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.
Objective To investigate the effect of photodynamic therapy (PDT) combined with intravitreal bevacizumab on wet age-related macular degeneration (AMD). Methods In this retrospective study, 34 eyes (28 cases) diagnosed with wet AMD received PDT combined intravitreal injection of bevacizumab, including 25 eyes with classic CNV and 9 eyes with minimally classic CNV by fluorescein angiography; On optical coherence tomography (OCT), 23 eyes showed intraretinal fluid (IRF) and 11 eyes presented subretinal fluid (SRF). After signing informed consent, all patients underwent initial standard PDT followed by intravitreal bevacizumab (1.25 mg) within succeeding 3 to 7 days. Best corrected visual acuity (BCVA) and OCT with routine eye examinations were evaluated monthly. Additional bevacizumab (1.25 mg) was injected intravitreally if new or increasing fluid appreciated on OCT, or BCVA lowered more than 5 letters even with stabilized fluid. Injection was discontinued if no fluid was showed on OCT (quot;dry macularquot;), or BCVA was stabilized even with fluid after two consecutive injections. BCVA and central retinal thickness (CRT) were analyzed and compared between baseline and 6 month follow-up. The correlation between parameters such as baseline BCVA, greatest linear dimension (GLD), type of CNV, SRF or IRF and posttreatment BCVA will be analyzed. The injection number of bevacizumab and complications were recorded. Results Compared to baseline, BCVA improved (9.4plusmn;10.2) letters and reach 44.9plusmn;21.3 letters (t=5.438，P＜0.01) and CRT decreased (184.6plusmn;214.6) mu;m (t=4.810，P＜0.01) at 6 month visit. The average of injection number was 1.9plusmn;0.9 (including initial injection of combination therapy). With multiple lineal regression analysis, only baseline BCVA correlated to posttreatment BCVA at 6 month visit (r=0.802.P＜0.01). The type of CNV, GLD, SRF or IRF on OCT and CRT at baseline were not associated to post-treatment BCVA (r=0.053, -0.183, 0.139 and 0.053, respectively.P＞0.05). BCVA of eyes with SRF (14.7 letters) increased more than eyes with IRF (6.9 letters) on OCT (t=-2.207，P=0.035). The change of BCVA after treatment (t=-0.076), change of CRT (t=-1.028) and number of injections (Z=-1.505) were not different between classic CNV and minimally classic CNV (P＞0.05). The change of CRT (t=-0.020) and number of injections (Z=-0.237) did not present difference between SRF and IRF (P＞0.05). The change of BCVA (t=1.159) and number of injections (Z=-1.194) were not correlated to whether residual fluid or not at 6 month visit (P＞0.05). No severe complications were noticed during follow-up.Conclusion For wet AMD patients, PDT combined intravitreal bevacizumab could improve visual acuity, reduce retinal thickness and control CNV progress in a short-term.
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.
Ovjective To observe the surgically excised specimens from eyes with hemorrhagic age-related macular degeneration (AMD). Methods Thirty-six surgically excised specimens were captured from 36 patients with hemorrhagic AMD, 26 specimens were diagnosed as occult choroidal neovascular membrane (CNVM), 10 specimens were diagnosed as polypoidal choroidal vasculopathy (PCV). All specimens were routinely processed by hematoxylin and eosin, periodic acidSchiffprime;s stain and Masson stainings. At the maximum horizontal and vertical slice of the specimens, the category and amount of the cells in the specimen were recorded, as well as the relationship between the specimens and the surrounding tissue. Results The 36 specimens are categorized as neovascular membrane dominant (19/36), collagen fiber dominant (6/36), blood clot dominant (8/36) and degenerated thickened Bruch`s membrane dominant (3/36). Eighteen occult CNVM specimens and 1 PCV specimen are categorized as neovascular membrane dominant; all 6 collagen fiber dominant specimens are occult CNVM; 1 occult CNVM and 7 PCV specimens are categorized as blood clot dominant; and 1 occult CNVM and 2 PCV specimens are categorized as degenerated thickened Bruch`s membrane dominant. The occult CNVM categorized as neovascular membrane dominant present as small blood vessel with single endothelium cell attached; the PCV specimen categorized as neovascular dominant presents as big blood vessel with thick vessel wall under the Bruch`s membrane, retinal pigment epithelium and choroidal melanocyte are both observed in the PCV specimens. Conclusion The components of the specimens captured from eyes with hemorrhagic AMD are diversified.
Objective To measure the macular pigment optical density (MPOD) and investigate the effects of lutein supplementation on MPOD in patients with early age-related macular degeneration (AMD).Methods Forty-two early AMD eyes, which have been diagnosed by visual acuity, fundus photography and indirect ophthalmoscopy, and 42 fellow eyes were enrolled in this study. Lutein was administered in dose of 15.1 mg daily for one month. The MPOD value before and after lutein supplementation were measured by heterochromatic flicker photometry. The relationship between the MPOD value and lutein supplementation was analyzed.Results The MPOD value of AMD eyes and fellow eyes before lutein supplementation was 0.347plusmn;0.182 and 0.426plusmn;0.173 respectively, the difference was statistically significant (t=-2.042,P=0.044). The MPOD value of AMD eyes and fellow eyes after lutein supplementation was 0.406plusmn;0.155 and 0.446plusmn;0.128 respectively, the difference was not statistically significant (t=-1.283,P=0.203). For AMD eyes, there was an increasing trend of MPOD values after lutein supplementation, but no statistically significant differences (t=-1.594,P=0.115). Furthermore, there was a negative correlation between the changes of MPOD and initial MPOD in both AMD eyes (r=-0.552,P=0.000) and the fellow eyes (r=-0.731,P=0.000).Conclusions Early AMD eyes have less MPOD. Lutein supplementation may play a role in enhancing the MPOD in these eyes.