Gabrielle E. Lang

Mechanisms of retinal neurodegeneration as a result of diabetes mellitus

Diabetic retinopathy is characterised by microvascular damage to the retina caused by diabetes mellitus. Early vascular findings are microaneurysms and a breakdown of the blood-retina barrier. Recent studies indicate that neurodegeneration and neuroinflammation of the retina play an important role in the pathogenesis of diabetic retinal changes. They can occur early and preceed vascular changes. Important features of neurodegeneration of the retina are apoptosis and glia activation. This results in the loss of neuroretinal tissue.

New developments in the pharmacological treatment of macular oedema due to retinal vein occlusion

The therapeutic options for retinal vascular diseases have changed due to new study results and the approval of dexamethasone (Ozurdex®) and ranibizumab (Lucentis®) by the EU commission for visual loss caused by macular oedema in retinal vein occlusion. In addition to laser treatment, we have now two approved drugs for the treatment of macular oedema. Therefore it is important to make decisions about the best treatment in retinal vein occlusion. This necessitates knowledge of the posology of the drug and assessment of the advantages and risks of the different treatment modalities. Therefore it is important to know the efficacy and safety data of the different therapies. The approval of dexamethasone and ranibicumab for the treatment of macular oedema in branch and central retinal vein occlusions improves the chances for the outcome, especially concerning visual acuity. The new results from the dexamethasone and ranibizumab studies in matters of efficacy and safety and treatment recommendations are described.

Photedynamic therapy in retinal angiomatous proliferations

PURPOSE In age-related macular degeneration (ARMD) angiomatous proliferation can progress from the retina into the subretinal space. Retinal angiomatous proliferation (RAP) can be diagnosed by angiographic findings and optical coherence tomography (OCT). We investigated the outcome of photodynamic therapy in patients with RAP. METHODS 14 patients with ARMD and RAP were retrospectively analysed using a standardised protocol. The protocol included best corrected visual acuity (BCVA), ophthalmoscopy, OCT examination, fundus photography and fluorescein angiography (FAG). In a masked fashion the OCT and angiographic findings were independently graded in 3 stages (RAP I: intraretinal neovascularisation, RAP II: subretinal neovascularisation with a retinal-retinal anastomosis or subretinal neovascularisation with a serous pigment epithelial detachment, RAP III: choroidal neovascularisation with vascularised pigment epithelial detachment and retinal-choroidal anastomosis). 15 eyes of these 14 patients were evaluated pre- and post-PDT with the standardised protocol and the data statistically analysed. RESULTS The age ranged from 58 to 90 years (median 76 years). In 15 eyes of 14 patients with RAP a PDT was performed. 6 of these 15 PDT cases were successfully treated and gained >or= 2 lines (dry macula), 3 eyes with RAP I and 3 with RAP II. 4 eyes stablilised with +/-1 line (persistent macular oedema) under PDT with 2 RAP I, 1 RAP II and 1 RAP III. 5 eyes showed a deterioration with loss of >or= 2 lines (increasing macula oedema) with 2 RAP I and 3 RAP III. The median BCVA was pre-PDT in the successful cases 0.3, post-PDT 0.6, in the stable cases pre-PDT 0.2, post-PDT 0.2 and in the deterioration group pre-PDT 0.4 and post-PDT 0.01. CONCLUSIONS According to our study PDT might be helpful in the treatment of RAP stages I and II in selected cases in ARMD patients. Further prospective studies are required to investigate the outcome of PDT in RAP.