Age-Related Macular Degeneration: Current Treatment Concepts

199 Pages·2001·25.549 MB·English

by  Florian Schütt MD, Frank G. Holz MD (auth.), Winfried E. Alberti MD, Gisbert Richard MD, Robert H. Sagerman MD, FACR (eds.)

MEDICAL RADIOLOGV
Radiation Oncology
Editors:
L,W.Brady,Philade1phia
H.-P.Heilmann,Hamburg
M.Molls,Munich
Springer-Verlag Berlin Heidelberg GmbH
W.E.Alberti· G.Richard . R.H.Sagerman (Eds.)
Age-Related
Macular Degeneration
Current Treatment Concepts
With Contributionsby
W E.Alberti .K.-G.AuEong.C.Bellmann .G.J.Bergink .P.Bischoff .P.Blacharski
L.WBrady.G.Brown.U.Chakravarthy· R.Coquard .P. Crossmann .J.Debus
E.deIuan,[r..A.F.Deutmann .E.Egger.K.Engelmann·R.Engenhart-Cabillic·P.T.Finger
J.Freire.G.Y.Fujii .J.-P.Gerard .H.Gerding .G.Goitein .S.Gorty .A.Hassenstein
K.Heimann .U.Holler .F.G.Holz.C.B.Hoyng .I.Immonen .S.B.Klein.M.Kocher
N.Kovăcs .G.Kovăcs .K.Krause.R.Krott .J.E.Lahaniatis .S.Y.Lee.D.M.Marcus
P.Martin .M.Mauget-Faysee.B.Micaily-C.T.Miyamoto .R.-P.Miiller .H.Niederberger
P.Niehoff.D.J.Pieramici .G.RichardG.Ries.R.H.Sagerman.A.Schalenbourg.F.Schiitt
R.Schwartz.W.c.Sheils.J.D.Slater.J.M.Slater-S.Staar.S.Taneri.C.E.Uhlig.K.Unnebrink
C.Valmaggia·M.Valtink-WA.J.van Daal·R.WM.vander Maazen.J.R.Vingerling
M.Wannenmacher.J.Weichel.T.E.Yaeger .1.T.Yonemoto.1. Zografos .J.Zurdel
Foreword by
L.W.Brady,H.-P.Heilmann and M.Molls
With 117Figuresin 150Separate Illustrations,46inColor and 33Tables
Springer
WINFRIEDE.ALBERTI,MD
Professor,DepartmentofRadiotherapyandRadiooncology
UniversityHospitalEppendorf
Martinistr.52
20246Hamburg
Germany
GISBERTRICHARD,MD
Professor,DepartmentofOphthalmology
UniversityHospitalEppendorf
Martinistr.52
20246 Hamburg
Germany
ROBERTH.SAGERMAN,MD,FACR
Professor,DepartmentofRadiationOncology
StateUniversity ofNewYork
UpstateMedicalUniversity
750EastAdamsStreet
Syracuse,NY13210
USA
MedicalRadiology.DiagnosticImaging and Radiation Oncology
Continuation of
Handbuchder medizinischen Radiologie
Encyclopedia ofMedical Radiology
ISBN 978-3-642-63071-2
LibraryofCongressCataloging-in-PublicationData
Age-relatedmaculardegeneration:currenttreatmentconcepts/W.E.Alberti,G.
Richard,R.H.Sagerman(eds.);withcontributionsbyW.E.Alberti ...[etal.);foreword
byL.W.Brady,H.-P.Heilmannand M.Molls
p.;cm,--(Medicalradiology)
Includesbibliographicalreferencesandindex.
ISBN 978-3-642-63071-2 ISBN 978-3-642-56439-0 (eBook)
DOI 10.1007/978-3-642-56439-0
1.Retinaldegeneration.1.Alberti,W.II.Richard,G.(Gisbert),1949-III.Sagerman,
RobertR.,1930-IV.Series.
[DNLM:1.MacularDegeneration--radiotherapy.2.MacularDegeneration--surgery.
WW270A264952000]
RE66l.D3A332000
617.7'3506--dc21 00-055661
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Dedicated to
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whose intelligence, humor, and support
sustained us throughout this project.
Foreword
This volume, edited by Professors Alberti, Richard and Sagerman, presents relevant and
contemporary data on age-related macular degeneration. Age-related macular degeneration
is the leading cause of severe blindness today in both the United States and Europe. The
incidence increases with age, affecting 11 % of those individuals between the ages of 65 and
74 years with rates rising to 28% of patients older than 75 years. Exudative or wet type
macular degeneration occurs when the choroidal vessels penetrate Bruch's membrane, caus
ing proliferation beneath the retinal pigment epithelium which leads to choroidal neovascu
larization, sub retinal hemorrhage, serous retinal detachment, and, ultimately, sclerosis and
fibriosis. Approximately 10% of patients with age-related macular degeneration develop the
wet form and these patients account for the majority of those who become legally blind.
When the choroidal neovascular membrane is sub foveal in character, prognosis is poor,
with severe visual loss in more than 75% of the patients at 2 years following its development.
Laser photocoagulation is the only available treatment in selected cases and many patients
are deemed ineligible for laser photocoagulation by the strict criteria put forth by the Macu
lar Photocoagulation Study. In those patients treated by laser ablation, there is a significant
immediate decline in visual acuity and a permanent scotoma. At 2 years, however, only 20%
of those treated had a visual acuity loss of six or more lines, compared with 37% of the
untreated eyes. More than 51 % of the treated eyes had persistent or recurrent choroidal neo
vascular membrane at 24 months after treatment.
Many treatment techniques have been pursued in the management of wet type macular
degeneration. These have included steroids, aspirin, antioxidants, laser photocoagulation,
macular translocation, and local radiation. With almost all studies, the outcome has been dis
appointing. However, preliminary results from the radiation therapy programs have shown
subjective visual improvement as well as documented objective improvement.
This volume deals with the various issues in age-related macular degeneration, not only
in its evolution and development, but also discusses the various treatment programs and
complications thereof. The contributions from this volume represent an important baseline
against which future studies can be measured.
Philadelphia 1. W. BRADY
Hamburg H.-P. HEILMANN
Munich M.MoLLS
Preface
Among the five senses, loss of vision would be most devastating. Age-related macular
degeneration (ARMD) is the most common cause of severe visual loss and of legal blind
ness for those older than 64 years, and the second most common cause for those aged
45-64, in Western societies. Increasing longevity is lending growing urgency to the search
for a way to prevent, or at least treat, macular degeneration. Interventions have included
laser therapy, hyperthermia, photodynamic therapy, submacular surgery, external beam
and plaque radiotherapy, corticosteroid and interferon intravitreal injection, antioxidant
vitamins, trace minerals, and anti angiogenic agents such as thalidomide, isoretinoin and
-po
interferon-a and
The Macular Photocoagulation Study Group in the United States, and other groups in
Europe, have studied macular degeneration for years. Despite all efforts, the only accepted
therapy for neovascular ARMD is laser treatment. However, only about 15-20% of patients
meet the criteria for laser therapy, and when the lesion is subfoveal there is an immediate
decrease in vision.
For almost a decade low doses of irradiation have been employed in an attempt at reduc
ing the damage secondary to the neovascularization and preserving useful vision. Despite
the publication of numerous institutional studies, and a few small, randomized, prospective
studies (from Heidelberg, Nijmegen, Zurich, St. Gallen and San Francisco), controversy
reigns and radiotherapy has not been established as beneficial. Only the results of larger,
well-controlled studies now in progress can settle this debate.
The lively discussions at an international conference held in Hamburg in February 1999
prompted the editors to gather up-to-date reports reflecting current views and techniques
from experts around the world to serve as a concise, handy reference of research in progress
and of the state of the art in management of macular degeneration.
Hamburg W. E. ALBERTI
Hamburg G. RICHARD
Syracuse R. H. SAGERMAN
Contents
Diagnosis and Clinical Features .............................................. .
1 Age-Related Macular Degeneration:
Current Concepts of Pathogenesis and Risk Factors
FLORIAN SCHUTT and FRANK G. HOLZ ...................................... 3
2 Clinical Manifestations and Natural History
of Age-Related Macular Degeneration
JAN ZURDEL and GISBERT RICHARD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 11
3 Diagnostic Workup
ANDREA HASSENSTEIN and GISBERT RICHARD .............................. , 19
4 Planimetry of Age-Related Macular Degeneration
R. SCHWARTZ ........................................................... , 27
Surgery of Age-Related Macular Degeneration (ARMD) .......................... 31
5 Surgery -an Overview
JAN ZURDEL and KATRIN ENGELMANN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 33
6 Limited Macular Translocation in Age-Related Macular Degeneration
KAH-GUAN Au EONG, DANTE J. PIERAMICI, GILDO Y. FUJII, and EUGENE DE JUAN, Jr. 37
7 Development of Microelectronic Visual Implants
HEINRICH GERDING, S. TANERI, C. E. UHLIG, and K. KRAUSE. . . . . . . . . . . . . . . . . .. 55
8 Transplantation of Retinal Pigment Epithelium Cells
MONIKA VALTINK, JUDITH WEICHEL, GISBERT RICHARD, and KATRIN ENGELMANN 65
Radiotherapy of Age-Related Macular Degeneration (ARMD) -Long-Term Results. .. 77
9 Radiation Biology of Choroidal Neovascularisation of Age-Related
Macular Degeneration
USHA CHAKRAVARTHY and Susan B. KLEIN ................................. , 79
10 Principles and Technique of Radiation Therapy of Age-Related
Macular Degeneration
ULRIKE HOLLER and WINFRIED E. ALBERTI. ................................ , 85
11 Radiation Effects on the Eye
LUTHER W. BRADY and THEODORE E. YAEGER ............................... , 95
12 Long-Term Results of Radiotherapy for Age-Related Macular Degeneration
G.J. BERG INK, C.B. HOYNG, R.W.M. VAN DER MAAZEN, J.R. VINGERLING,
W.A.J. VAN DAAL, and A.F. DEUTMANN ...................................... 103
XII Contents
13 External Beam Radiation Therapy for Age-Related Macular Degeneration:
Two-Year Results
ROBERT H. SAGERMAN and SRI GORTY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 111
14 Virtual Three-Dimensional CT Simulation of Radiotherapy for Exudative
Age-Related Macular Degeneration
PETER NIEHOFF, N. KovAcs, and G. Kov ACS .................................. 119
15 Radiation Therapy for Age-Related Macular Degeneration -a Wet Type Summary
LUTHER W. BRADY, JOHN E. LAHANIATIS, JORGE FREIRE, CURTIS T. MIYAMOTO,
BIZHAN MICAILY, and THEODORE E. YAEGER ................................. 125
16 External Beam Radiotherapy in Age-Related Macular Degeneration -
an Ineffective Approach?
SUSANNE STAAR, R. KROTT, M. KOCHER, R.-P. MUELLER, and K. HEIMANN ....... 129
Clinical Studies of Age-Related Macular Degeneration (ARMD) .................... 137
17 Results of a Prospective, Randomized, Double-Blind Multicenter Trial
on Radiation Therapy of Age-Related Macular Degeneration (RAD-Study)
CAREN BELLMANN, KRISTINA UNNEBRINK, J. DEBUS,
RITA ENGENHART-CABILLIC, M. WANNENMACHER, and FRANK G. HOLZ .. . . . . .. 139
18 External Beam Radiotherapy as a Treatment for Choroidal Neovascularisation in
Age-Related Macular Degeneration
USHA CHAKRAVARTHY .................................................... 149
19 Long-Term Results of High Doses of External Radiotherapy for Age-Related
Macular Degeneration with Subfoveal Neovascularization
MARTINE MAUGET-FAYSEE, REGIS COQUARD, JEAN-PIERRE GERARD,
and PILIPPE MARTIN......... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 155
20 Low-Dose Radiotherapy for Age-Related Macular Degeneration
with Subfoveal Choroidal Neovascularization: Update of Results
of the St. Gallen Prospective Randomized Study
CHRISTOPHE VALMAGGIA, GERHARD RIES, PETER COSSMANN, PETER BISCHOFF,
and HUGO NIEDERBERGER ................................................. 161
Special Radiotherapy Techniques ............................................ " 165
21 Brachytherapy for Macular Degeneration Associated
with Subretinal Neovascularization
PAUL T. FINGER, ILLKA IMMONEN, JORGE FREIRE, and GARY BROWN ............. 167
22 Proton Radiation Therapy of Age-Related Macular Degeneration
LES T. YONEMOTO, JERRY D. SLATER, PAUL BLACHARSKI, and JAMES M. SLATER .... 175
23 Various Therapeutic Regimens for Proton Beam Irradiation of Neovascular
Membranes in Age-Related Macular Degeneration
EMMANUEL EGGER, L. ZOGRAFOS,A. SCHALENBOURG, and G. GOITEIN ........... 181
24 Radiation Therapy for Age-Related Macular Degeneration
W. CHRIS SHEILS, S.YOUNG LEE, and DENNIS M. MARCUS ...................... 187
Subject Index ............................................................... 199
List of Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 203
Diagnosis and Clinical Features