|LETTER TO EDITOR
|Year : 2001 | Volume
| Issue : 2 | Page : 141
Lalit Verma1, Taraprasad Das2
1 Dr.Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi - 110 029, India
2 L.V. Prasad Marg, Hyderabad - 500 034, India
Dr.Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Verma L, Das T. In reply. Indian J Ophthalmol 2001;49:141
| In reply|| |
We appreciate Dr Nagpal's comments.
Thermal photocoagulation and submacular surgery were the only available options in management of choroidal neovascular membrane (CNV) caused by age-related macular degeneration (AMD). Consequently the macular photocoagulation study (MPS) and the submacular surgery trial (SST) demonstrated the scope and limitation of these treatment modalities. With continuing research, several new and novel treatment modalities are now available for treatment of CNV in AMD.
Some of these options were discussed in the communication. The purpose of this article was to acquaint the readers with the well researched and published results of some of the treatment options. We emphasized the treatment modalities that have been tried by several groups of clinical researchers, or the results of randomized trials where available. This communication in itself was neither meant to be exhaustive nor all-inclusive. Currently many old studies such as thalidomide, submacular surgery, and radiation are still undergoing multicentric clinical trials. The new studies include use of diode laser (Transpupillary thermotherapy, and prophylactic diode laser treatment), micronutrients (beta-carotene), angiostatic agents (anacortave acetate) and a variety of photosensitizing dyes (Sn ET2 and Lutex). In addition, studies are underway to find new indications of verteporfin such as in ocular histo-plasmosis and occult CNV.
The initial results of Reichel et al are very promising. The British Study Group has reported similar results.We are also aware of one recent adverse report. At the initial stages of a study such diametrically opposite views are not surprising. The ongoing "transpupillary thermotherapy for choroidal neovascularization clinical trial" (TTT4CNV) could elaborate upon the scope and limitations of TTT.
The non-inclusion of TTT in our article was not intended to ignore this wonderful and less expensive modality of treatment of AMD-CNV. This was only a postponement of its discussion till the treatment and the outcome are rationalized.
| References|| |
Macula Photocoagulation Study Group. Argon laser photocoagulation for neovascular maculopathy. Three-year results from randomized clinical trials. Arch Ophtalmol
Malberg-Holekemp N, Thomas MA. The submacular surgery trials. In Clinical trials in Ophthalmology
, (editors) Kertes PJ, Conway MD. Philadelphia: Lipincott Williams & Wilkins; 1988. pp185-194
Verma L, Das T, Binder S, Heriot WJ, Kirchhof B, Venkatesh P et al. New approaches in the management of choroidal neovascular membrane in age-related macular degeneration. Indian J Ophthalmol
Reichel E, Berrocal AM, Ip M, Kroll AJ, Desai V, Puliafito CA. Transpupilary thermotherapy of occult subfoveal choroidal neovascularization in patients with age-related macular degeneration. Ophthalmology
Newsom RSB, McAlister JC, Saeed M, McHugh JDA. Transpupillary thermotherapy for the treatment of choroidal neovascularization. Br J Ophthalmol
Sanders JB, Cummings H, McMillan T, Googe J, Gunn J, Miller J et al. Treatment of predominantly occult subfoveal choroidal neovascularization secondary to age-related macular degeneration with transpupillary thermotherapy. Invest Ophthalmol Vis Sci (abstract) 2001;42:s 513