PATHOGENETICALLY DIRECTED METHOD OF PREVENTION AND TREATMENT OF AGE-MACULAR DEGENERATION

Abstract

Background. Age-related macular degeneration is one of the most common causes of blindness in developed countries, especially in people over 60 years old. The incidence of AMD is projected to increase to 288 million in 2040 compared to 196 million in 2020. Cardiovascular factors, smoking, alcohol consumption, overweight, genetic factors, and metabolic disorders are risk factors for the development of AMD. There are disorders of lipid metabolism, as well as hyperreactivity of platelet purine receptors may be associated with the progression of AMD. The AREDS2 formula is currently used to treat AMD. New therapeutic strategies aimed to correct metabolic disorders are needed to decrease the development of the late stages of AMD. Aim: to investigate the effectiveness of improving pathogenetically directed method of prevention and treatment of age-related macular degeneration. Materials and methods. We observed 40 patients (80 eyes), aged 50-85 years, with AMD of category 3 (intermediate AMD), who were divided into 2 groups. The main group included 20 patients (40 eyes), 14 women and 6 men, who have prescribed a complex drug according to the standard AREDS2 scheme, as well as fenofibrate (200 mg) and clopidogrel bisulfate (75 mg). The control group included 20 patients (40 eyes), 13 women and 7 men. These patients received AREDS2 standard treatment. Progression was evaluated according to the results of OCT of the macular area according to the AREDS classification and control of corrected visual acuity (CVA). The observation period was 2 years. Results. No signs of progression were noted in patients of both observation groups within 6 months from the start of the prescribed therapy. In the patients of the control group, the progression of the disease was recorded after 1 year of observation according to both defined criteria. Changes in OCT were observed in 7,5% of patients in the control group, and a decrease in CVA- in 5%. In the patients of the main group who used the extended therapeutic regimen, after 1 year of follow-up, progression according to OCT signs was noted in 2,5% of cases, but there was no worsening of CVA. After 2 years of observation, signs of progression according to OST were recorded in the main group by 50% less than in the control group. According to CVA, disease progression was detected in 15% of the main group and 30% of the control group. Conclusions. This study complemented already existing therapeutic strategies for the preventive treatment of AMD.