MUDr. Dana Maňasková


Vyhledávání na medicinman.cz
 

nemoci-sympt/OCNI/makularni-degenerace/terapie-zlepseni-podpurne

Aflibercept

  • The VEGF receptor decoy


Avastin

  • Humanized anti-VEGF monoclonal antibody
  • Clinical trials as
    • A treatment for several solid tumors
    • In the treatment of age-related macular degeneration.

Bevacizumab

  • Can regress retinal, iris and disc neovascularization.
  • Clinical trials are investigating the utility of anti-VEGF therapy in

Bevasiranib and AGN 211745

  • Small interfering RNA-based therapies


Carotenoids

Beta-carotene, lycopene, lutein and zeaxanthin

  • Beneficial effects of carotenoids - as antioxidants

Beta-Carotene

  • Ability to be converted to vitamin A
  • Trials with large doses of beta-carotene found an adverse effect on the incidence of lung cancer in smokers and workers exposed to asbestos.

Lutein and zeaxanthin

  • Absorb damaging blue light that enters the eye
  • Fruits and vegetables,
  • Egg yolk - highly bioavailable source of lutein and zeaxanthin

Lycopene



Fotokoagulace

  • Disappearance of drusen spontaneously
  • And in areas adjacent to laser photocoagulation scars
  • Photocoagulation-induced drusen regression
    • Might prevent patients with drusen from developing exudative maculopathy
  • Mechanism for spontaneous drusen regression


Glutamate, cysteine, and glycine



Glutathione (GSH) or its precursor amino acids

Cultured human retinal pigment epithelium (RPE)


Hloh

  • K léčbě srdečních onemocnění, ale má také vlastnosti, které mohou být prospěšné pro zdraví očí.
  • Studie prokázaly, že může pomoci zlepšit průtok krve v oku a chránit sítnici před poškozením.


Kurkuma

  • kurkumin, látku s protizánětlivými a antioxidačními vlastnostmi.
  • Studie prokázaly, že kurkumin může pomoci zpomalit progresi makulární degenerace.


Lutein, zeaxanthin, meso-zeaxanthin

  • Predominant carotenoids of the macular pigment

Lutein and zeaxanthin

  • Often referred to as xanthophylls or macular pigment.
  • 5x higher content of these carotenoids in the macula
    • Compared with the peripheral retina
  • Macaque monkeys
    • Have foveal cone types like the human retina
    • More zeaxanthin than lutein in the foveal centre
  • In the periphery zeaxanthin declines more rapidly than lutein, so that lutein becomes dominant.
  • Correlation between macular pigment density and iris colour
    • Correlation between dietary carotenoid intake and macular pigment density

Case Control Study Group for Eye Diseases


Melatonin

  • Pomáhá regulovat spánek. Může také pomoci chránit sítnici před poškozením.

Ovesné vločky

  • Obsahují beta-glukany, které mohou pomoci snížit zánět a zlepšit průtok krve v oku.

Pegaptanib

  • RNA aptamer pegaptanib
  • Anti-VEGF agent able to prevent vision loss in neovascular age related macular degeneration


Pigment epithelium-derived factor-based therapies

Nicotinic acetylcholine receptor antagonists

Integrin antagonists

Sirolimus


Ranibizumab, bevacizumab x photodynamic therapy

  • Partial and full-length antibodies
  • Hazard of mortality was significantly lower with ranibizumab therapy than with photodynamic therapy
    • Hazard ratio, 0.85; 99% confidence interval, 0.75-0.95
  • Pegaptanib use (0.84; 0.74-0.95)
  • Hazard of myocardial infarction
    • Significantly lower with ranibizumab use than with photodynamic therapy
      • (0.73; 0.58-0.92)
  • no significant differences in the hazard of mortality or myocardial infarction
    • Between bevacizumab use and the other therapies
  • no statistically significant relationship between treatment group and bleeding events or stroke.
  • www.ncbi.nlm.nih.gov/pubmed/20937996

Ranibizumab

  • Anti-VEGF Antibody
  • Prevented moderate vision loss in neovascular age related macular degeneration
  • Substantial proportion of patients regained vision.
  • Gold standard in the US for the treatment of neovascular AMD
    • Binding and inhibition of all isoforms of VEGF.
    • Impressive outcomes, but treatment with ranibizumab requires sustained treatment regimens and frequent intravitreal injections.
  • www.ncbi.nlm.nih.gov/pubmed/18484796



SB203580, U0126, inhibitors of MAP kinases

  • VEGF mRNA levels and protein secretion induced by TGF-beta
    • Were significantly inhibited by


Oční světlík (Euphrasia officinalis)

  • Po staletí k léčbě očních onemocnění.
  • Může pomoci zmírnit zánět a podráždění očí.


TGF-beta receptor type II antibody

  • Significantly reversed induction of VEGF secretion by TGF-beta

Tyrosine kinase inhibitors



Combined UV and blue-light filtering

  • Attenuated light-induced cell damage significantly
    • More than UV filtering alone
    • Significant time-dependent decrease in Bcl-2
    • Increase in Bax and VEGF-alpha that were significantly less with the tinted IOL than with the untinted IOL.
    • www.ncbi.nlm.nih.gov/pubmed/19185255

V případě operace pro šedý zákal chtít čočku s filtry na UV a modré světlo




VEGF Trap is a receptor decoy



Zinek

  • Důležitý pro zdraví očí a může pomoci zpomalit progresi makulární degenerace.


Antioxidant index = ascorbic acid, alpha tocopherol, beta carotene

  • High plasma alpha tocopherol - and ARMD
  • Correlation between ARMD and an antioxidant index

Blue light-filtering intraocular lens

  • Cytoprotective effects on human retinal pigment epithelium
  • By reducing phototoxic effects on vascular endothelial growth factor-alpha, Bax, and Bcl-2 expression.

Borůvka (Vaccinium myrtillus)

  • Obsahují antokyany, které mohou pomoci zlepšit noční vidění a chránit sítnici před poškozením.

Zvýšená cirkulace v n.II. a antiox. kapacita

  • Potencionální zlepšení deg. onem. oka - AMD, katrakty i glaukomu.
  • Nutrition and the Eye, Basic and clinical research, Albert J. Augustin, vyd. Krager

Podobné postupy jako u diabetické retinopatie



Dieta s redukcí cukru



Egg yolk and maize (corn)

  • Contained the highest mole percentage (% of total) of lutein and zeaxanthin
    • More than 85% of the total carotenoids

Maize

  • Was the vegetable with the highest quantity of lutein (60% of total)

Orange pepper

  • Vegetable with the highest amount of zeaxanthin (37% of total)

Kiwi fruit, grapes, spinach, orange juice, zucchini (or vegetable marrow), and different kinds of squash

  • Substantial amounts of lutein and zeaxanthin (30-50%)
  • There are fruits and vegetables of various colours with a relatively high content of lutein and zeaxanthin.

Most of the dark green leafy vegetables

  • Previously recommended for a higher intake of lutein and zeaxanthin
    • Have 15-47% of lutein
    • But a very low content (0-3%) of zeaxanthin

Fruits and vegetables of various colours


Eggs

  • Higher intake of cholesterol through the addition of more eggs in the diet
    • Results in an increase of serum cholestero
    • An increase of HDL cholesterol
  • Since HDL cholesterol is protective against atherosclerosis
    • Extra egg consumption may not change the risk index for ischaemic heart disease based on the cholesterol levels
  • Consumption of eggs could be beneficial in order to obtain a higher intake of lutein and zeaxanthin
    • Has no severe adverse effects on cardiac risk.
  • Evidence for conversion between lutein and zeaxanthin through several oxidation intermediates
    • Intake of lutein can also raise macular levels of zeaxanthin.
  • www.ncbi.nlm.nih.gov/pmc/articles/PMC1722697/pdf/v082p00907.pdf


HDL-raising allele of the LIPC gene (T)


HDL - lutein and zeaxanthin

  • Low density lipoproteins (LDL) carries most of the total carotenoids in plasma
  • Individual carotenoids are not uniformly distributed among lipoproteins
  • 67% of beta carotene was found in LDL
  • 53% of lutein and zeaxanthin was found in high density lipoproteins (HDL)
  • Might be possible that the retina is able to use this preselection of carotenoids
    • By the lipoproteins to accumulate lutein and zeaxanthin from the plasma carotenoids

Lutein

  • In many fruits and vegetables

Zeaxanthin

  • Only in a small number of fruits and vegetables, and in eggs .

Maize

  • 85 mole% of the carotenoids are lutein and zeaxanthin

Most dark green vegetables

  • Scallions, green lettuce, celery, spinach, and Brussels sprouts, only traces of zeaxanthin were found

Orange pepper


Látky blokující novotvorbu cév




Inhibition of the tyrosine kinase cascade

  • Downstream from the VEGF receptor

Vatalanib, TG100801, pazopanib, AG013958 and AL39324



Inhibition of vascular endothelial growth factor

  • Main target of current antiangiogenic treatment in AMD


Liposolubilní kurkumin

  • Blokátor VEGF2, antioxidant

Pravidlené preventivní kontroly očním lékařem

  • V případě nálezu se lékaře cíleně tázat na možnosti terapie blokátory VEGF
    • Ev. zařídit konzultaci na specializovaném pracovišti přímo na terapii makulární degenerace, kde je možno v případě potřeby možno zahájit nitrooční aplikaci účinných látek

Small interfering RNA technology-based therapies



Stav s nezvýšeným LDL a celkovým cholestrolem

  • Tedy stav bez inzulínové rezistence a bez zánětu

Omega-3 mastné kyseliny

  • Kyselina eikosapentaenová (EPA) a kyselina dokosahexaenová (DHA)
  • V tučných rybách, jako je losos, sardinky a makrela
  • Silné protizánětlivé účinky a mohou pomoci snížit riziko vzniku makulární degenerace.
  • Several studies have shown that omega-3 fatty acids can help reduce the risk of age-related macular degeneration (AMD)

A study published in the Journal of the American Medical Association (JAMA) in 2001

  • People who ate fish at least twice a week
  • Were less likely to develop AMD than those who did not eat fish
  • tuk-zbytecnost-nebo-nezbytnost">www.crossfitpardubice.cz/blog/rybi-tuk-zbytecnost-nebo-nezbytnost

A study published in the Archives of Ophthalmology in 2006

A meta-analysis of 17 studies published in the British Journal of Ophthalmology in 2011


Vitamin C

  • Silný antioxidant
  • V citrusových plodech, jahodách a zelených listových zeleninách
  • Může pomoci chránit sítnici před poškozením volnými radikály.

Vitamin E

  • V rostlinných olejích, ořeších a semínkách.
  • Může také pomoci chránit sítnici před poškozením volnými radikály.

Zinek

  • Důležitý pro zdraví očí.
  • Může pomoci chránit sítnici před poškozením a může také pomoci zlepšit zrak.


Any kind of nuts

  • Reduces ARMD risk

Pigment epithelial factor, angiostatin, endostatin

  • Inhibits VEGF

Intake of the fish products

  • At least twice a week
  • Reduces ARMD risk

Prevence noční hypoxie

  • Vyšetření ve spánkové laboratoři
    • Při zcáyhtu C-pap

Nošení kvalitních brýlí s UV filtrem

  • Při příliš slunném počasí, na horách


O úroveň výše

Poslední aktualizace: 1. 2. 2024 0:38:03