ABSTRACT
Age-related macular degeneration (AMD) is referred to as the leading cause of irreversible visual loss in developed countries, with a profound effect on the quality of life. The neovascular form of AMD is characterized by the formation of subretinal choroidal neovascularization, leading to sudden and severe visual loss. Research has identified the vascular endothelial growth factor (VEGF) as an important pathophysiological component in neovascular AMD and its intraocular inhibition as one of the most efficient therapies in medicine. The introduction of anti-VEGF as a standard treatment in wet AMD has led to a great improvement in the prognosis of patients, allowing recovery and maintenance of visual function in the vast majority of cases. However, the therapeutic benefit is accompanied by a difficulty in maintaining the treatment schedule due to the increase in the amount of patients, stress of monthly assessments, as well as the associated economic burden. Therefore, treatment strategies have evolved from fixed monthly dosing, to individualized regimens, aiming for comparable results, with fewer injections. One such protocol is called "pro re nata", or "treat and observe". Patients are given a loading dose of 3 monthly injections, followed by an as-needed decision to treat, based on the worsening of visual acuity, clinical evidence of the disease activity on fundoscopy, or OCT evidence of retinal thickening in the presence of intra or subretinal fluid. A different regimen is called "treat and extend", in which the interval between injections is gradually increased, once the disease stabilization is achieved. This paper aims to review the currently available anti-VEGF agents--bevacizumab, ranibizumab, aflibercept, and the aforementioned treatment strategies.
Subject(s)
Angiogenesis Inhibitors/therapeutic use , Bevacizumab/therapeutic use , Ranibizumab/therapeutic use , Receptors, Vascular Endothelial Growth Factor/therapeutic use , Recombinant Fusion Proteins/therapeutic use , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Wet Macular Degeneration/drug therapy , Humans , Quality of Life , Visual AcuityABSTRACT
We present the case of a 42-year-old female who presented to our clinic for phosphenes in the left eye, occurring along with eye movement. A diagnosis of choroidal melanoma suspect was made. Due to the patient's profile, young, active woman, surgeon, and the limited therapeutic options in Romania, a conservative treatment and brachytherapy were chosen, which were successfully performed abroad. The patient has been followed-up, so far, for five years after the procedure, with spectacular results.
Subject(s)
Brachytherapy , Choroid Neoplasms/radiotherapy , Melanoma/radiotherapy , Ruthenium Radioisotopes/therapeutic use , Adult , Choroid Neoplasms/diagnostic imaging , Choroid Neoplasms/pathology , Conservative Treatment , Female , Fluorescein Angiography , Humans , Melanoma/diagnostic imaging , Melanoma/pathology , Tomography, Optical Coherence , Visual Acuity , Visual FieldsABSTRACT
PURPOSE: to show how we diagnosed and treated a rarer form of angle-closure glaucoma; the pathogenic mechanism was angle crowding through thick peripheral iris roll. METHODS: we show the investigations: biomicroscopy of the fundus, tonometry, pachymetry, gonioscopy, perimetry, ultrasound biomicroscopy, optical coherence tomography of the anterior segment--that helped us to diagnose the angle-closure glaucoma and its pathogenic mechanism; we also show our choice for surgery--lens extraction--and our arguments for this choice. RESULTS: first postoperative day--intraocular pressure was 14 mmHg; a week postoperatively--intraocular pressure was 13 mmHg; three months postoperatively--intraocular pressure was 13 mmHg. CONCLUSIONS: lens extraction may be a very good choice in several forms of angle-closure glaucoma.
