AGE RELATED MACULAR DEGENERATION
One elderly lady had complaints of
diminished vision in the right eye of 15 days duration. She was 69 years
old and had already lost vision in the left eye 3 years back. She was
not a diabetic or hypertensive. Visual acuity in the right eye was 6/24
and in the left was counting fingers 2 meters. She had Pseudophakia
(Intraocular Lens) in both the eyes, having undergone cataract
surgery 5 years back. Fundus examination right eye showed a whitish
lesion in the macula with surrounding thickening and hemorrhage, while
the left eye showed a large scar in the central area (macula).
She underwent Fundus Fluorescein Angiography that showed a
well-defined leak in the right eye. The patient was diagnosed as having
Choroidal Neovascular Membrane in the right eye and Macular scar
in the left eye due to Age Related Macular Degeneration.
It was explained to her that the treatment is aimed only at preventing
further visual loss by trying to close the Neovascular Membrane and not
at improving vision. The need for regular post treatment follow-ups was
also emphasized to detect any recurrences, which are quite common. She
was offered the best treatment available for this condition i.e. Photodynamic
Therapy (PDT) with the drug Verteporfin. She underwent the same the
next day and 3 months later the hemorrhage had resolved and the vision
was slightly better at 6/18p. Subjectively she was feeling much better
with the reduction in distortion and haziness of vision.
A 62 - year old gentleman
presented with fall in vision in the left eye noticed few days back. On
examination visual acuity in the right eye was 6/9 while left eye was
6/36. Intraocular Pressures were normal. Fundus examination was normal
in the right eye and in the left eye showed an area of edema with sub
retinal hemorrhages in the macula. A choroidal Neovascular Membrane
due to age related macular degeneration was suspected, which was
confirmed on Fluorescein Angiography.
He was advised to undergo Photodynamic therapy left eye, but he
refused to undergo it due to financial reasons. He was then offered Transpupillary
Thermotherapy (TTT) but explained that its results are variable and
unpredictable. He underwent the same 2 days later. On follow up 1 month
later the edema (thickening) and hemorrhages were less than before. At
his 6 months follow up the vision in the left eye was still 6/36 and the
hemorrhage had markedly reduced.
At tenth month follow up he again had a fall in vision due to
recurrence of the Neovascular Membrane. He underwent a repeat TTT after
a Fluorescein Angiography and 3 months post treatment the Neovascular
Membrane had regressed with vision stabilizing at 6/60. Patient was
quite satisfied with the quality of vision post treatment.
An elderly female complained of
diminution of vision in right eye since few months visual acuity in the
right eye was 6/36 while left eye was 6/9. Intraocular Pressures were
Fundus examination was normal in the left eye and in the right eye
showed an area of submacular bleed and exudates. A subretina Neovascular
Membrane due to age related macular degeneration was suspected, which
was confirmed on Fluorescein Angiography. He underwent laser treatment
and after two days was given intravitreal Avastin in right eye. On
follow up 1 month later the edema (thickening) and hemorrhages were less
than before. At his 6 months follow up the vision in the right eye
improved to 6/9 and the SRNVM had markedly reduced.
Patient was quite satisfied with the quality of vision post treatment.