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J. I. Khoroshikh, O. Krivosheina, I. Zapuskalov, K. Nazarenko; Role of Chronic Inflammation in Pathogenesis of Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2007;48(13):28.
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Age-related macular degeneration (AMD) is the second leading cause of visual disability and legal blindness in individuals over 60 years of age all over the world. It has been shown that neovascularization and formation of subretinal membranes in the macular area occur due to local stimulation of various growth factors, including vascular and endothelial. However, these substances are also known to appear as a result of inflammation process. Aims of this work were: 1) to study the clinical course of AMD as a process resulted from chronic retinal inflammation; 2) to evaluate the efficacy of anti-inflammatory treatment in AMD patients.
50 patients, aged 58-74 years, diagnosed with different stages of AMD were enrolled into the study. Before and after treatment all patients were followec up with indirect ophthalmoscopy extended in each patient to detailed examination of retinal periphery using scleral depressor. All patients underwent demarcating laser coagulation of peripheral retina or peripheral transscleral cryopexy followed with complex anti-inflammatory therapy. Follow-up period was from 4 months to 2.5 years.
In all patients, prior to the treatment, retinal periphery exam showed presence of chronic intermediate uveitis revealing multiple early inflammatory lesions along with old atrophic changes at the area of ora serrata. Visual acuity varied from light perception to 0.08. After performed laser coagulation or cryotherapy, stabilizing of both the uveitis and the macular changes was observed. Visual acuity was preserved at the same level in all patients.
Effective treatment of intermediate uveitis, such as cryopexy, in AMD patients provides stabilization of pathological process in macula. We propose that as the intraocular fluid circulates from ciliary body towards the posterior pole, inflammatory and proliferative factors excreted by the cells of inflamed peripheral retina reach macular area causing chronic inflammatory process, which later is recognized as AMD. We believe that chronic inflammation of the peripheral retina represents an important pathogenetic mechanism associated with the development of AMD.
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