This document discusses anti-VEGF drugs used to treat retinal diseases caused by abnormal blood vessel growth stimulated by VEGF. It begins by explaining what VEGF is and its role in normal and abnormal angiogenesis in the retina. It then covers the major anti-VEGF drugs - pegaptanib, bevacizumab, ranibizumab, aflibercept - comparing their mechanisms of action, dosages, and indications. The document also discusses common adverse reactions and complications of intravitreal injections, as well as criteria for determining treatment response and failure. Overall, the document provides an overview of anti-VEGF drugs for retinal diseases, how they work, and their clinical use and monitoring.
medical management of chronic open angle glaucoma, primary angle closure glaucoma after iridotomy, normotensive glaucoma and acute angle closure attack.
Novel Development in treatment of Diabetic Macular Edema, by Dr. Fritz Allen, presented at VO, Lecture Series 11, Feb 20, 2011
COPE Course ID: 30657-PS
direct ophthalmoscope
fundoscopy course
fundus examination
medical students
ophthalmology
faculty of medicine
kafrelsheikh university
new mansoura university
delta university
Acute Limb Weakness
case presentation
PBL session
3rd year
neuro ophthalmology
new mansoura university
A 54-year-old man, Mr. Stephen Smith, was brought by ambulance to the Emergency Department. He had woken up from sleep with slurring of speech and weakness of his right arm and leg. His wife was extremely distressed as Mr Smith had been perfectly well the previous night when he went to sleep. Within 20 minutes after the initial call was made Mr. Smith was admitted to the Emergency Department and was reviewed by the SpR covering the Regional Specialist Stroke Unit. Mr. Smith had been on regular antihypertensive medication (lisinopril) for 8 years. He smoked 5-8 cigarettes a day and was a social drinker consuming about 6 units of alcohol a week. He was not diabetic.
His Serum lipids were checked and was advised to reduce weight and started on a Statin (Simvastatin). There was no family history of hyperlipidaemia but his grandfather died after a Stroke. Mr. Smith had an urgent appendectomy 1 week and made an uneventful recovery. He lives with his wife in a 4-bedroom detached house.
Neurological examination showed that Mr. Smith was fully conscious and alert. He had an upper motor neuron facial palsy on the right side. He had expressive dysphasia but appeared to comprehend speech. He was just able to lift his right arm off the bed for a short period but had no grip. His right leg was weak.
Reflexes on the right side were exaggerated and his right plantar was extensor. He responded to touch and pin prick equally on both sides. He either had visual inattention or a visual field defect on the right side. He had no papilloedema His blood pressure was 164/96, pulse 84 per min, regular. Other systems were entirely normal.
ECG and all routine blood tests were performed. An emergency CT scan was requested and even though the scan was normal the SpR ruled out emergency thrombolysis in this instance. Mr. Smith was admitted to the Acute Stroke Unit and was seen by the Stroke Consultant. Mr. Smith remained fully conscious and alert but had some difficulty in swallowing. Hence an intravenous infusion was commenced and an alternate strategy was adopted for providing his nutritional requirements. A carotid Doppler scan was requested.
After 3 weeks, Mr. Smith seemed to make good progress and the MDT meeting recorded a consistent improvement in his Barthel Index. The Stroke Team met him with his wife and discussed arrangements for discharge home. His wife was keen to know what support measures were available to them when Mr. Smith returned home. She also wanted to know about the risk of a future stroke and how this could be cut down.
ILOs:-
1- Consider the differential diagnosis of speech.
2- Discuss the risk factors for stroke and primary prevention of stroke.
3- Discuss the overall management of a patient with an acute stroke.
4- Complications of stroke
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. VEGF means Vascular Endothelial Growth Factor, which
is responsible for growth of blood vessels.
Besides having a role in normal vascular growth,
maintaining adequate blood flow to RPE and photoreceptors.
VEGF is also responsible for many retinal diseases by:
1. Stimulates angiogenesis
2. Inducer of vascular permeability causing retinal swelling
3. Pro-inflammatory
4. CLINICAL SIGNIFICANCE
VEGF – A is important in diabetic retinopathy.
The microcirculatory problems in the
retina in Diabetics can cause retinal
ischemia
Ischemia results in the release of VEGF
– A
VEGF – A causes creation of new blood
vessels in the retina and else where in
the eye
HYPOXIA
VEGF Isoforms
VEGF A Proteins
Anti VEGF
VEGF receptors
Neovascularization
Retina Anterior Segment
5. ANTI-VEGF
The anti-VEGF agents block the VEGF molecules and thus
benefit the patients by decreasing the abnormal and harmful
new blood vessels formation and by decreasing the leakage
and swelling of the retina.
This leads to stabilization of vision and even improvement in
vision in many cases.
Before the year 2000, the treatment
of any vascular abnormality in the
macular region was merely restricted
to laser photocoagulation
7. PEGAPTANIB: MACUGEN
Pegylated Aptamer
Discovered by Gilead Sciences and licensed in 2000 to
EyeTech Pharmaceuticals.
Approval was granted by the U.S. Food and Drug
Administration (FDA) in December 2004.
Administered in a 0.3 mg dose once every six weeks by
pre-filled syringe .
CONTRAINDICATED in patients with ocular or
periocular infections.
8. BEVACIZUMAB: AVASTIN
Recombinant humanized monoclonal antibody that blocks
angiogenesis by inhibiting VEGF-A
It received its first approval in 2004, for combination use
with standard chemotherapy for metastatic colon cancer.
Not yet approved by FDA (Off label use) in Ophthalmology.
Rosenfield et al were the first ones to describe & publish the
off label use of intravitreal Bevacizumab in 2005.
9. The injection of 1.25 mg/ 0.05ml in adults, and half that
dose in babies.
Typically administered at 4-6 week intervals, although
this varies widely based on disease and response.
• “The highest concentration is seen in the
anterior chamber from day 1 to 4 after an Intra-
Vitreal injection and it regresses by day 14.”
10. RANIBIZUMAB: LUCENTIS
Lucentis is an monoclonal antibody fragment( Fab)
developed from the identical parent antibody as Avastin.
Lucentis was approved for neovascular AMD in the U.S.
in 2006.
It has a FDA approval for use in DME in 2015.
Dose: 0.5 mg/0.05 ml once every month
Safe in renal impairment
11. AFLIBERCEPT: EYLEA
Recombinant fusion protein
Approval was granted by the U.S. Food and Drug
Administration (FDA) in December 2011.
Recommended dose is 2 mg/0.05 mL every 4 weeks
(monthly) for the first 12 weeks (3 months), followed by
2 mg/0.05 mL once every 8 weeks (2 months).
12. PEGAPTANIB RANIBIZUMAB BEVACIZUMAB
TRADE NAME Macugen® Lucentis® Avastin®
COMPOUND Aptamer Antibody
fragment
Full humanized
monoclonal
antibody
VEGF BINDING
PROPERTY
VEGF-A165
Selective
VEGF-A all forms
(1 binding site)
VEGF-A all forms
(2 binding site)
Half life 4 Days 3 Days 21 Days
DOSE 0.3 mg in 90 ul
1/6 weeks
0.5 mg in 0.05 ml
1/month
1.25 mg in 0.05
ml
1/3 months
ADVANTAGES • Low
immunogenicit
y
• Selective
action
• More
prospective
safety &
efficacy data
• Cost effective
• Long acting
DISADVANTAGE
S
• Cost • CVS Risks
• Cost
• HTN,CVS
Risks
• Rebound
macular
14. OTHER INDICATIONS
POSTERIOR SEGMENT ANTERIOR SEGMENT
1. COATS disease 1. Iris neovascularization*
2. EALES disease 2. Before Keratoplasty to
reduce to reduce corneal
neovascularization*
3. Refractory post surgical
CME
3. Pterygium
Dosage: 2.25 mg in 0.1ml. (exact
dosage ??)
4. Trabeculectomy (to
modulate wound healing)
15. Iris Neovascularization after CRVO
Intravitreal Injection of
Avastin
(1.25mg/0.05ml)
Intracameral Injection
of Avastin
(0.25mg/0.02ml)
16. ONE Week after IVA injection
• Regressed NVI
• IOP = 18 mm Hg
• P.R.P was
performed.
17. HOW TO GIVE INTRAVITREAL
INJECTION?
Injection volume
An injection volume of 0.05 mL is most commonly used
except injection of gas for pneumatic retinopexy and the
injection of multiple intravitreal agents in one session.
Maximum safe volume to inject without preinjection
paracentesis is believed to be 0.1 mL to 0.2 mL.
18. Needle selection
Studies suggest that smaller, sharper needles require less
force for penetration and result in less drug reflux.
Needle size varies according to the substance injected:
27-gauge needles used for crystalline substances such as
triamcinolone acetonide
30-gauge needles commonly used for the anti-VEGF
agents.
Needle length between 0.5 inches (15 mm) is
recommended, longer needles may increase risk of
retinal injury if the patient accidentally moves forward
during the procedure.
19. Injection site
Injection in the inferotemporal
quadrant is common, although any
quadrant may be used.
The patient should be instructed to
direct his or her gaze away from
the site of needle entry.
1-6 m. 1.5mm from limbus
6 m. - 1y. 2mm
1-2 y. 2.5 mm
2-6 y. 3mm
>6y. 3.5 to 4 mm in phakic eyes and 3 to 3.5 mm in pseudophakic or aphakic.
20. Injection technique
Pulling the conjunctiva over the injection site with forceps
or a sterile cotton swab to create a steplike entry path.
The needle is removed, and a sterile cotton swab is
immediately placed over the injection site to prevent
reflux.
IOP and CRA perfusion is assessed.
Topical Antibiotic is administered for one week
21. • Dosing regimens:
– Monthly dosing produces best outcomes but has
greatest treatment burden
– Treat and extend currently most popular strategy
– Predominantly as needed (PRN).
– Loading dose+ PRN
24. 1-Anatomical criteria:
<50% reduction in CMT after 3 monthly injection=
Inadequate response.
2-Functional criteria(BCVA):
Failed to improve to 20/40 after 3 monthly injection=
Inadequate response
Ideal response
25. Therapy Failure
• Tachyphylaxis:
Phenomena causing reduced drug efficacy by
repeated administration.
* 2 strategies:
• Discontinuation (risk of irreversible retinal damage)
• Switching (drug with different mechanism of action)
• Tolerance:
Slow loss of efficacy over time.
*Effect restored by increasing dosage or shortening
time intervals.
26. Refractory group:
Persistent sub/intraretinal fluid for 4-6m.
(Chronic ME) despite monthly injections.
*Effect restored by steroid implant.
Increased intra/subretinal fluid
after 2 or more IVR.
Recurrency group:
Well response but frequent IVR injections
to maintain a dry macula.
30. 30
Neovascular AMD and DME primarily
affect different vascular systems
• Primarily associated with breakdown
of the inner BRB2
• Primarily associated with breakdown
of the outer BRB1
1. Cummings M, Cunha-Vaz J. Clin Ophthalmol 2008;2:369–375
2. Bhagat N et al. Surv Ophthalmol 2009;54:1–32
Neovascular AMD DME
RPE layer
Retinal capillaryMicroaneurysm
Fovea Fovea
Choroid
Druse
n
PR
L
ON
L
INL
IPL
OP
L
IPL, inner plexiform layer; INL, inner nuclear layer; OPL, outer
plexiform layer; ONL, outer nuclear layer; PRL, photoreceptor layer
Choroidal neovascularization
(CNV)
Edema
Retina
Hard exudate
31. 31
Structural changes observed1,2
• Retinal thickening
• Subretinal fluid accumulation
• Cystoid spaces
• Pigment epithelial detachment
• CNV
OCT of neovascular AMD
Structural changes observed3,4
• Retinal swelling (thickening)
• Cystoid macular edema
• Serous retinal detachment
• Vitreomacular traction
• Hard exudates
OCT of DME
Differences in neovascular AMD and
DME are evident from OCT images
1. Liakopoulos S et al. Invest Ophthalmol Vis Sci 2008;49:5048–5054
2. The Royal College of Ophthalmologists. AMD: guidelines for management. 2009.
http://www.rcophth.ac.uk/docs/publications/AMD_GUIDELINES_FINAL_VERSION_Feb_09.pdf [accessed Sep 2009]
3. Bhagat N et al. Surv Ophthalmol 2009;54:1–32
4. Lang GE. In Developments in ophthalmology. 2007. p31–47
Retina
RPE layer
Choroid