[Alternative therapies for choroidal neovessels resulting from age-related macular degeneration]

Classic neovessels (CNVs) identified on fluorescein angiography may benefit from thermal laser photocoagulation when sparing the fovea. If they extend into it, photodynamic therapy may halt the natural progression to a central scotoma. Occult CNVs, when subfoveal, may benefit from photodynamic therapy when isolated (not associated with classic CNV or with a pigment epithelium detachment). A number of therapeutic approaches are being evaluated in order to diversify the therapeutic choices available for treatment of CNVs. Transpupillary thermotherapy, which causes a limited increase in retinal temperature, could produce a sclerosis of occult isolated CNV. This approach has shown interesting results in pilot studies but also carries a risk for iatrogenic effects. The American randomized clinical trial currently under way will provide an evaluation of this treatment. An antiangiogenic therapy currently in progress is studying anecortave acetate and another is investigating anti-VEGF compounds. Anecortave acetate, which demonstrated its angiostatic activity in experimental models as well as in a phase II study, is now in a worldwide randomized clinical trial. The anti-VEGF molecules (antibodies and oligonucleotides) have shown very interesting preliminary results and are being evaluated in a large number of patients. Finally, a preventive therapy consisting of oral supplementation with antioxidants (vitamins C, E, and A) and zinc is a major step forward, providing the possibility of a real and effective prevention of the complications of age-related maculopathy.