98th Annual Meeting DOG 2000

K 778

Three-year follow-up after photocoagulation of soft drusen in age-related macular degeneration (AMD)

U. Siepe, K. Müller-Jensen

Background: AMD is the most common reason for loss of central vision in patients over 50 years of age in western countries. Until the year 2050 we can count the triple of patients beyond the 80-ties. A third of these patients is expected to have symptoms of AMD. Although the incidence of AMD is increasing, still its therapie is for the patient as well as for the doctor more or less frustrating. Only the smallest part of patients with AMD can be treated sufficiently. Further therapies are developing but even in the nearer future they still wont be available for greater parts of AMD-patients. Reflecting this prophylaxis gets more and more important.

Methods: In cases of AMD with soft drusen we performed a photocoagulation. Following precautionary measures - espacially a choroidal neovascularisation or an exsudation had to be excluded by angiography – a mild grid-laser-photocoagulation of the macular region in the worse eye has been performed. We compared the best corrected vision of the treated and of the not treated eye before and after photocoagulation. An angiographic control followed as well.

Results: In the treated eyes (14) an improvement of visual acuity was observed in 10 cases, a stabil vision in 3 cases and a worsening of vision in only 1 case whereas in the not coagulated eyes (14) we saw stabil vision in 4 cases and loss of vision in 10 cases. None of these eyes showed an improvement of vision. After several months a significant decrease of drusen could be observed in treated eyes. Most of the patients expressed themselves positivly regarding the treatment. They reported on a more steady visual impression and on a decrease of metamorphopsia, which could be confirmed by means of the Amseler-net. No negative side-effects could be observed.

Conclusion: In our opinion the prophylactic grid-photocoagulation of soft drusen is a satisfactory and - following some precautions - also benevolent therapy that can lead to visual improvement in cases of AMD. If also by these means the prognosis regarding the developement of choroidal neovascularisation is improving is unsure and requires further examinations.

Augenklinik des Städt. Klinikums, Moltkestr. 90, D - 76133 Karlsruhe