Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow –...
-
Upload
jody-anthony -
Category
Documents
-
view
214 -
download
0
Transcript of Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow –...
![Page 1: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/1.jpg)
![Page 2: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/2.jpg)
Anti VEGF
![Page 3: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/3.jpg)
![Page 4: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/4.jpg)
![Page 5: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/5.jpg)
Options in the management of CNV
1)Observation occult CNV also requires close follow – up .every 3 month 2) Laser coagulation 3) Surgery 4) Triamcinolone 5) Anti angiogenic drugs (lucentice,Avastin)6) PDT & TTT7) Diet rich antioxidantswith severe AMD) .(217 cases)
![Page 6: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/6.jpg)
Used for:
1) Wet Macular degeneration
2) Diabetic retinopathy
3) Rubeosis iridis
4) CRVO
![Page 7: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/7.jpg)
VEGF and diabetic eye disease
1) Diabetic retinopathy remains the major cause of blindness in working – eye adults in the world.
![Page 8: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/8.jpg)
2) It appears to be different retinopathy phenotype and many eyes may remain with minimal retinopathy changes and good vision for an entire lifetime.
![Page 9: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/9.jpg)
Inhibition of the enzyme
PK- C (proteinkinas-c) (angiogenesis
factor) with ruboxistaurin represents
a particularly exciting therapeutic
approach it works at the early stages
of the diabetic retinal disease when
the disease is still reversible.
![Page 10: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/10.jpg)
![Page 11: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/11.jpg)
(Intravitreal) SteroidsHave been used with some success in advanced situations of chronic diffuse diabetic macular edema.
Are effective only in the short term and are associated with complications such as cataract and glaucoma.
![Page 12: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/12.jpg)
The combination of
intravitreal steroid with
laser therapy has been
shown is another
interesting alternative.
![Page 13: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/13.jpg)
VEGFAn increase in VEGF (vasoendothelial growth factor) has been repeatedly demonstrated in the vitreous of advanced case of diabetic retinopathy
![Page 14: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/14.jpg)
VEGF INHIBITORS 1) (Avastin) Bevacizumab.
2) (Macugen) or pegaptanib sodium.
3) (lucentis) or Ranibizumab
![Page 15: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/15.jpg)
Avastin costs less than 150 $
Per treatment compared with 2000$ per treatment for lucentis.
![Page 16: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/16.jpg)
![Page 17: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/17.jpg)
Anti-VEGFFreeman:
Anecdotaly the Anti _ VEGF drugs have proven.
Very useful in treating proliferative diabetic retinopathy.
![Page 18: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/18.jpg)
Anti-VEGF It is proven that is effective in wet macular degeneration and there is a growing consensus that this will be true in diabetes and retinal vascular disease.
![Page 19: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/19.jpg)
![Page 20: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/20.jpg)
Moderate NPDR with CSME
![Page 21: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/21.jpg)
![Page 22: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/22.jpg)
![Page 23: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/23.jpg)
![Page 24: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/24.jpg)
Rubeosis Iridis
![Page 25: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/25.jpg)
![Page 26: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/26.jpg)
![Page 27: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/27.jpg)
![Page 28: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/28.jpg)
![Page 29: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/29.jpg)
![Page 30: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/30.jpg)
BRVO
![Page 31: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/31.jpg)
![Page 32: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/32.jpg)
![Page 33: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/33.jpg)
Avastin or Lucentis
1) Reduce macular edema in diabetic pts.
2) Reduce or stop proliferative retinopathy
![Page 34: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/34.jpg)
The big problem with these drugs is that they have to be given on an on going basis
These drugs don't cure any thing.
They reduce VEGF
![Page 35: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/35.jpg)
![Page 36: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/36.jpg)
Anti VEGF
When the drug wears off the patients need injections every four to six weeks.
![Page 37: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/37.jpg)
ChallengeThe challenge is to deliver these drugs in away that would suppress VEGF chronically we don't know how to do this yet.
![Page 38: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/38.jpg)
Kenalog(Triamcinolone)
and anti- VEGF causes
actual vision
improvement.
![Page 39: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/39.jpg)
Laser + subtenon
injection of Kenalog
(steroid) stabilize the
vision.
![Page 40: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/40.jpg)
![Page 41: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/41.jpg)
Stabilize the vision
If you stabilize vision when patient is still at 20/30 that patient is going to do better than someone in whom the diagnosis is delayed and vision is worse.
![Page 42: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/42.jpg)
Laser problem
Loosing
peripheral and
night vision
![Page 43: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/43.jpg)
Avastine injections monthly
![Page 44: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/44.jpg)
Treated patients
1) Showed better visual acuity
2) Greater reductions in retinal thickness
3) Reduced need for PRP
4) Regression of Neovascularization
5) Microaneurysms and hemorrhage
improvement
![Page 45: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/45.jpg)
![Page 46: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/46.jpg)
Bevacizumab (Avastin) is in clinical trial for treatment of diabetic macular edema and retinopathy at centers in IRAN , Mexico & Venezuela
![Page 47: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/47.jpg)
Ruboxistaurin
![Page 48: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/48.jpg)
Ruboxistaurin is a drug that is administered in tablet form and also produced promising early results.
However, it is now uncertain whether Eli Lilly will
continue to develop the drug, following a recent FDA
decision mandatimy three years of additional clinical
trials.
![Page 49: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/49.jpg)
Remote diabetic retinopathy screening by:
1) Digital imaging
2) Non-mydriatic exams.
3) Internet
![Page 50: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/50.jpg)
![Page 51: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/51.jpg)
Genome-wide scan of native Americans suggests genetic loci for diabetic retinopathy
![Page 52: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/52.jpg)
![Page 53: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/53.jpg)
Macugen
in addition to PDT pegaptanib sodium injection ( macugen) is proven to preserve
visual acuity regardless of CNV ,type , lesion size or baseline visual acuity
![Page 54: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/54.jpg)
70% of 1186 patients who had 0.3mg of macugen every 6 weeks
lost fewer than 3 lines of vision on the eye chart compared with 55% of patients in the control group a
27% treatment benefit
![Page 55: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/55.jpg)
Ranibizumab ( Lucentis ) is another anti VEGF compound
that has recorded very positive initial results
![Page 56: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/56.jpg)
Ranibizumab
Approximately 95% of patients maintained or improved vision at one year compared to 62%
of those in the control. Control group demonstrated substantial
decrease in mean visual acuity from base line to 12 months
![Page 57: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/57.jpg)
New agents under investigation
1)Avastine ( bevacizumb)
2) Squalamine lactate
3) Aminosterol ( extracted from dogfish) shark
4) Tyrosine
5) Gene therapy
![Page 58: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/58.jpg)
We have increasing options for treatment of CNV but we have to bring all our clinical experience to bear in deciding what combination
of approaches will work best for our patients
![Page 59: Anti VEGF Options in the management of CNV 1)Observation occult CNV also requires close follow – up.every 3 month 2) Laser coagulation 3) Surgery.](https://reader038.fdocuments.net/reader038/viewer/2022110206/56649d055503460f949d9455/html5/thumbnails/59.jpg)