlažne ili eksudativne forme dolazi još i do stvaranja neovaskularnih membrana, eksudacije, krvarenja, i posljedičnih fibrovaskularnih ožiljkavanja. Iako je neovaskularna forma znatno rjeđa od suhe, taj oblik bolesti uzrokuje najveći postotak teškog oštećenja vida uzrokovanog makularnom degeneracijom. Dijagnostika uključuje kompletni oftalmološki pregled, fotografiju fundusa, fluoresceinsku angiografiju, optičku koherentnu tomografiju, i druge metode. Učinkovita terapija suhe forme ne postoji, a progresija bolesti nastoji se usporiti korištenjem određenih dodataka prehrani. Neovaskularnu formu liječimo intravitrealnom primjenom anti-VEGF lijekova, fotodinamskom terapijom, i kombinacijom navedenih. Drugi modaliteti liječenja su istraživani, ali nisu polučili velik uspjeh.Age-related macular degeneration is the leading cause of blindness in older adults in the industrialized countries. Macular degeneration results primarily in loss of central vision. Degenerative changes associated with both forms of the disease (the dry and the wet form) occur in the central part of the retina, the macula, but the exact etiopathogenesis is not yet fully understood. The dry or atrophic form is characterized by retinal pigment epithelium abnormalities and drusen. In addition to these, the wet or exudative form includes neovascular membrane formation, exudation, and hemorrhage, leading to fibrovascular scarring. Although the total prevalence of the neovascular form is significantly lower, wet macular degeneration accounts for the majority of cases with severe visual loss due to AMD. Diagnosis is confirmed by complete ophthalmologic evaluation and different imaging techniques, such as fundus photography, fluorescein angiography, optical coherence tomography, etc. Although no approved therapy for dry AMD exists, some dietary supplements may help to delay disease progression. Effective therapies for exudative form include intravitreal injection of a VEGF inhibitor, photodynamic therapy, or a combination of both, in patients who fail to respond to initial anti-VEGF therapies. Other researched forms of treatment had limited success and no consistent evidence of benefit
