Pembuluh Darah Koroid Bengkak

Penglihatan kawasan tengah menjadi kabur sama ada secara berperingkat atau dengan tiba-tiba adalah gejala bagi penyakit mata dipanggil kemerosotan makular berkaitan usia (AMD).

Penghidap AMD akan mendapati satu bintik hitam di tengah pandangan dan perlu melirik bola mata ke tepi untuk melihat. Malah, jarak pandangan penghidap AMD menjadi kabur, objek warna kurang jelas, sukar melihat dalam cahaya kelam dan pandangan kedua-dua belah mata tidak sama. Masalah AMD yang juga gangguan pada retina mata ini menyebabkan penghidapnya sukar untuk memandu, mengenali wajah, membaca dan perkara lain yang memerlukan pandangan teliti.

AMD terbahagi kepada kering dan basah. Kebanyakan orang mengalami AMD kering disebabkan penuaan dan penipisan tisu makula. Kemerosotan makular bermula apabila protein lemak dipanggil drusen terbentuk di bawah retina menyebabkan makula menjadi tipis dan fungsinya terjejas sehingga penglihatan lambat-laun menjadi buta.

Bagi AMD basah, ia menyebabkan kerosakan penglihatan kawasan tengah lebih teruk apabila saluran darah tidak normal mula terbentuk di bawah retina sebelum ia bocor dan mengeluarkan darah atau cecair.

Darah atau cecair itu kemudian mengganggu penglihatan kawasan tengah dan risiko buta menjadi pantas serta lebih cepat disedari. Pertumbuhan saluran darah tidak normal boleh berlaku pada sebelah mata atau kedua-dua belah mata.

Perunding Kanan Pakar Oftalmologi Pusat Mata Kebangsaan Singapura, Profesor Dr Gemmy Cheung berkata, AMD basah adalah jenis kemerosotan makular paling teruk dan boleh menjurus kepada kehilangan penglihatan dengan pantas, progresif dan kekal dalam tempoh sekurang-kurangnya tiga bulan jika dibiarkan tanpa rawatan.

“AMD basah menyebabkan kebutaan kepada tiga juta penduduk dunia dan di Asia Pasifik bilangan penghidap penyakit mata ini dianggarkan melonjak daripada tujuh juta penduduk pada 2010 kepada 17 juta penduduk pada 2040.

“Ia berlaku disebabkan pengeluaran protein yang menggalakkan pertumbuhan saluran darah baharu atau dikenali ‘vascular endothelial growth factor’ (VEGF) yang berlebihan sehingga mencetuskan pembentukan saluran darah tidak normal di bawah retina.

“Saluran darah yang tidak normal ini mempunyai membran yang tipis dan mudah pecah serta mengeluarkan darah, lipid dan cecair menyebabkan makula membengkak. “Bengkak yang tidak dirawat mengakibatkan parut dan merosakkan retina yang kemudian membawa masalah lebih buruk iaitu kehilangan penglihatan dan buta,” katanya.

Beliau berkata demikian pada sesi pembentangan kajian keberkesanan rawatan suntikan ke dalam mata antiVEGF menggunakan ubat aflibercept, EYLEA, kepada penghidap AMD basah yang mempunyai pembuluh darah koroid membengkak atau ‘polypoidal choroidal vasculopathy’ (PCV).

EYLEA dibangunkan bersama syarikat biofarmaseutikal, Regeneron Pharmaceuticals, Inc dan syarikat farmaseutikal, Bayer, untuk rawatan kemerosotan makular basah.

Keberkesanan EYLEA sebagai rawatan tunggal (monoterapi) kepada penghidap AMD basah dengan PCV berdasarkan keputusan daripada program percubaan klinikal berfasa dikenali sebagai, Planet, dan dibentangkan sempena Kongres Persatuan Vitreo Retina Asia Pasifik (APVRS) Ke-10, baru-baru ini.

Mengenai PCV, Dr Gemmy berkata, gangguan pada retina itu dicirikan oleh bengkak atau polip pada hujung saluran darah yang tidak normal di belakang mata dan imej struktur saluran darah itu didiagnosis menggunakan angiografi indocyanine hijau (ICGA).

“Alat ICGA berupaya menunjukkan cabangan pembuluh darah koroid yang berpolip apabila ia muncul dalam imej pendafluor tinggi. Polip yang berkembang seperti bunga kobis jika tidak dirawat akan menyebabkan pendarahan pada retina, bengkak, parut pada retina dan hilang penglihatan.

“Penghidap PCV juga akan melihat tompok-tompok hitam di kawasan tengah penglihatan yang boleh membesar sedikit demi sedikit, manakala mereka nampak garisan lurus bergelombang atau membengkok.

“PCV lebih banyak berlaku dalam kalangan mereka yang berusia antara 50 dan 65 tahun. Namun, banyak faktor lain menyebabkan PCV seperti sejarah keluarga, tabiat merokok, menghidap penyakit lain seperti darah tinggi, diabetes dan arteri koronari.

“Dalam kalangan populasi Asia pula lebih ramai lelaki didiagnosis dengan PCV. Malah, didapati penduduk Jepun mempunyai risiko menghidap PCV antara 23 hingga 55 peratus, penduduk Taiwan (49 peratus), penduduk Korea dan China (22 hingga 25 peratus), manakala orang Kaukasia pula antara lapan hingga 13 peratus,” katanya.

Selain suntikan antiVEGF, Dr Gemmy berkata, PCV turut dirawat menggunakan kaedah laser haba terapi fotodinamik (PDT) yang disasarkan untuk memusnahkan saluran darah tidak normal, mengelakkan kebocoran atau pendarahan dan mencegah pembentukan semula saluran darah tidak normal itu.

“Bagaimanapun, penggunaan PDT terbatas apabila ia memerlukan peralatan dan latihan khas yang tidak dimiliki semua klinik atau hospital. Malah, prosesnya juga mengambil masa yang lama dan turut dikhuatiri memburukkan lagi kerosakan pada retina,” katanya.

Sementara itu, Ketua Bahagian Vitreo Retina, Jabatan Oftalmologi Hospital Saint Mary Seoul, Universiti Katolik Korea, Profesor Dr Won Ki Lee berkata, kajian Planet selama 52 minggu terhadap 333 penghidap PCV berusia lebih 50 tahun bagi menilai keberkesanan dan keselamatan penggunaan EYLEA secara monoterapi dalam kalangan penghidap PCV.

Dalam kajian ini turut membandingkan penggunaan EYLEA secara monoterapi dan kombinasi EYLEA bersama PDT. Hasil akhir pada minggu ke-52 kajian Planet mendapati perubahan min bagi ketajaman penglihatan diperbetulkan (BCVA) bagi peserta dalam kumpulan penggunaan EYLEA secara monoterapi menunjukkan peningkatan dibandingkan kombinasi EYLEA bersama PDT.

“Hasil kajian Planet ini mengesahkan apa yang kami jangka dalam amalan klinikal bahawa ubat aflibercept ini menawarkan manfaat anatomi dan penglihatan yang lebih jelas dalam kalangan penghidap PCV. Malah, penggunaan EYLEA secara monoterapi juga menandakan ia boleh menjadi pilihan rawatan utama kepada mereka yang mempunyai penglihatan terjejas akibat PCV.

“Kajian ini juga mendapati tiada polip yang aktif dikesan dalam 81.7 peratus peserta yang menerima suntikan ubat aflibercept secara monoterapi dan polip tersingkir sepenuhnya diperhatikan dalam 38.9 peratus peserta kumpulan yang sama.

“Penghidap AMD basah dalam kalangan populasi Asia didapati cenderung mendapat PCV dan kajian terbaru Planet ini berupaya memberi manfaat kepada mereka mengenai kelebihan penggunaan EYLEA secara monoterapi berbanding rawatan PDT yang mengambil masa lama dan kemungkinan mendapat kesan sampingan,” katanya.

Katanya, peluang penghidap PCV menyelamatkan penglihatan kawasan tengah mereka adalah cerah jika ia dikesan dan dirawat lebih awal dengan ubat aflibercept berkenaan dengan kaedah monoterapi, malah dapat menyekat lebih banyak pertumbuhan polip.

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