The therapeutic approach to macular problems
The therapeutic approach was very narrow until several years ago, while today it is possible to act even in the cases of very aggressive forms – in terms of stopping the progression of the disease if the reaction comes in time.
Of course, it is still essential to prevent the disease and remove risk factors in the first place.
The early recognition of the problem and timely applied therapy reduce the risk of fudroajant, irretrievable loss of central vision. With cataract surgery nowadays, particularly if the patient’s macula is also damaged, it is increasingly recommended to implant a special, foldable intraocular lens with an integrated filter that absorbs and blocks the penetration of UV and blue light, thus acting protectively on the macula (the so-called yellow spot or natural intraocular lenses). This is one of the forms of preventive action.
The differential diagnosis of the types of macular diseases is made by a clinical examination, filming the back of the eye – fundus with or without the contrast (angiography) and by the latest diagnostic procedure – OCT (optical coherence tomography) that provides fantastic, almost histological sections through the macula and its detailed three-dimensional imaging.
In this way, the two basic types of the wet form of macular degeneration – occult and classic, whose therapeutic possibilities and prognosis are different, can be differentiated easily. In addition, with the use of the OCT diagnostics, many other processes in the macula (oedemas, traction phenomena, etc.) can also be detected quickly and easily.
By the application of the photodynamic therapy (PDT), bad blood vessels are destructed – in a targeted manner, without damaging the surrounding tissue, which was not possible with the earlier generation of thermal lasers. In our country, this type of therapy is only performed in Special Hospital SVETI VID where we pay special attention to the problem of macular degeneration.
The surgical approach applied in recent years is the so-called translocation or the relocation of the macula. This is a complex surgery applied in a restricted number of cases, while the macular problems are mostly solved in a simpler manner, by injecting the drug into the vitreus (anti-VEGF) separately or within vitrectomy. The routine surgery performed here is the macular hole surgery, as well as the macular pucker surgery.