nfluence of Haemorheopheresis in the Dry Form of the Age Related Macular Degeneration
Authors:
E. Rencová 1; M. Bláha 2; M. Blažek 2; V. Bláha 3; J. Studnička 1; J. Dusová 1; D. Solichová 3; G. Kyprianou 1; H. Langrová 1
Authors place of work:
Oční klinika Lékařské fakulty UK a FN, Hradec Králové, přednosta prof. MUDr. Pavel Rozsíval, CSc.
1; Oddělení klinické hematologie 2. interní kliniky Lékařské fakulty UK a FN, Hradec Králové, přednosta prof. MUDr. Jaroslav Malý, CSc.
2; Gerontometabolická klinika Lékařské fakulty UK a FN, Hradec Králové, přednosta prof. MUDr. Luboš Sobotka, CSc.
3
Published in the journal:
Čes. a slov. Oftal., 65, 2009, No. 2, p. 43-48
Summary
Introduction:
The age related macular degeneration (ARMD) is the most common cause of practical blindness in the population older than 60 years of age. Usually it starts as a dry form with soft drusen. The progression of the dry form is difficult to control- promising seems to be the influence of rheologic factors in the choroid and the retina and thus improvement of their blood flow.
Aim:
By means of haemorheopheresis to improve blood rheology and thus micocirculation in the choroid and retina. The authors describe the development of the dry form of the ARMD in the sensitive stage with soft drusen and the eventual presence of retinal pigment epithelium detachment (RPED) after haemorheopheresis. The treated patients were compared with a control group (natural course of the ARMD) with the same number of patients.
Methods:
In a prospective, randomized study, comprising of 16 patients with the dry form of ARMD were treated with haemorheopheresis (cascade filtration) and 16 patients in the control group. Haemorheopheresis treatment comprised of 8 cycles in 10 weeks. Plasma obtained by separator was filtered by the Evaflux 4A (Japan) separator, where, the defined spectrum of high molecular proteins was captured. This lead to a decrease in blood and plasma viscosity and thus to improvement of rheologic conditions of the retina.
Results:
Results show a positive influence on the absorption of soft drusen, reduction of the retinal pigment epithelium detachment, and the possibility to improve the visual acuity of the treated patients.
Conclusion:
Comparing to the worsening of clinical signs and visual functions in natural course of the ARMD development, the rheopheresis as well tolerated method may cause the retardation or stop of the unfavorable course of the disease.
Key words:
age related macular degeneration, soft drusen, retinal pigment epithelium detachment, haemorheophresis, plasmatic filtration
Zdroje
1. Bláha, M., Rencová, E., Bláha, V. et al.: Significance of changes in microcirculation during hemorheopheretic therapy of age related macular degeneration – our experience. Vnitř. Lék. 52, 2006, 11: 1102.
2. Borberg, M., Tauchert, M.: Rheohaemapheresis of ophthalmological diseases and diseases of the microcirculation, Transf. Sci 2006: 41–49.
3. Boyer, D.S., Gallemore, R.P.: Clinical trials assess rheopheresis, available at http: //www.mdsupport. Org/library/ rheotri2.html Accessed on February 28, 22206.
4. Bressler, N.M.: Age-related macular degeneration is the leading cause of blindness, JAMA 291, 2004: 1900–1901.
5. Bressler, S.: Prevalence and racial differences in AMD. American Academy of Ophthalmology Las Vegas. Retina 5, 2006, 1901: 10–11.
6. Brunner, R., Widder, R.A., Fischer, R.A.: Clinical efficacy of haemorheological treatment using plasma exchange, selective adsorption and membrane differential filtration in maculopathy, retinal vein occlusion and uveal effusion syndrome. Transfus. Sci 17, 1996: 493–8.
7. Brunner, R., Widder, RA., Walter, P. et al.: Influence of membrane differential filtration on the natural course of age-related macular degeneration – a randomized trial. Retina 20, 2000: 483–91.
8. Donaldson, M.J., Pulido, J.S.: Treatment of nonexsudative (dry) age-related macular degeneration. Current Opinion in Ophthalmology 17, 2006: 267–274.
9. Ferrarinni, M., Vischini, G., Parravano, C. et al.: Rheopheresis in vascular disease. The International Journal of Artificial Organs 29, 2006: 521.
10. Figueroa, M., Schocket. L.S., Dupot J. et al.: Long-term effect of laser treatment for dry age-related macular degeneration on choroidal hemodynamics. Am. J. Ophthalmol. 7, 2006, ahead of print.
11. Friberg, TR., Musch, D.C., Lim, J.I.: PTAMD Study Group: Prophylactic fragment of age-related macular degeneration report number l: 810 nanometer laser to eyes with drusen. Unilaterally eligible patients. Ophthalmology 113, 2006, 4: 622.
12. Klein, R., Klein, B.E.K., Knüdtson, M.D. et al.: Fifteen-year cumulative incidence of age-related macular degeneration. The Beaver Dam Eye Study Ophthalmology 114, 2007: 253- 291.
13. Klein, R., Meuer, S.M., Knüdtson, M.D. et al.: The epidemiology of retinal reticular drusen. Amer. J. Ophthalmol. 145, 2008,2: 317-326.
14. Klingel, R., Fassbender, C., Tischer, I. et al.: Rheopheresis for age-related macular degeneration: a novel indication for therapeutic apheresis in Ophthalmology. Ther. Apher. 6, 2002: 271–81. Review.
15. Klingel, R., Fassbender, C., Fassbender, T. et al.: Clinical studies to implement Rheopheresis for age-related macular degeneration guided by evidence- based-medicine. Transfusion and Apheresis Science 29, 2003: 71–84.
16. Marmor, M.F., Holder, G.E., Seeliger, M.W. et al.: International Society for Clinical Electrophysiology of Vision. Standard for clinical electrorretinography (2004 update). Doc. Ophthalmol. 108, 2004: 107–114.
17. Pulido, J.S. and Multicenter Investigation of Rheopheresis for AMD (MIRA-1) study Group: Multicenter prospective, randomised, double-masced, placebo-controlled study of rheopheresis to treat nonexudative age-related macular degeneration: interim analysis. Trans. Am. Ophthalmol. Soc. 100, 2002: 85–107.
18. Pulido, J.S., Winters, J.L., Boyer, D.: Preliminary analysis of the final multicenter investigation of rheopheresis for age related macular degeneration (AMD) trial (MIRA-l) results. Trans. Am. Ophthalmol. Soc. 104, 2006: 221–31.
19. Zion, I.B., Harris, A., Siesky, B. et al.: Pulsatile ocular blood flow: relationship with flow velocities in vessels supplying the retina and choroid. Br. J. Ophthalmol. 91, 2007: 882–4.
Štítky
OphthalmologyČlánok vyšiel v časopise
Czech and Slovak Ophthalmology
2009 Číslo 2
Najčítanejšie v tomto čísle
- Central Serous Choroidopathy as Rare Complication of the Corticosteroid Treatment
- nfluence of Haemorheopheresis in the Dry Form of the Age Related Macular Degeneration
- Septo-optic Dysplasia – Omitted Interdisciplinary Clinic Entity: Report on Three Patients
- Statistical Analysis of the Nerve Fiber Layer in Color Digital Images of the Retina