2M.D. Professor, Hacettepe University Faculty of Medicine, Department of Ophthalmology, Ankara/TURKEY Age-related macular degeneration (AMD) is the leading cause of vision loss in people 50 years of age or older in the developed world. Neovascular AMD (NVAMD) is the less prevalent type (15%), but responsible for 90% of cases of severe central vision loss. Over the years, many pharmacological and surgical treatments have been developed for NVAMD, among which anti-VEGF treatments are the current standard of care.
Regarding surgical techniques; firstly ‘Submacular surgery with surgical removal of choroidal neovascularisation (CNV)' was found to be beneficial especially for hemorrhagic lesions. Secondly, ‘Macular Translocation' came into use especially for cases with the damaged retinal pigment epithelium (RPE). Specifically full macular translocation was preferred. Another option is ‘RPE Transplantation' which involves autologous transplantation, resulting in improved vision at the beginning. However, recovery is not persistent and there is still a risk of NVAMD. Besides, immunological reactions and rejection possibility are important limiting factors.
‘Submacular Hemorrhage Displacement' is another approach, useful in cases complicated by massive submacular hemorrhage. Lastly, the ‘GEM study' is an ongoing study regarding gene therapy in NVAMD and involves subretinal placement of lentiviral vector designed to inhibit the effects of both endostatin and angiostatin.
Although intravitreal anti-VEGF injections are the current standard of care, surgical techniques should also be kept in our armamentarium especially for cases complicated by submacular hemorrhage or large AMD lesions, and those that fail to respond or stop responding to anti-VEGF treatment.
Keywords : Age-related macular degeneration, neovascular, submacular surgery, translocation, submacular hemorrhage