{"id":9377,"date":"2019-10-24T08:11:04","date_gmt":"2019-10-24T08:11:04","guid":{"rendered":"https:\/\/jurmed.ro\/medici\/?p=9377"},"modified":"2019-10-24T08:11:04","modified_gmt":"2019-10-24T08:11:04","slug":"degenerescenta-maculara-exsudativa-provocari-terapeutice","status":"publish","type":"post","link":"https:\/\/jurmed.ro\/medici\/degenerescenta-maculara-exsudativa-provocari-terapeutice\/","title":{"rendered":"Degenerescen\u021ba macular\u0103 exsudativ\u0103 &#8211; provoc\u0103ri terapeutice"},"content":{"rendered":"<p style=\"text-align: justify\"><strong>\u00a0<\/strong><\/p>\n<p style=\"text-align: justify\"><a href=\"https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2019\/10\/Dr-Mercut-1.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-9378 alignleft\" src=\"https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2019\/10\/Dr-Mercut-1-300x224.jpg\" alt=\"\" width=\"300\" height=\"224\" srcset=\"https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2019\/10\/Dr-Mercut-1-300x224.jpg 300w, https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2019\/10\/Dr-Mercut-1.jpg 630w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<p style=\"text-align: justify\"><em><strong>Autor:<\/strong><\/em><\/p>\n<p style=\"text-align: justify\"><em><strong>Georgeta MERCUT,<\/strong><\/em><\/p>\n<p style=\"text-align: justify\"><em>medic primar oftalmolog, doctor \u00een \u0219tiin\u021be medicale<\/em><\/p>\n<p style=\"text-align: justify\"><em><strong>Centrul Medical Irina, Craiova<\/strong><\/em><\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: justify\">Degenerescen\u0163a macular\u0103 neovascular\u0103, legat\u0103 de v\u00e2rst\u0103 este principala cauz\u0103 a pierderii severe a vederii \u015fi a orbirii la persoanele de peste 65 de ani, din America de Nord, Europa, Australia \u015fi Asia. Se estimeaz\u0103 c\u0103 frecven\u0163a bolii va cre\u015fte \u00een toat\u0103 lumea, ca urmare a cre\u015fterii speran\u0163ei de via\u0163\u0103. Aceast\u0103 afec\u0163iune cronic\u0103 necesit\u0103 un tratament continuu \u015fi monitorizare, pentru a controla evolu\u0163ia bolii exsudative.<\/p>\n<p style=\"text-align: justify\"><strong>DMLV<\/strong>neovascular\u0103 se caracterizeaz\u0103 prin exsudarea vaselor de s\u00e2nge anormale de la nivelul maculei, ceea ce duce la degenerarea progresiv\u0103 a fotoreceptorilor \u0219i a epiteliului pigmentar retinian. Pe parcursul bolii, cre\u0219terea anormal\u0103 a vaselor retiniene cre\u0219te riscul de hemoragie, ca urmare a cre\u0219terii nivelurilor factorilor de cre\u0219tere endotelial\u0103 vascular\u0103 (VEGF), iar ulterior, acumularea crescut\u0103 de lichid retinian duce la edem \u0219i deteriorare func\u021bional\u0103 a zonei retiniene afectate. Tomografia de coeren\u021b\u0103 optic\u0103 (OCT) a ar\u0103tat c\u0103 modific\u0103rile structurale ale epiteliului pigmentar duc la acumul\u0103ri lichidiene cu diferite localiz\u0103ri. OCT este folosit\u0103 pentru a urm\u0103ri evolu\u021bia \u0219i pentru a ghida tratamentul prin compara\u021bii ale examin\u0103rilor ini\u021biale \u0219i ulterioare acestuia.<\/p>\n<p style=\"text-align: justify\">\u00cen timp ce grosimea retinei centrale are importan\u021b\u0103 pentru ghidarea terapiei \u00een practica clinic\u0103, localizarea fluidelor \u00een diferite compartimente retiniene ofer\u0103 valoare prognostic\u0103.<\/p>\n<p style=\"text-align: justify\">Prezen\u021ba lichidului retinian \u0219i cre\u0219terea grosimii retiniene sunt indicatori ai evolu\u021biei bolii, mai degrab\u0103 dec\u00e2t acuitatea vizual\u0103 corectat\u0103. Prezen\u021ba lichidului din orice strat retinian, \u00een examinarea OCT, necesit\u0103 instituirea tratamentului anti-VEGF.<\/p>\n<p style=\"text-align: justify\">Utilizarea agen\u021bilor anti-vasculari are ca scop reducerea la minimum a pierderii vederii, pentru a men\u021bine independen\u021ba pacien\u021bilor. Experien\u021ba ultimilor ani a demonstrat reducerea semnificativ\u0103 a inciden\u021bei orbirii, aceast\u0103 op\u021biune de tratament devenind acum standardul de \u00eengrijire \u00een degenerescen\u021ba macular\u0103 exsudativ\u0103.<\/p>\n<p style=\"text-align: justify\">Ghidurile EURETINA recomand\u0103 injec\u021bii intravitreene cu agen\u021bi anti-VEGF disponibili \u00een prezent: ranibizumab, bevacizumab \u0219i aflibercept ca terapie de prim\u0103 linie pentru exsudatia retinian\u0103. Tratamentele anti-VEGF \u00eencep cu o faz\u0103 de \u00eenc\u0103rcare, const\u00e2nd din 3 injec\u021bii lunare, \u00een primele 3 luni \u0219i o faz\u0103 de \u00eentre\u021binere, c\u00e2nd \u00eentreruperea tratamentului este decis\u0103 \u00een func\u021bie de evolu\u021bia bolii.<\/p>\n<p style=\"text-align: justify\"><strong><a href=\"https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2019\/10\/Dr-Mercut-2.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\" wp-image-9379 alignleft\" src=\"https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2019\/10\/Dr-Mercut-2-300x175.jpg\" alt=\"\" width=\"299\" height=\"174\" srcset=\"https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2019\/10\/Dr-Mercut-2-300x175.jpg 300w, https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2019\/10\/Dr-Mercut-2.jpg 630w\" sizes=\"auto, (max-width: 299px) 100vw, 299px\" \/><\/a>Ranibizumab<\/strong> \u2013 Se recomand\u0103 injec\u021bii lunare continue timp de 2 ani cu monitorizare lunar\u0103 strict\u0103 folosind imaginile OCT. Tratamentul se continu\u0103 lunar p\u00e2n\u0103 la atingerea acuit\u0103\u021bii vizuale maxime posibile, la 3 evalu\u0103ri lunare consecutive. \u00cen perioada posttratament, acuitatea vizual\u0103 se evalueaz\u0103 lunar. Tratamentul trebuie reluat atunci c\u00e2nd monitorizarea indic\u0103 pierderea AV, iar injec\u021biile lunare se continu\u0103 p\u00e2n\u0103 c\u00e2nd aceasta este stabil\u0103 din nou, pentru trei evalu\u0103ri lunare consecutive.<\/p>\n<p style=\"text-align: justify\"><strong><a href=\"https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2019\/10\/Dr-Mercut-3.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-9380 alignleft\" src=\"https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2019\/10\/Dr-Mercut-3-300x175.jpg\" alt=\"\" width=\"300\" height=\"175\" srcset=\"https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2019\/10\/Dr-Mercut-3-300x175.jpg 300w, https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2019\/10\/Dr-Mercut-3.jpg 630w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a>Bevacizumab<\/strong> &#8211; Cele mai bune rezultate folosind bevacizumab sunt ob\u021binute cu un regim fix de tratament lunar. Ranibizumab, fa\u021b\u0103 de bevacizumab pare s\u0103 p\u0103streze rezultatele mai bune \u00een timp, prin absen\u021ba lichidului la OCT \u0219i modificarea dimensiunii leziunii peste 24 de luni.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: justify\"><strong><a href=\"https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2019\/10\/Dr-Mercut-4.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-9381 alignleft\" src=\"https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2019\/10\/Dr-Mercut-4-300x175.jpg\" alt=\"\" width=\"300\" height=\"175\" srcset=\"https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2019\/10\/Dr-Mercut-4-300x175.jpg 300w, https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2019\/10\/Dr-Mercut-4.jpg 630w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a>Aflibercept<\/strong> &#8211;\u00a0 Injec\u021bii lunare \u00een primele 3 luni urmate de o doz\u0103 fix\u0103 \u200b\u200bla fiecare opt s\u0103pt\u0103m\u00e2ni, f\u0103r\u0103 monitorizare ulterioar\u0103. Studii recente nu au demonstrat nicio eficacitate suplimentar\u0103 atunci c\u00e2nd afliberceptul a fost administrat la fiecare 4 s\u0103pt\u0103m\u00e2ni, comparativ cu administrarea la 8 s\u0103pt\u0103m\u00e2ni. De altfel, mai multe studii sugereaz\u0103 o eficacitate imagistic\u0103 superioar\u0103 a afliberceptului comparativ cu ranibizumab \u0219i bevacizumab. Dup\u0103 12 luni de tratament, intervalele de tratament pot fi prelungite, \u00een func\u021bie de starea func\u021bional\u0103 \u0219i anatomic\u0103 a pacientului.<\/p>\n<p style=\"text-align: justify\">Dup\u0103 remiterea edemului retinian, pacien\u021bii sunt trata\u021bi doar atunci c\u00e2nd exist\u0103 semne de reactivare a bolii. De\u0219i aceast\u0103 abordare ajut\u0103 la reducerea frecven\u021bei \u0219i a costurilor inject\u0103rii, necesit\u0103 totu\u0219i o monitorizare frecvent\u0103. De obicei, pacien\u021bii urmeaz\u0103 un program lunar de vizite clinice, \u00een care decizia se bazeaz\u0103 pe un set de criterii (acuitate vizual\u0103, scan\u0103ri OCT).<\/p>\n<p style=\"text-align: justify\">Brolucizumab este primul fragment de anticorp cu o greutate molecular\u0103 sc\u0103zut\u0103 (26 kDa). Dimensiunea sa mic\u0103 poate facilita p\u0103trunderea eficient\u0103 a straturilor retiniene. Brolucizumab a fost dezvoltat pentru a avea mai mult\u0103 eficienta\/volum, furniz\u00e2nd mai mult medicament pe doz\u0103, pentru un efect mai \u00eendelungat.<\/p>\n<p style=\"text-align: justify\">La nivel global, afliberceptul \u0219i brolucizumab au avut profile de siguran\u021b\u0103 comparabile, cu inciden\u021ba comparabil\u0103 a reac\u021biilor adverse.<\/p>\n<p style=\"text-align: justify\">\u00cen prezent, sunt \u00een studiu mai mul\u021bi agen\u021bi anti-VEGF intravitreeni, cu inten\u021bia de a reduce frecven\u021ba injec\u021biilor, de a prelungi intervalul \u00eentre tratamente \u0219i de a \u00eembun\u0103t\u0103\u021bi complian\u021ba pacien\u021bilor la terapie.<\/p>\n<p style=\"text-align: justify\">Conbercept este o protein\u0103 de fuziune \u0219i molecul\u0103 mare, cu caracteristici asem\u0103n\u0103toare\u00a0 aflibercept. Un studiu recent a comparat eficacitatea \u0219i siguran\u021ba conberceptului prin compara\u021bie cu ranibizumab. S-a constatat c\u0103 ambele medicamente au ob\u021binut recuper\u0103ri vizuale similare \u0219i \u00eembun\u0103t\u0103\u021biri anatomice la 1 an, doar c\u0103 conbercept a fost administrat la intervale mai lungi de tratament.<\/p>\n<p style=\"text-align: justify\">Abicipar-pegol este o clas\u0103 a medicamentului cunoscut sub numele de DARP, proteine \u200b\u200bmici care se leag\u0103 de proteine \u200b\u200b\u021bint\u0103, cu specificitate \u0219i afinitate ridicat\u0103. Tratamentele intravitreene cu abicipar au demonstrat o eficacitate similar\u0103 dup\u0103 6 sau 8 injec\u021bii, comparativ cu 13 injec\u021bii cu ranibizumab, \u00eenjum\u0103t\u0103\u021bind num\u0103rul injec\u021biilor intravitreene necesare pentru men\u021binerea vederii comparativ cu ranibizumab. Totu\u0219i, evenimente inflamatorii pegol-abicipar\/ranibizumab au fost 15% \/1%.<\/p>\n<p style=\"text-align: justify\">Studiile prospective \u0219i retrospective au demonstrat c\u0103 pacien\u021bii trata\u021bi mai rar tind s\u0103 piard\u0103 c\u00e2\u0219tigurile de vedere ini\u021biale ob\u021binute prin dozare fix\u0103 \u200b\u200b\u0219i, de obicei, mai frecvent\u0103.<\/p>\n<p style=\"text-align: justify\">Studiul eficacit\u0103\u021bii tratamentelor anti-VEGF continua, eforturile fiind i\u00eendreptate spre g\u0103sirea solu\u021biei terapeutice mai eficiente, mai rar de administrat \u0219i lipsita de reac\u021bii secundare.<\/p>\n<p style=\"text-align: justify\">\u00cen timp ce biomarkerii OCT consacra\u021bi, cum ar fi grosimea retinei, prezen\u021ba cicatricilor subretiniene \u0219i integritatea fotoreceptorilor r\u0103m\u00e2n importante, biomarkeri mai noi, ca localizarea fluidelor retiniene (intra \u0219i subretinian) ar permite medicului curant s\u0103 personalizeze tratamentele pentru fiecare pacient \u0219i boal\u0103 individual\u0103. \u00cen acest fel se poate asigura un control adecvat al bolii, pentru a minimiza recuren\u021ba, daunele neurosenzoriale \u0219i pentru a limita num\u0103rul de interven\u021bii invazive \u0219i costisitoare. Mai mult dec\u00e2t at\u00e2t, biomarkeri care permit anticiparea evolu\u021biei bolii pot reduce poten\u021bial sarcina de monitorizare.<\/p>\n<p style=\"text-align: justify\">Bibliografie:<\/p>\n<p>1. Understanding Treatment Durability in nAMD, Pravin U. Dugel, MD; Carl Regillo, MD;<\/p>\n<p>2. Insights Into Neovascular Age-Related Macular Degeneration Treatment, Rishi P. Singh, MD, Cole Eye Institute, Cleveland Clinic;<\/p>\n<p>3. Study finds no link between anti-VEGF injections and cardiac events, Allen Chiang MDAmerican Academy of Ophthalmology.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u00a0 Autor: Georgeta MERCUT, medic primar oftalmolog, doctor \u00een \u0219tiin\u021be medicale Centrul Medical Irina, Craiova &nbsp; Degenerescen\u0163a macular\u0103 neovascular\u0103, legat\u0103 de v\u00e2rst\u0103 este principala cauz\u0103 a pierderii severe a vederii [&hellip;]<\/p>\n","protected":false},"author":9,"featured_media":9378,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[33,78],"tags":[],"class_list":["post-9377","post","type-post","status-publish","format-standard","has-post-thumbnail","category-articole","category-oftalmologie"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.0 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Degenerescen\u021ba macular\u0103 exsudativ\u0103 - provoc\u0103ri terapeutice<\/title>\n<meta name=\"description\" content=\"Degenerescen\u021ba macular\u0103 exsudativ\u0103 - provoc\u0103ri terapeutice\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/jurmed.ro\/medici\/degenerescenta-maculara-exsudativa-provocari-terapeutice\/\" \/>\n<meta property=\"og:locale\" content=\"ro_RO\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Degenerescen\u021ba macular\u0103 exsudativ\u0103 - provoc\u0103ri terapeutice\" \/>\n<meta property=\"og:description\" content=\"Degenerescen\u021ba macular\u0103 exsudativ\u0103 - provoc\u0103ri terapeutice\" \/>\n<meta property=\"og:url\" content=\"https:\/\/jurmed.ro\/medici\/degenerescenta-maculara-exsudativa-provocari-terapeutice\/\" \/>\n<meta property=\"og:site_name\" content=\"Jurmed - Medici\" \/>\n<meta property=\"article:published_time\" content=\"2019-10-24T08:11:04+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2019\/10\/Dr-Mercut-1.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"630\" \/>\n\t<meta property=\"og:image:height\" content=\"470\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Alina\" \/>\n<meta name=\"twitter:label1\" content=\"Scris de\" \/>\n\t<meta name=\"twitter:data1\" content=\"Alina\" \/>\n\t<meta name=\"twitter:label2\" content=\"Timp estimat pentru citire\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\/\/jurmed.ro\/medici\/degenerescenta-maculara-exsudativa-provocari-terapeutice\/#article\",\"isPartOf\":{\"@id\":\"https:\/\/jurmed.ro\/medici\/degenerescenta-maculara-exsudativa-provocari-terapeutice\/\"},\"author\":{\"name\":\"Alina\",\"@id\":\"https:\/\/jurmed.ro\/medici\/#\/schema\/person\/1203ddfc75cb6a85fecd32186ee55582\"},\"headline\":\"Degenerescen\u021ba macular\u0103 exsudativ\u0103 &#8211; 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