Surgical Procedures for Macular DegenerationEn Español (Spanish Version)
At the present time, there are no effective procedures or treatments for the dry form of macular degeneration.
There are currently several treatment options for people with wet macular degeneration: laser photocoagulation, photodynamic therapy, and anti-VEGF injections. Only about 20% of patients are candidates for the first two therapies. In this group, only approximately half will have an improved outcome. For those who do benefit from the procedure, the gains are often temporary.
Laser photocoagulation, used to treat a number of eye conditions, is used in some cases of wet macular degeneration. When blood vessels under the macula multiply in wet macular degeneration, they leak, causing damage and death to the cells of the macula. Photocoagulation involves aiming a strong laser light beam onto the new blood vessels to destroy them. It is not a cure for macular degeneration, but helps prevent further vision loss. Unfortunately, the treatment itself can lead to visual loss.
The procedure is done on an outpatient basis. You will be given eye drops to dilate your pupil and numb your eye. The procedure is performed while you are seated in a chair. You will remain awake, and you may feel minimal discomfort as the pulses of laser light are directed at the blood vessels. The treatment usually takes less than thirty minutes to complete, and you can go home immediately following surgery. It may take several weeks before you know if the surgery has been successful. You may need additional laser treatments to manage macular degeneration and prevent further vision loss.
Photodynamic therapy is a newer type of laser procedure used to treat wet macular degeneration. It involves using a low-powered laser in conjunction with a light-sensitive dye. The dye will be injected into a vein in your arm and will circulate through your body. As the dye circulates through your eye, it collects in the abnormal blood vessels. Low-intensity laser is aimed at the blood vessels, and the dye absorbs the laser energy and destroys the blood vessels.
The procedure is done on an outpatient basis. You will be given eye drops to dilate your pupil and numb your eye. You will also receive an injection of dye into a vein in your arm. You may feel minimal discomfort as the pulses of laser light are directed at the blood vessels. You may need additional treatments to manage blood vessel growth and prevent further vision loss.
A recent review of three trials found that photodynamic therapy may reduce vision loss caused by macular degeneration. The most serious side effect was a severe decrease in visual acuity. This affected about 1 in 50 patients within a week of treatment.*
Anti-VEGF injections can be used for all forms of wet macular degeneration. The medication is injected directly into the eye after you are given topical numbing medication. It blocks a signal that causes the abnormal blood vessels to grow and leak. These injections are usually performed by a retina specialist and are usually given every six weeks. Although not a cure, these injections can help slow progression and preserve the vision you currently have.
Surgical removal of blood and abnormal blood vessels below the macula have been attempted, but has not been very successful. Researchers are currently investigating this and other forms of surgical intervention for macular degeneration.
American Academy of Ophthalmology’s Eye Care America website. Available at: http://www.eyecareamerica.org/eyecare/conditions/macular-degeneration/index.cfm.
Association for Macular Diseases, Inc. website. Available at: http://www.macula.org/.
Macular Degeneration Foundation website. Available at: http://www.eyesight.org/.
11/1/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Wormald R, Evans J, Smeeth L, Henshaw K. Photodynamic therapy for neovascular age-related macular degeneration. Cochrane Database of Systematic Reviews. 2007;(4). DOI: 10.1002/14651858.CD002030.pub3.
Last reviewed August 2007 by Marc Ellman, MD
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