Intravitreal injections (Aylea injection)
Macular degeneration
Macular degeneration is a lesion of the central part of the retina. It most often leads to a decrease or loss of central vision. The affected eye sees the world, but cannot see faces, letters, objects. The objects to which the eye is directed are covered by a spot.
Changes develop gradually. At first, the brightness and colour saturation may decrease. Small fragments in the image may disappear. Over time, the image in the centre of the field of vision becomes dim, and distortions appear. Gradually, the ability to see in front of you is lost. Only peripheral vision remains. It is extremely difficult to take care of yourself in this situation.
The main cause of such problems is vascular diseases. Vascular damage occurs throughout the body. The load on them in the eye is very high. The price of their failure or damage can be blindness.
Age-related macular degeneration (AMD), diabetes, circulatory disorders, and damage to the central part of the retina against the background of high myopia cause the greatest damage to vision and often lead to disability. The triggering mechanisms for these diseases are different, but the result can be the same – the death of the central part of the retina, which is responsible for visual acuity. The retina can either dry out or swell, and can be replaced by a scar in case of a retinal haemorrhage.
In any of these diseases, ischaemia (lack of oxygen) develops in the retina due to lack of blood flow. The content of vascular endothelial growth factor (VEGF) increases in the tissue. It stimulates increased permeability of normal vessels and growth of new ones. The greater the edema, the more waste and toxic products accumulate in the retina. The newly formed vessels are very weak and often burst. In addition, they further deform the delicate structure of the macula.
Anti-VEGF therapy
A modern and effective way to treat the above diseases is anti-VEGF therapy.
In our country Ailia, Vabysmo, Vsiqq and Lucentis are approved for use in ophthalmology. The medicine is injected directly into the eye in the operating room (intravitreal injection).
Contraindications:
- Hypersensitivity to the drug or any other component of the drug;
- active or suspected intra- or periocular infection;
- active severe intraocular inflammation;
- pregnancy and breastfeeding;
- Age under 18 years.
The course of treatment always starts with three injections with an interval of 1 month (in case of DME – with five). Subsequently, for complete stabilisation of the process, treatment is continued at long intervals.
The main diagnostic criterion for prescribing anti-VEGF therapy is the presence of retinal edema according to OCT (optical coherence tomography). Our centre uses spectral OCT. If necessary, angio-OCT is performed.
Treatment of general diseases (arterial hypertension, diabetes mellitus, etc.) should not be interrupted! In the evening before the procedure and in the morning on the day of the procedure, blood pressure should be checked. You do not need to change your diet.
Prevention
Prevention of the development of age-related macular degeneration is the control of blood pressure, weight, and smoking cessation. You should follow the recommendations of your general practitioner. It is useful to protect your eyes from bright sunlight with sunglasses with an ultraviolet filter. People over 50 years of age are at risk.
The damage to the centre of the retina in people with diabetes mellitus is called diabetic macular edema (DME). The worse the sugar and blood pressure are compensated, the higher the risks of retinal, kidney and foot damage (diabetic retinopathy, diabetic nephropathy, diabetic foot). Approximately one third of patients have diabetic retinopathy. A third of them develop AMD. And in one third, macular edema is prolonged.
Retinal circulatory disorders, or retinal vein thrombosis, are the result of general vascular problems. First of all, hypertension. It is a kind of heart attack in the eye. In case of macular damage, only timely treatment can guarantee success.
High myopia (HM) requires the exclusion of any high overloads. Physical, visual, psycho-emotional. Hard physical labour, work with prolonged bending to the legs, concussions, bruises are extremely undesirable. The formation of pathological vessels in the macula in the absence of treatment leads to the formation of a scar (Fuchs’ spot) and irreversible loss of central vision.
Course
The time from the onset of the disease to the terminal stage can vary greatly and can last from several months (rapidly) to many years (sluggishly).
The processes can be reversible. Often the process can be stopped. But when a retinal scar or large ischaemic edema has formed, treatment is currently ineffective.