(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy)
Abstract: This patient is a 66-year-old male. 1 month ago, he began to have bilateral blurred vision, more severe in the right eye than in the left eye, with visual distortion and bending in the right eye, along with dark shadows in front of his eyes, which could not be relieved after resting to the clinic. After fundus examination and fluorescence angiography, he was diagnosed with age-related macular degeneration in both eyes. Intralesional injection of anti-VEGF (vascular endothelial growth factor) was given. After treatment, the symptoms gradually resolved.
Basic information】Male, 66 years old
Disease Type】Age-related macular degeneration
Hospital】The First Hospital of Harbin Medical University
Date of consultation】November 2021
【Treatment plan】Intraspheric injection of anti-VEGF (vascular endothelial growth factor) treatment
Treatment Period】6 months of outpatient treatment
Effectiveness of treatment] Gradual relief of symptoms
I. Initial consultation
Patient’s description: 1 month ago, he began to have double vision, the right eye was more severe than the left eye, the right eye had straight line bending phenomenon, and there was a fixed black shadow in front of the eyes, which could not be relieved after rest, so he came to our hospital. He had a history of smoking for 40 years, did not drink much alcohol in general, and was obese. Physical examination: right eye visual acuity 0.1, left eye visual acuity 0.2. Funduscopic examination: hemorrhage and exudation in the macula of both eyes. Fluorescence angiogram: lamellar strong fluorescence was seen in the retinal macula of both eyes, with late fluorescence leakage and lamellar hemorrhage obscuring the fluorescence, and the preliminary diagnosis was age-related macular degeneration (wet) in both eyes.
(Fluorescence angiography)
II. Treatment history
In view of the patient’s usual smoking and obesity, we first told the patient that the etiology of vision loss was age-related macular degeneration, and that the primary treatment plan was intravitreal injection of anti-VEGF (vascular endothelial growth factor) therapy because of the association with age, smoking and obesity. Treatment strategy: 1 injection per month for the first 3 months, after which the macular lesion will be tested and if macular edema is present, intra-spherical anti-VEGF (vascular endothelial growth factor) will be injected again. After 3 injections of treatment, if macular edema appears again in the 6th month, then intra-spherical injection of anti-VEGF (vascular endothelial growth factor) treatment will be performed again.
III. Treatment effect
After 3 months of treatment, the patient’s visual acuity was 0.4 in the right eye and 0.5 in the left eye, and the distortion and darkening of vision disappeared. After 6 months, the patient’s visual acuity decreased again and the visual distortion was relieved; OCT examination showed interlaminar edema in the macula. Intraglobular injection of anti-VEGF (vascular endothelial growth factor) was again administered, and recovery was achieved after 3 days. In conclusion, through systematic and timely treatment, the patient’s symptoms of visual distortion and curvature improved significantly.
IV. Notes
We are glad that the patient’s symptoms improved after treatment, but since age-related macular degeneration is an age-related disease that can increase in incidence year by year with age and is one of the common blinding eye diseases in the elderly, the patient also needs to pay attention to the changes in vision after treatment and whether vision loss and bending of vision reappear. Once they appear, promptly seek medical attention, review the fundus and promptly administer anti-VEGF (vascular endothelial growth factor) therapy if any changes are found. In addition, daily attention needs to be paid to risk factors such as obesity, blood lipids and smoking, and appropriate exercise to reduce weight and enhance physical fitness. In life, pay attention to a light diet, avoid high-fat, high-sugar and high-salt diet, and need to quit smoking and alcohol.
V. Personal insight
By understanding the condition of the patient in this case, we learned that age-related macular degeneration is usually caused by hypoxia, oxidative stress and other factors that lead to macular lesions, which in turn cause changes such as retinal macular hemorrhage and retinal edema, and can cause blindness in severe cases. Because its risk factors include: high blood lipids, obesity, smoking, etc., good lifestyle habits can reduce the incidence of age-related macular degeneration. If risk factors such as blood lipids and obesity can be effectively controlled or the lesions can be detected early, the progression of the disease can be effectively controlled and the vision of patients with age-related macular degeneration lesions can be improved, thus improving the quality of life.