Wydanie 4/2004

Idiopatyczne nowotwórstwo podsiatkówkowe u młodych dorosłych - współczesne poglądy na etiologię, diagnostykę i leczenie

Idiopatic choroidal neovascularization of young adults - contemporary view at etiology, diagnosis and treatment

Anna Otto, Aneta Paćkowska

Katedra i Klinika Okulistyki I Wydziału Lekarskiego Akademii Medycznej w Warszawie Kierownik: prof. nadzw. dr hab. med. Dariusz Kęcik

Summary: Age-related macular degeneration is the most popular reason of choroidal neovascularization (CNV) appearance and treatment. However CNV may occur in population of young people (younger than 50 yrs) without relation to any, well known ophtalmological disease. This type of choroidal neovascularization is called an idiopatic CNV (ICNV). Patobiology of CNV is a very complicated process related with many factors. The best known one is VEGF (vascular endothelial growth factor), but there are also some mediators produced by macrophages taking part in this process. These are for example: MCP (monocyt colonization protein), MMPS (matrix metaloproteinazy), aTNF (tumor necrosis factor). Dynamic stages between pro and antyangiogenic factors plays the most important role in prevention of CNV appearance. Following methods have the most important meaning in CNV diagnosis: fluoroscein and indocianin angiography as well as optical coherent tomography examination. As far as treatment of ICNV is concerned we should consider methods like: photodynamic therapy (PDT), laser photocoagulation, vitreorethinal surgery ? macular translocation or removal of the subfoveal choroidal neovascular membranes. Comparison outcomes have shown that PDT is the most efficient kind of CNV treatment. Experiments on animals proved that it is possible to change CNV activity by factors like Anecortev and synthetic VEGF. The most important for the right prognosis as to final vision acuity is extensiveness of the neovascular membranes during the first AF examination, so when planning right treatment the natural history of disease must be always considered. As it was proven by many authors ICNV doesn?t lead to a serious lost of vision.