Angiomatozna proliferacija v mreznici in polipi v zilnici - fenotipa neovaskularizacij pri starostni degeneraciji makule

Abstract

Age-related macular degeneration (AMD) is the leading cause of loss of visual acuity in developed countries. Antagonists of Vascular Endothelial Growth Factor (anti-VEGF) have been successfully used intravitreally in treating the neovascular form of this disease (nAMD) and limiting vision loss. With the latest developments in multimodal imaging we can discern multiple types of neovascularization, some of which have an unusual course, despite treatment with anti-VEGF. Indocianine green angiography (ICGA) and optical coherence tomography (OCT) have been used to distinguish two special forms of nARMD, i.e., retinal angiomatous proliferation (RAP) and polypoidal choroidal vasculopathy (PCV). RAP appears in 1015 % of newly discovered nARMD, usually in older patients and is also known as type 3 neovascularisation, which starts intraretinally. It responds well to anti-VEGF. However, it requires closer monitoring, since in 75 % of patients requires repeated treatment. In contrast, PCV evolves in the choroid and typically causes hemorrhagic exudative maculopathy, which is relatively unresponsive to anti-VEGF. It appears in 414 % of nAMD, and in somewhat younger patients. It requires a specic approach to treatment, combining anti-VEGF with laser therapy, and close monitoring.