Guías de práctica clínica de la SERVTratamiento de la degeneración macular asociada a la edad (DMAE) exudativa

  1. J.M. Ruiz-Moreno
  2. L. Arias-Barquet
  3. F. Armadá-Maresca
  4. A. Boixadera-Espax
  5. A. García-Layana
  6. F. Gómez-Ulla-de-Irazazábal
  7. J. Monés-Carilla
  8. A. Piñero-Bustamante
  9. M. Suárez-de-Figueroa
Revista:
Archivos de la Sociedad Española de Oftalmologia

ISSN: 0365-6691

Ano de publicación: 2009

Volume: 84

Número: 7

Páxinas: 333-344

Tipo: Artigo

DOI: 10.4321/S0365-66912009000700004 DIALNET GOOGLE SCHOLAR lock_openAcceso aberto editor

Outras publicacións en: Archivos de la Sociedad Española de Oftalmologia

Resumo

Objetivo: La Degeneración Macular Asociada a la Edad (DMAE) en su forma húmeda supone una grave enfermedad que condiciona ceguera legal en muchos pacientes y con mal pronóstico si no es tratada. Pretendemos establecer una guía de actuación clínica con las diferentes opciones terapeúticas que existen en el momento actual, que puedan ayudar al oftalmólogo en su práctica clínica. Métodos: Un grupo de expertos en retina médica seleccionados por la SERV han evaluado los resultados de los diferentes estudios publicados con los fármacos actualmente disponibles, llegando a un consenso basado en la evidencia. Se han establecido unas recomendaciones para el diagnóstico, tratamiento y seguimiento de los enfermos con DMAE húmeda. Resultados: La inyección intravítrea de ranibizumab a la dosis de 0,5 mg permite obtener mejorías significativas de la agudeza visual en lesiones subfoveales, según los datos obtenidos de estudios con máximo nivel de evidencia. Debe ser considerado como el fármaco de primera elección. El empleo de bevacizumab, fármaco sin indicación aprobada para uso intraocular, ni para el tratamiento de la DMAE húmeda, puede aportar un beneficio más próximo a los resultados obtenidos con el ranibizumab que a los obtenidos con la terapia fotodinámica (TFD) y el pegaptanib. El uso de pegaptanib sódico en inyección intravítrea a la dosis de 0,3 mg como tratamiento de lesiones subfoveales permite obtener resultados parecidos a la TFD, pero en un abanico más amplio de lesiones Conclusiones: Los resultados de los estudios basados en la evidencia constituyen una buena guía de actuación en el tratamiento de esta enfermedad.

Referencias bibliográficas

  • (1991). Argon laser photocoagulation for neovascular maculopathy: Five-years results from randomized clinical trials. Arch Ophthalmol. 109. 1109-1114
  • (1994). Argon laser photocoagulation for juxtafoveal choroidal neovascularization: Five-years results from randomized clinical trials. Arch Ophthalmol. 112. 500-509
  • (1991). Laser photocoagulation of subfoveal neovascular lesions in age-related macular degeneration.: Results of a randomized clinical trials. Arch Ophthalmol. 109. 1220-1231
  • Bhatt, NS, Al-Shirawi, NM, Diamond, JG. (1999). Krypton laser photocoagulation of peripapillary choroidal neovascular membrane. Ophthalmic Surg Lasers. 30. 56-58
  • Lai, TY, Chan, WM, Lam, DS. (2004). Laser photocoagulation of indocyanine green aniographically identified feeder vessels to idiopathic polypoidal choroidal vasculopathy. Am J Ophthalmol. 138. 693-694
  • Johnson, TM, Glaser, BM. (2006). Focal laser ablation of retinal angiomatous proliferation. Retina. 26. 765-772
  • Roth, DB, Scott, IU, Gloth, JM, Green, SN, Yarian, DL, Wheatley, M. (2007). Micropulsed laser photocoagulation and intravitreal triamcinolone acetonide injection for the treatment of retinal angiomatous proliferation. Retina. 27. 1201-1204
  • Merrill, PT, LoRusso, FJ, Lomeo, MD, Saxe, SJ, Khan, MM, Lambert, HM. (1999). Surgical removal of subfoveal choroidal neovascularization in age-related macular degeneration. Ophthalmology. 106. 782-789
  • Kokame, GT, Yamaoka, S. (2005). Subretinal surgery for peripapillary subretinal neovascular membranes. Retina. 25. 564-569
  • (1999). Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: one-year results of 2 randomized clinical trials - TAP report. Arch Ophthalmol. 117. 1329-1345
  • (2001). Photodynamic Therapy of Subfoveal Choroidal Neovascularization in Pathologic Myopia with Verteporfin: one-year results of a randomized clinical trial - VIP report no. 1. Ophthalmology. 108. 841-852
  • Bressler, NM. (2002). Verteporfin therapy of subfoveal choroidal neovascularization in age-related macular degeneration: two-year results of a randomized clinical trial including lesions with occult with no classic choroidal neovascularization-verteporfin in photodynamic therapy report 2. Am J Ophthalmol. 133. 168-169
  • Ruiz-Moreno, JM, Montero, J, Barile, S, Zarbin, M. (2006). Photodynamic therapy and high doses intravitreal triamcinolone to treat exudative age-related macular degeneration: One year outcome. Retina. 26. 602-612
  • Arias, L, Garcia-Arumi, J, Ramon, JM, Badia, M, Rubio, M, Pujol, O. (2006). Photodynamic therapy with intravitreal triamcinolone in predominantly classic choroidal neovascularization: one-year results of a randomized study. Ophthalmology. 113. 2243-2250
  • Kaiser, PK. (2003). Five-year results of verteporfin therapy for subfoveal CNV due to AMD: third year of an open-label extension of the TAP Investigation. Invest Ophthalmol Vis Sci. 44.
  • Chakravarthy, U, Soubrane, G, Bandello, F, Chong, V, Creuzot-Garcher, C, Dimitrakos, SA. (2006). Evolving European guidance on the medical management of neovascular age related macular degeneration. Br J Ophthalmol. 90. 1188-1196
  • Gragoudas, ES, Adamis, AP, Cunningham, ET Jr, Feinsod, M, Guyer, DR. (2004). Pegaptanib for neovascular age-related macular degeneration. N Engl J Med. 351. 2805-2816
  • Chakravarthy, U, Adamis, AP, Cunningham, ET Jr, Goldbaum, M, Guyer, DR. (2006). Year 2 efficacy results of 2 randomized controlled clinical trials of pegaptanib for neovascular age-related macular degeneration. Ophthalmology. 113. 1508-1521
  • Heier, JS, Boyer, DS, Ciulla, TA, Ferrone, PJ, Jumper, JM, Gentile, RC. (2006). Ranibizumab combined with verteporfin photodynamic therapy in neovascular age-related macular degeneration: year 1 results of the FOCUS Study. Arch Ophthalmol. 124. 1532-1542
  • Antoszyk, AN, Tuomi, L, Chung, CY, Singh, A. Ranibizumab combined with verteporfin photodynamic therapy in neovascular age-related macular degeneration (FOCUS): year 2 results. Am J Ophthalmol. 145. 862-874
  • Rosenfeld, PJ, Brown, DM, Heier, JS, Boyer, DS, Kaiser, PK, Chung, CY. (2006). Ranibizumab for neovascular age-related macular degeneration. N Engl J Med. 355. 1419-1431
  • Brown, DM, Kaiser, PK, Michels, M, Soubrane, G, Heier, JS, Kim, RY. (2006). Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med. 355. 1432-1444
  • Kaiser, PK. (2006). Antivascular endothelial growth factor agents and their development: therapeutic implications in ocular diseases. Am J Ophthalmol. 142. 660-668
  • Kim, KJ, Li, B, Houck, K, Winer, J, Ferrara, N. (1992). The vascular endothelial growth factor proteins: identification of biologically relevant regions by neutralizing monoclonal antibodies. Growth Factors. 7. 53-64
  • Chen, Y, Wiesmann, C, Fuh, G, Li, B, Christinger, HW, McKay, P. (1999). Selection and analysis of an optimized anti-VEGF antibody: crystal structure of an affinity-matured Fab in complex with antigen. J Mol Biol. 293. 865-881
  • Rosenfeld, PJ, Schwartz, SD, Blumenkranz, MS, Miller, JW, Haller, JA, Reimann, JD. (2005). Maximum tolerated dose of a humanized anti-vascular endothelial growth factor antibody fragment for treating neovascular age-related macular degeneration. Ophthalmology. 112. 1048-1053
  • Dalton, Michelle. Lucentis at one year. Eyeworld.
  • Ip, MS, Scott, IU, Brown, GC, Brown, MM, Ho, AC, Huang, SS. (2008). Anti-vascular endothelial growth factor pharmacotherapy for age-related macular degeneration: a report by the American Academy of Ophthalmology. Ophthalmology. 115. 1837-1846
  • Michels, S, Rosenfeld, PJ, Puliafito, CA, Haraus, EN, Venkatraman, AS. (2005). Systemic bevacizumab (Avastin) therapy for neovascular age-related macular degeneration twelve-week results of an uncontrolled open-label clinical study. Ophthalmology. 112. 1035-1047
  • Rosenfeld, PJ, Fung, AE, Puliafito, CA. (2005). Optical coherence tomography findings after an intravitreal injection of bevacizumab (Avastin) for macular edema from central retinal vein occlusion. Ophthalmic Surg Lasers Imaging. 36. 336-339
  • Rosenfeld, PJ, Moshfeghi, AA, Puliafito, CA. (2005). Optical coherence tomography findings after an intravitreal injection of bevacizumab (Avastin) for neovascular age-related macular degeneration. Ophthalmic Surg Lasers Imaging. 36. 331-335
  • Spaide, RF, Laud, K, Fine, HF, Klancnik, JM Jr, Meyerle, CB, Yannuzzi, LA. (2006). Intravitreal bevacizumab treatment of choroidal neovascularization secondary to age-related macular degeneration. Retina. 26. 383-390
  • Aisenbrey, S, Ziemssen, F, Volker, M, Gelisken, F, Szurman, P, Jaissle, G. (2007). Intravitreal bevacizumab (Avastin) for occult choroidal neovascularization in age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol. 245. 941-948
  • Chen, E, Kaiser, RS, Vander, JF. (2007). Intravitreal bevacizumab for refractory pigment epithelial detachment with occult choroidal neovascularization in age-related macular degeneration. Retina. 27. 445-450
  • Rich, RM, Rosenfeld, PJ, Puliafito, CA, Dubovy, SR, Davis, JL, Flynn, HW Jr. (2006). Short-term safety and efficacy of intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration. Retina. 26. 495-511
  • Emerson, MV, Lauer, AK, Flaxel, CJ, Wilson, DJ, Francis, PJ, Stout, JT. (2007). Intravitreal bevacizumab (Avastin) treatment of neovascular age-related macular degeneration. Retina. 27. 439-444
  • Wu, L, Martinez-Castellanos, MA, Quiroz-Mercado, H, Arevalo, JF, Berrocal, MH, Farah, ME. (2007). Twelve-month safety of intravitreal injections of bevacizumab (Avastin®): results of the Pan-American collaborative retina study group (PACORES). Graefes Arch Clin Exp Ophthalmol. 246. 81-87
  • Cleary, CA, Jungkim, S, Ravikumar, K, Kelliher, C, Acheson, RW, Hickey-Dwyer, M. (2008). Intravitreal bevacizumab in the treatment of neovascular agerelated macular degeneration, 6- and 9-month results. Eye. 22. 82-86
  • Bashshur, ZF, Haddad, ZA, Schakal, A, Jaafar, RF, Saab, M, Noureddin, BN. (2008). Intravitreal bevacizumab for treatment of neovascular age-related macular degeneration: a one-year prospective study. Am J Ophthalmol. 145. 249-256
  • Chen, CY, Wong, TY, Heriot, WJ. (2007). Intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration: a short-term study. Am J Ophthalmol. 143. 510-512
  • (1993). Laser photocoagulation of subfoveal neovascular lesions of age-related macular degeneration: Update findings from two clinical trials. Ophthalmology. 111. 1200-1209
  • Fung, AE, Lalwani, GA, Rosenfeld, PJ, Dubovy, SR, Michels, S, Feuer, WJ. (2007). An optical coherence tomography-guided, variable dosing regimen with intravitreal ranibizumab (Lucentis) for neovascular age-related macular degeneration. Am J Ophthalmol. 143. 566-583
  • Regillo, CD, Brown, DM, Abraham, P, Yue, H, Ianchulev, T, Schneider, S. (2008). Randomized, double-masked, sham-controlled trial of ranibizumab for neovascular age-related macular degeneration: PIER Study year 1. Am J Ophthalmol. 145. 239-248