YAŞ İLİŞKİLİ MAKULAR DEJENERASYON (YİMD) ( AMD)

Tanım: Makulanın etkilenmesi sonucunda ilerleyen merkezi görme kaybına neden olan bir durumdur. 

Gerekçe:Reoferez kullanılmasının arkasındaki mantık YİMD gelişimine eşlik eden risk faktörlerinin (fibrinojen, LDL, fibronektin, vWF gibi yüksek moleküler ağırlıklı moleküllerin) hasta plazmasından uzaklaştırılmasıdır. Bu durum netice olarak kan vizkozitesinin ve trombosit agregasyonunun azalması ve eritrosit membran esnekliğinin artması ile sonuçlanır. Bu da retinal pigment epitelinin perfüzyonunu iyileştirir, hipoksiyi azaltır ve retinal pigment epiteli iĢlevinin iyileşmesine olanak tanır 

İşlem: Reoferez 

İşlenen Volüm: 0.8-1.2 TPH 

Sıklığı: Haftada 1 veya 2 kez 

Replasman Sıvısı: Gerektiğinde Albumin, TDP, HES 

Uygulama sayı ve/veya süresi: 8-21 haftalık süreçte haftada 2 işlem olacak şekilde 8-10 iĢlem veya ilk hafta 2 işlem akabindeki 8 hafta boyunca haftada 1 işlem olacak şekilde toplam 10 işlem 

YARARLANILAN LİTERATÜRLER

*Brunner R, Widder RA, Fischer RA, Walter P, Bartz-Schmidt KU, Heimann K, Borberg H. Clinical efficacy of haemorheological treatment using plasma exchange, selective adsorption ULUSAL TERAPÖTĠK AFEREZ REHBERĠ __________________________________________________________________________________ 140 

and membrane differential filtration in maculopathy, retinal vein occlusion and uveal effusion syndrome. Transfus Sci 1996;17:493–498. 

*Brunner R, Widder RA, Walter P, Borberg H, Oette K. Change in hemorrheological and biochemical parameters following membrane differential filtration. Int J Artif Organs 1995;18:794–798. 

*Brunner R, Widder RA, Walter P, Luke C, Godehardt E, Bartz-Schmidt KU, Heimann K, Borberg H. Influence of membrane differential filtration on the natural course of age-related macular degeneration: a randomized trial. Retina (Philadelphia, PA) 2000;20:483–491. 

*Fell A, Wahls W, Fassbender C, Klingel R, Engelmann K. Effect of rheopheresis on visual function in patients with early age-related macular degeneration. Invest Ophthalmol Vis Sci 2000;41:S181. 

*Fell AJ, Engelmann K, Richard G, Fassbender C, Wahls W, Klingel R. Rheophoresis. A systematic approach to therapy of age-related macular degeneration (AMD)? Ophthalmologe 2002;99:780–784. 

*Klingel R, Fassbender C, Fassbender T, Gohlen B. Clinical studies to implement Rheopheresis for age-related macular 

degeneration guided by evidence-based-medicine. Transfus Apher Sci 2003;29:71–84. 

*Luke C, Widder RA, Walter P, Brunner R, Kirchhof B, Borberg H. The effect of membrane differential filtration on the colloid osmotic pressure in patients with age-related macular degeneration: significance to visual function? Ther Apher Dial 2003;7:263–268. 

*Koss MJ, Kurz P, Tsobanelis T, Lehmacher W, Fassbender C, Klingel R, Koch FH. Prospective, randomized, controlled clinical study evaluating the efficacy of Rheopheresis for dry age-related macular degeneration. Dry AMD treatment with Rheopheresis Trial-ART. Graefes Arch Clin Exp Ophthalmol 2009;247:1297–1306. ULUSAL TERAPÖTĠK AFEREZ REHBERĠ __________________________________________________________________________________ 141 

*Pulido J, Sanders D, Winters JL, Klingel R. Clinical outcomes and mechanism of action for rheopheresis treatment of agerelated macular degeneration (AMD). J Clin Apher 2005;20:185–194. 

*Pulido JS. Multicenter prospective, randomized, doublemasked, placebo-controlled study of Rheopheresis to treat nonexudative age-related macular degeneration: interim analysis. Trans Am Ophthalmol Soc 2002;100:85–106; discussion 106–107. 

*Pulido JS, Winters JL, Boyer D. Preliminary analysis of the final multicenter investigation of rheopheresis for age related macular degeneration (AMD) trial (MIRA-1) results. Trans Am Ophthalmol Soc 2006;104:221–231. 

*Soudavar F, Widder RA, Brunner R, Walter P, Bartz-Schmidt KU, Borberg H, Heimann K. Changes of retinal haemodynamics after elimination of high molecular weight proteins and lipids in patients with age-related macular degeneration (AMD). Invest Ophthalmol Vis Sci 1998;39:S386. 

*Swartz M, Rabetoy G. Treatment of non-exudative age-related macular degeneration using membrane differential filtration apheresis. Invest Ophthalmol Vis Sci 1999;40:S319. 

*Widder RA, Farvili E, Reis RGJ, Luke C, Walter P, Kirchhof B, Borberg H, Brunner R. The treatment of age-related macular degeneration (ARMD) with extracorporeal treatment procedures. Invest Ophthalmol Vis Sci 2002;43:2906. 

*Widder RA, Luke C, Walter P. Long-term treatment of agerelated macular degeneration with extracorporeal apheresis. Ophthalmologe 2000;97:S172.