Anti vegf in atypical indications (2)

1,039 views

Published on

Published in: Health & Medicine
0 Comments
7 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,039
On SlideShare
0
From Embeds
0
Number of Embeds
4
Actions
Shares
0
Downloads
0
Comments
0
Likes
7
Embeds 0
No embeds

No notes for slide

Anti vegf in atypical indications (2)

  1. 1. jmones@institutmacularetina.com<br />Anti VEGF Therapy in Atypical Indications<br />Jordi Monés<br />Institut de la Màcula i de la Retina<br />CM Teknon, Barcelona<br />
  2. 2. jmones@institutmacularetina.com<br />Anti VEGF therapyeffective in exudative AMD<br />
  3. 3. jmones@institutmacularetina.com<br />Anti VEGF therapyeffective in CNV secondarytopathologic MYOPIA<br />
  4. 4. Anti VEGF therapy in atypicalindications?<br />Angioidstreaks<br />Idiopathic CNV<br />Inflammatoryconditions<br />Heritaryretinaldiseases: <br />Patterndystrophies, Best<br />Opticnervedrusen<br />Central serouscoriorretinopathy<br />Choroidalrupture<br />jmones@institutmacularetina.com<br />
  5. 5. Angioidstreaks<br />72-86% patientsdevelop CNV, 50% bilateral<br />PDT poorresults, 50% patients < 20/200<br />Heimann H, Gelisken F, Wachtlin J, Wehner A, Völker M, Foerster MH et al. Photodynamictherapywithverteporfinforchoroidalneovascularizationassociatedwithangioidstreaks. GraefesArchClinExpOphthalmol 2005; <br />jmones@institutmacularetina.com<br />
  6. 6. Angioidstreaks<br />jmones@institutmacularetina.com<br />
  7. 7. Angioidstreaks<br />jmones@institutmacularetina.com<br />Trends:<br /><ul><li>B Gupta. Intravitrealbevacizumabfor CNV 2ry toother causes than AMD. Eye 2009</li></ul>Gain and mean # injectionsindependent of previousTx<br />No difbettweenregimenswithloadingphase vs PRN<br />#injectionsmyopia < angioidstreaks < AMD<br />Area of CNV maybeverysmall, OCT maybe 1st<br />
  8. 8. CML, female 74 angioidstreaks<br />CML<br />female 74 <br />AngioidStreaks, <br />RE<br />scar 20/200<br />LE <br />PDT + macugen 1y<br />avastin 2y before<br />20/20<br />
  9. 9. CML, female 74 angioidstreaks<br />20/20<br />20/20<br />20/20<br />20/20<br />May 07<br />June 07<br />May 08<br />Jan 07 <br />
  10. 10. CML, female 74 angioidstreaks<br />20/20<br />20/20<br />20/20<br />20/20<br />Mar 09<br />Apr 09<br />Jun 09<br />Aug 09<br />
  11. 11. IG<br />male 50y<br />RE 20/640<br />LE 20/20 <br />withrecent<br />metamorphopsia<br />
  12. 12. 20/20<br />20/20<br />20/20<br />20/25<br />Sep 07<br />Oct 07<br />Dec 07<br />Dec 08<br />
  13. 13. 20/25<br />20/20<br />20/20<br />20/20<br />02/09<br />03/09<br />06/09<br />09/09<br />
  14. 14. Inflammatoryconditions<br />CNV frequentcomplication 2ry to post uveitisoruveiticscars<br />B Gupta. Intravitrealbevacizumabfor CNV 2ry toother causes than AMD. Eye 2009<br />110 patients<br />Naivepatientsbetteroutcome<br />PRN regimen are fine <br />No inflammationrelatedtothedrug<br />jmones@institutmacularetina.com<br />
  15. 15. Inflammatoryconditions<br />jmones@institutmacularetina.com<br />
  16. 16. Inflammatoryconditions<br />jmones@institutmacularetina.com<br />
  17. 17. FSB<br />Male 56<br />Tuberculosis <br />whenyoung<br />RE 20/100<br />LE 20/32<br />
  18. 18. 20/32<br />20/25<br />20/25+<br />20/20<br />Jul 08<br />Aug 08<br />Sep 08<br />Oct 08<br />
  19. 19. 20/20<br />20/20<br />20/20<br />20/20<br />Dec 08 <br />Feb 09<br />Mar 09<br />Oct 09<br />
  20. 20. Idiopathic CNV<br />jmones@institutmacularetina.com<br />
  21. 21. Idiopathic CNV<br />PDT wasusefulto “stabilize” VA<br />Pooled data<br />B Gupta. Intravitrealbevacizumabfor CNV 2ry toother causes than AMD. Eye 2009<br /> 52 eyes, improvement 0,8 logMARto 0,33 <br />Mean #injections 1,55<br />jmones@institutmacularetina.com<br />
  22. 22. EPE<br />Female 36 y<br />20/15<br />20/200<br />
  23. 23. EPE<br />Female 36 y<br />2 yearslater<br />20/64<br />20/200<br />
  24. 24. 20/64<br />20/20<br />20/100<br />20/20<br />May 09<br />Jun 09<br />Jul 09<br />Aug 09<br />
  25. 25. 20/32<br />20/17<br />20/15<br />Sep 09<br />Oct 09<br />Nov 09<br />
  26. 26. SFB<br />Female 17y<br />-5 myopia<br />RE 20/20<br />LE 20/32<br />
  27. 27. Mujer 17 años -5d, 20/32<br />M 2,5<br />20/20<br />M 1<br />20/25<br />M 4<br />20/50<br />M 5<br />20/40<br />M 8<br />20/20<br />20/ 32<br />
  28. 28. Oct 08<br />Jan 09<br />Apr 09<br />Sep 09<br />
  29. 29. Anti VEGF therapy in atypicalindications?<br />Angioidstreaks<br />Idiopathic CNV<br />Inflammatoryconditions<br />Heritaryretinaldiseases: <br />Patterndystrophies, Best<br />Opticnervedrusen<br />Central serouscoriorretinopathy<br />Choroidalrupture<br />jmones@institutmacularetina.com<br />
  30. 30. AGG<br />Male 13y<br />RE 20/63<br />LE 20/20<br />
  31. 31. AGG Male 13y CNV 2ry BEST DISEASE<br />20/63<br />20/20<br />20/20<br />20/20-2<br />Apr 09<br />May 09<br />Aug 09<br />Oct 09<br />
  32. 32. Anti VEGF therapy in atypicalindications?<br />Angioidstreaks<br />Idiopathic CNV<br />Inflammatoryconditions<br />Heritaryretinaldiseases: <br />Patterndystrophies, Best<br />Opticnervedrusen<br />Central serouscoriorretinopathy<br />Choroidalrupture<br />jmones@institutmacularetina.com<br />
  33. 33. AFD<br />Female 45y<br />RE 20/125<br />
  34. 34. AFD 45y female CNV 2ry OPTIC NERVE DRUSEN <br />20/125<br />20/20<br />
  35. 35. Summary<br />CNV secondary to other causes has numerous subtypes and can not be studied in randomized trials. However, the trend is that ALL respond to bevacizumab/ranibizumab, although agressivity and duration of the effect may vary among the different etiologies<br />Angioid streaks has evolved in a manageable disease, although long term recurrences are frequent, and idiopathic CNV may have very aggressive recurrences<br />PRN seems to be fine for most situations, but perhaps not in idiopathic CNV<br />jmones@institutmacularetina.com<br />

×