Objectives The prevalence of age-related macular degeneration (AMD) is rising in China in recent years, and there are more and more drug treatment modalities for this disease. However, all over the country many ophthalmologists have only limited knowledge of prevention and intervention of AMD. In most hospitals the management of AMD is personal experience-based without consensus. It is urgent to propose a standardized clinical pathway for AMD in China. Methods The clinical guideline and clinical pathway development committee of AMD is established under the Chinese Ocular Fundus Diseases Society. The committee proposed the Chinese AMD clinical pathway (hereinafter referred to as quot;clinical pathwayquot;), based on existed international guidelines, and updated clinical research evidence, the specific types of AMD and the current socio-economic status in China. Results This clinical pathway was developed on the basis of the clinical stages and clinical types of AMD, including the choice of examination items, treatment Methods , follow-up and low vision aids. The clinical pathway was designed in flow sheets, which is easy to understand and implement for ophthalmologists, thus to standardize AMD clinical management procedures. Conclusions The clinical pathway, which followed the basic principles of evidencebased medicine and combined with the actual demands of patients with AMD in China, provides principle guidance for the diagnosis and treatment of AMD. The clinical pathway was designed to meet the requirements of the majority of AMD patients; clinicians should also consider individual situations of patients, available treatment options, the patient's affordability and other factors when making treatment decisions.
Age-related macular degeneration (AMD), a set of age-related macular disease, is induced by a variety of factors. New intervention Methods help us to understand the AMD pathogenesis further; however, we only have limited knowledge of these novel Methods . To improve diagnosis and treatment practices of AMD, it is a priority to propose a standardized clinical procedure of AMD management in China. The Chinese Ocular Fundus Association has just proposed a Chinese AMD clinical pathway based on expertsprime;opinions and evidence based medicine. This clinical guideline is implementable for different stages and subtypes of AMD patients, and hopefully will be updated frequently with more clinical practice. Implementing this AMD pathway in China will improve the quality of clinical practice and research of AMD in China.
The diagnosis and treatment of age-related macular degeneration (AMD) is an international hotspot of eye research. Successful clinical applications of antiVEGF drugs promoted both basic research and clinical practice of AMD. A number of countries and professional societies have established clinical guidelines for AMD management, including the epidemiology, risk factors, diagnosis, classification, and treatment process. These AMD guidelines are mostly based on recently published results of clinical trials, provided good model of evidence based medicine. It is urgent and necessary to have our own guideline which is suitable for Chinese patients. Reviewing and learning existed guidelines will help us to improve the clinical practice of AMD in China.
Objective To observe the therapeutic effects of transpupillary thermal therapy (TTT) on exudative agerelated macular degeneration (AMD) accompanied with subfoveal choroidal neovascularization (CNV).Methods The clinical data of 44 eyes of 41 patients with exudative AMD diagnosed by fundus fluorescein angiography (FFA) who had undergone 810 nmdiode laser were retrospectively analyzed. In the 44 eyes of 41 patients, there were 26 eyes of 24 patients had occult CNV,12 eyes of 12 patients had classic CNV,and 5 eyes of 5 patients had small classic CNV. According to the focus sizes, the diameters of beam spot was 1.2-3.0 mm,the power of laser was 160-400 mW,and the duration was 60 s.The frequency of photocoagulation was once to thrice with the mean of 1.48.The followup duration was 3-24 months with the mean of 10.8 months.Visual acuity, haemorrhage in ocular fundus,absorption of exudation, and the closure of CNV were examined in the followup examination.Results A total of 42 eyes of 40 patients were examined at the last time in the followup duration,in which the visual acuity kept still or improved in 35 eyes of 33 patients (83.34%) and reduced in 7 eyes of 7 patients (16.67%). The results of OCT revealed that 1 and 3 months after the treatment and at the last time of followup duration, the decrease rate of exudative liquid at the macular area was 79.5%,86.4%,and 88.1%, respectively. Three months after the treatment,the macular volume decreased significantly than that before the treatment (P=0.01).The results of FFA demonstrated that at the last time in the folowup duration,the closure rate of occult CNV,classic CNV,and small classic CNV was 79.16%,46.15%,and 60%,respectively.The exudates increased in 6 eyes of 5 paitnets,including 5 eyes of 4 patients with classic CNV and 1 eye of 1 patient with small classic CNV.Conclusion TTT is effective for AMD accompanied with occult CNV,classic CNV, and small classic CNV.
Objective To summarize the therapeutic effect and clinical characteristics of repetitive photodynamic therapy (PDT) for patients with exudative age-related macular degeneration (AMD). Methods The clinical data from 78 patients (94 eyes) with exudative AMD who had undergone PDT from July, 2002 to March, 2005 were retrospectively analyzed. The average age of the patients was 68.4, and the treated times was 132 (mean 1.4). Thirty eyes underwent PDT 68 times, including twice in 22 eyes (73.3%), 3 times in 7 eyes (23.3%), and 6 times in 1 eye (3.3%). The follow-up period lasted 3-32 months with the average of 16.7 months. Results In the final follow-up examination, the results of fundus fluorescein angiography or combined with indocyanine green angiography showed that the leakage of choroidal neovascularization (CNV) stopped in 14 eyes (46.7%), reduced in 12 (40%), and remained in 4 (13.3%). Compared with the condition before first PDT, the correct visual acuity increased ge;2 lines in 7 eyes (23.3%), changed plusmn;1 line in 14 eyes (43.3%), and decreased ge;2 lines in 9 eyes (30%) in the final examination. After first PDT, the best corrected visual acuity increased ge;2 lines in 13 eyes (43.3%), changed plusmn;1 line in 12 eyes (40%), and decreased ge;2 lines in 5 eyes (16.7%). During the follow-up period, the best corrected visual acuity occurred after first PDT in 24 eyes (80%), after second PDT in 5 eyes (16.7%), and after third PDT in 1 eye (3.3%). Conclusions In patients undergone repetitive PDT, CNV in most of the affected eyes completely or partly closed and the visual acuity improved or remained still in 67.8% of the patients in the final follow-up examination. The best correct visual acuity mainly happened after the first PDT, and as the times of PDT increased, the probability of the best correct visual acuity decreased. (Chin J Ocul Fundus Dis, 2006, 22: 220-223)