[The Position of the Retinological Society, the German Ophthalmological Society and the Professional Association of Ophthalmologists--comments on the current therapy for neovascular AMD].
BACKGROUND
Until recently, only two options were available for the treatment of choroidal neovascularization (CNV) due to age-related macular degeneration (AMD): laser photocoagulation and photodynamic therapy (PDT) with verteporfin. However, potential new treatments for CNV are under development, and data from phase III clinical trials are now available. Referring to these data, expert guidance is required to supply ophthalmologists with expertise in the management of AMD to select and use the most appropriate therapies in the treatment of neovascular AMD.


METHODS
The therapeutic modalities discussed include thermal laser photocoagulation, PDT with verteporfin, triamcinolone acetonide and the possible combination with PDT, anecortave acetate, pegaptanib sodium and ranibizumab. After a short description of the treatment principles, a summary of the discussion of all relevant study results of the different treatment options with respect to the different subtypes of neovascular AMD is presented. These discussions resulted in an "up-to-date" recommendation of therapeutical strategies in neovascular AMD.


RESULTS
For subfoveal lesions with predominantly classic CNV, or with occult with non-classic CNV and a lesion size < or = 4 macular photocoagulation study (MPS) disc areas (DA), PDT with verteporfin is recommended; for subfoveal lesions with minimally classic CNV, treatment with PDT or pegaptanib sodium is possible, even if there are some problems with the statistics in the studies with both treatment modalities. PDT with verteporfin should be considered for juxtafoveal lesions that are so close to the fovea that laser photocoagulation would almost certainly extend under the center of the foveal avascular zone, and for all other juxtafoveal lesions and for extrafoveal lesions laser photocoagulation is suggested. Therapy should be performed not later than one week after the initial fluorescein angiogram upon which the clinical decision for treatment is based. At each follow-up best-corrected visual acuity and a fundus examination should be performed as well as a fluorescein angiography every three months.


CONCLUSIONS
These recommendations provide good clinical guidance for the choice and use of laser and pharmacotherapies for the management of CNV due to AMD. Revisions of the recommendations will be required as new data become available.
Pauleikhoff
D
D
Augenabteilung des St. Franziskus Krankenhauses, Münster. kpl-auge@muenster.de
Bornfeld
N
N
Gabel
V-P
VP
Holz
F
F
Roider
H
H
D020256:Choroidal Neovascularization / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008268:Macular Degeneration / Q000150:complications / Q000628:therapy*; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D010778:Photochemotherapy / Q000379:methods*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012955:Societies, Medical; D016896:Treatment Outcome