How Maculopathy is treated: Operations and Laser

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Interventions for the Treatment of Maculopathy

The treatment of maculopathy has completely changed in recent years thanks to the new drugs and new technologies available. The most innovative interventions for the treatment of maculopathy today are:

  1. Intravitreal injections
  2. Vitrectomy
  3. Gene Therapy
  4. EyeMax the new therapy
  5. Artificial Retina

Intravitreal injections

Drugs

Today they are the cornerstone in the treatment of exudative maculopathy . Different types of drugs are injected into the vitreous near the macula to treat maculopathy. The most used drugs for intravitreal injections are anti-VEGF (Vascular Endothelial Growth Factor) drugs . They allow us to stop the progression of exudative maculopathy and in some cases improve vision. They block the growth in the newly formed blood vessels characteristic of exudative maculopathy. There are different types , the most modern have superior effectiveness and require injections every two months or quarterly. Other drugs widely used for intravitreal injections contain cortisone . They are mostly used in exudative maculopathies secondary to diabetes, venous thrombosis or uveitis. 

The procedure

The intravitreal injection is carried out in a few minutes and in the operating room to guarantee the necessary sterility. Multiple injections spaced 1-3 months apart are required until vision stabilizes . The current therapeutic orientation is to perform a cycle of 3 injections on a monthly basis (loading phase) and then re-treat only in the presence of visual loss or new fluid on OCT-angiography exams.

The risks

The main risk of intravitreal injections is infection (endophthalmitis – approximately 1.5%) for this reason it is essential to comply with all the hygiene and therapeutic rules given by the ophthalmologist. Therapy with anti-VEGF drugs for maculopathy should be used with extreme caution in cardiac patients . It is contraindicated in the presence of events such as myocardial infarction or stroke in the immediately preceding months.

Vitrectomy

Vitrectomy is a fundamental surgical procedure for the treatment of maculopathies. It consists in the removal of the vitreous body which occupies most of the volume of the eyeball using a probe and an automated scalpel. Today, thanks to the latest technological innovations , the 25G or 27G vitrectomy can also be performed with a sutureless technique . In fact, instruments are used that are so small that the wall of the eye closes on its own without the need for sutures. This type of intervention is mostly indicated in the treatment of Myopic Maculopathy, Macular Pucker, Macular Hole, Diabetic Maculopathy. The vitreous body is removed and can be replaced by aqueous humor or in some cases by substances such as gases or silicone oil. These are substances that must buffer, that is, support the retina in its healing. The gas remains in the eye for about one to two months and then reabsorbs, the silicone oil is usually removed after three months. Vitrectomy is often associated with or followed by laser photocoagulation of the retina in order to promote a speedy recovery.

Gene Therapy

Gene therapy is a promising therapy for the treatment of hereditary maculopathies such as maculopathy associated with a specific type of retinitis pigmentosa or Leber’s congenital amaurosis , which are associated with the mutation of a single gene called RPE65. Gene therapies are also being studied for the treatment of age-related wet and dry maculopathy. To have access to these therapies, careful genetic analysis is required.

EyeMax the New Therapy

EyeMax is the new intraocular lens designed specifically to treat those suffering from Maculopathy. The lens is inserted inside the eye with normal cataract surgery or can be inserted in patients who have already had cataract surgery previously . EyeMax is a “wide angle” intraocular lens that projects sharp images over a large area of the macula, a bit like a large-screen television. Unlike other intraocular lenses regularly used for cataract surgery, the EyeMax lens provides high quality images not only at the center of the macula but up to 10 degrees of eccentricity and also produces a slight magnification of the images . Patients suffering from maculopathy with a central scar but relatively functional surrounding macula improve their vision with the EyeMax lens implant . iolAMD The EyeMax intraocular lens does not cure maculopathy, it simply allows you to improve vision in selected cases . Traditional treatments to stop exudative maculopathy such as intravitreal injections or in rare cases laser therapy remain the most appropriate choice to stop the disease. When exudative maculopathy is stabilized or in cases of dry maculopathy, the insertion of the EyeMax intraocular lens can be considered. The results of this EyeMax lens in patients suffering from Cataracts and Maculopathy are in some cases exciting as reported in scientific literature . Where a good functional residue of the peripheral macula persists, vision can improve significantly. Where the peripheral macula is seriously damaged, unfortunately there is no benefit even with this technology. EyeMax is used in cases of exudative senile maculopathy in the quiescent phase, dry senile maculopathy, myopic maculopathy, diabetic maculopathy, macular hole, Stargardt’s and Best’s maculopathy. Not in all cases there is a benefit from the use of EyeMax: only a specific examination of the individual case through instrumental examinations and visual simulations allows the actual benefit of the EyeMax lens to be assessed. We were the first in Italy to use EyeMax and we are the center with the widest experience in Europe. You can find the experiences of patients operated on for cataracts and maculopathy with the EyeMax lens on our website in the Testimonials section dedicated to cataract surgery with the EyeMax intraocular lens .

Artificial Retina

In the treatment of serious forms of maculopathy, the last frontier is represented by the artificial retina. These are cases in which, in addition to the macula, peripheral vision is also compromised, as in retinitis pigmentosa maculopathy associated with severe loss of the lateral visual field. There are different models and every year technology offers important innovations in this field which we present to you in detail

Laser for the treatment of maculopathy

There are different types of laser treatment for maculopathy. Let’s discover together the most used and most effective laser techniques.

Laser photocoagulation

Laser photocoagulation is used to treat exudative maculopathy . Laser maculopathy therapy uses a beam of concentrated light to destroy the newly formed blood vessels of exudative maculopathy from which fluid leaks. The treatment is performed on an outpatient basis using eye drops for anesthesia. If the new vessels are clearly visible on Fluorangiography (classical form), it is possible to close them with the laser. This is only possible when they are not located in the center of the macula (extrafoveal) and if treated early. Laser therapy for maculopathy is useful for closing the anastomosis (feeder vessel) responsible for RAP (retinal angiomatous proliferation) . New types of laser for maculopathy are currently available which are much safer and more effective than those used in the past.

Micropulsed Yellow Laser and Maculopathy

The Micropulsed Yellow Laser is a new treatment modality for some types of maculopathy such as Central Serous Corio Retinopathy (CRSC) , diabetic retinopathy with macular edema , retinal vein thrombosis with macular edema. Laser for the treatment of maculopathy has been used for several years. micropulsed laser The traditional laser causes heating of the macula which results in a scar. This scar, depending on where it is located, can cause a decrease in vision. Today, only lesions of the peripheral macula are treated with the traditional laser. The central part of the macula, called the fovea, cannot in fact be treated with a conventional laser because it would result in an immediate reduction in vision. The micro-pulsed laser is a treatment modality based on the division of laser energy into numerous peaks (pulses) of energy separated by rest pauses. While the conventional laser sends a continuous stimulus to the retina, the micro-pulsed laser sends many energy peaks interspersed with small pauses. The presence of laser intervals and non-laser intervals allows the heating of the tissues to be limited and therefore the damage produced by the laser is greatly reduced. In fact, with the micro-pulsed laser the formation of scars on the macula is not observed and this allows the central area of the macula, called the fovea, to be safely treated. Added to this is that the yellow laser is not absorbed by the pigment present in the fovea but only by the cells of the underlying layer, the pigmented epithelium. Precisely the cells of the layer beneath the macula are activated by this laser stimulation and start functioning again. While with the traditional laser the cells were destroyed. yellow laser before and after The difference between traditional laser and micro-pulsed laser lies precisely here: with the traditional laser cells were burned to induce the activation of the surrounding cells, while with the micro-pulsed laser nothing is burned and there is a widespread activation of the cells of the pigmented epithelium. The results of the micro pulsed yellow laser are usually observed after an interval of one to three months and therefore usually take longer than is observed after traditional laser treatment. For some forms of maculopathy the traditional laser still remains the gold standard, for other forms in which there are foveal lesions the yellow laser is a valid alternative. Only an ophthalmologist expert in maculopathy, after a careful examination and all the appropriate tests, such as OCT and fluorescein angiography, will be able to advise you on the best treatment modality. Dr. Badalà has been treating maculopathies with micro-pulsed yellow lasers since 2014 in Milan and Catania.

2RT laser

This type of laser is used in the treatment of dry maculopathy . The rationale would be to reduce the chances of worsening of dry maculopathy. However, an important study has shown that receiving this treatment makes no difference to the risk of worsening of dry maculopathy. Click here to discover the scientific study published by the American Academy of Ophthalmology. yellow laser before and after

Photodynamic Therapy

Photodynamic therapy of maculopathy was the first treatment for exudative maculopathy to show efficacy and safety. It is used for the treatment of exudative maculopathy . A photosensitizing substance that selectively accumulates in the new vessels (verteporphyrin) is injected intravenously and a non-thermal laser is subsequently applied. It is necessary not to expose yourself to light at all for 3 days following the treatment . This laser is especially indicated in myopic maculopathies and/or in association with antiangiogenic therapy (anti-VEGF drugs).

Complications Treatment Maculopathy

Maculopathy never leads to complete blindness so even if the disease does not stop there is always a certain degree of peripheral vision which usually allows the patient to be independent. The most serious complication after treatment of maculopathy with intravitreal injections or vitrectomy is the ‘infection. This extremely rare complication can be very serious and therefore it is absolutely necessary to carry out post-operative instructions with great care and avoid frequenting dirty environments for the first seven days after surgery. If you have a red or irritated eye, contact your ophthalmologist immediately. Other maculopathy therapies rarely have serious complications, however it should be remembered that laser photocoagulation treatment if not performed according to the most accurate standards or if the patient were to move may present a risk of worsening vision.