Wet Macular Degeneration

History
Mrs. Smith is a 75 year old female with a history of Macular Degeneration. She developed progressive decline in vision in the left eye.

Ocular Medications
Ocuvite Preservision: High dose vitamin supplements

Examination
Visual acuity of 20/25 in the right eye and 20/70 in the left.
Moderate cataracts are present in both eyes.
Macula exam: drusen in the right eye
Drusen with sub retinal fluid in the left eye, no lipid or blood is present.

Fluorescein Angiography
Irregular and stippled leakage of dye in left eye consistent with an occult subfoveal choroidal neovascular membrane.



Leakage of dye in late image (increased intensity and fuzziness of white area centrally) is typical of occult wet AMD.

Diagnosis
“Wet” Age Related Macular Degeneration with occult subfoveal choroidal neovascular membrane of the left eye. Secondary progressive decline in vision.

Treatment Options
1. Observation
2. Photodynamic Therapy with Visudyne
3. Photodynamic Therapy with Visudyne and intravitreal Kenalog injection
4. Avastin or Lucentis injections

Patient's Decision
Intravitreal Kenalog followed by PDT

Clinical Course
Following a single session of combination treatment, the fluid resolved and the vision improved to 20/40. The angiogram demonstrates a decrease in leakage.



Compare to Image 1, leakage resolved.
There is a progression of cataract in the left eye which may require removal soon.

Conclusion
Photodynamic Therapy combined with intravitreal Kenalog may cause regression of Wet Macular Degeneration and subsequent stability or improvement in vision. This combination therapy is being used more frequently by Retinal Surgeons to treat Wet Macular Degeneration.

AREDS vitamin supplements may decrease the risk for the development of Wet AMD in the right eye.