Mild Transcleral Cryotherapy for the Treatment of Wet Age Related Macular Degeneration

Abstract

Abstract: : Purpose:To describe the effects of mild cryotherapy for the treatment of subfoveal choroidal neovascularization (CNV) and pigment epithelium detachment (PED) in age related macular degeneration (AMD). Methods: A prospective, longitudinal, descriptive and investigational study was conducted including eight patients with visual acuity ranging from 20/200 to Hand Motion (HM). We evaluate the changes in best corrected Visual Acuity (BCVA), Color Fundus photographs, Optic Coherence Tomography (OCT) at 1, 3 and 6 months follow up. The surgical technique consisted in conjuntival peritomy and tenon capsule incision to reach subtenon posterior space. The application was done in the center of the lesion (PED) avoiding bleaching of RPE, until a moderate change of color was observed under treated area. Results:Nine phakic eyes of eight patients . Ages ranged between 59 and 77 years (mean 69.75). A regression of PED and exudative manifestations was observed 4 weeks after treatment; at that time, visual acuity had improved from CF 1 m to 20/100 in one patient, from HM to CF in two and in five (six eyes) have no showed improvement of visual acuity. Up to 3 to 6 months from the follow up, no further changes were observed. Optical coherence tomography disclosed partial restoration of normal architecture due to fluid resolution from PED and subretinal fluid. Preoperatively macular thickness measured by OCT ranged between 240–531 µ (mean 414.55) and between 116 to 540 µ (mean 335.7) 3 to 6 months after procedure with no correlation in the visual acuity improvement. Conclusions: Regression of occult CNV and PED occurred after mild transcleral cryotherapy it may be a viable treatment in selected cases of wet AMD; cryotheraphy induces the release of RPE cells in the subretinal space and stimulates the production of local factors that induce CNV scaring and limitation of the damage. The antiangiogenic effect of cryotherapy in retina vasoproliferative diseases is very well known. Cryotherapy likewise laser treatment of RPE may unregulated pigment epithelium–derived factor.

Keywords: age-related macular degeneration • cytoskeleton • retinal pigment epithelium