Polypoidal Choroidal Vasculopathy

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This document discusses several studies on treatments for polypoidal choroidal vasculopathy (PCV), a disease that mainly affects Asians and pigmented individuals. The first study found that photodynamic therapy (PDT) improved fundus findings in most patients with PCV over 24 months, though recurrences were observed later. Visual acuity was preserved or improved in most patients. The second study found that a single injection of intravitreal bevacizumab improved visual acuity and central retinal thickness in most patients with PCV over 3 months, though angiographic findings showed only partial regression of polyps. The third study observed regression of PCV lesions and improved vision in most patients treated

Health & Medicine

VA Conference May 19, 2009 Michele Todman

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Clinical trials established in 2005 the efficacy of Ranibizumab (Lucentis, Genentech) for the treatment of neovascular age-related macular degeneration (wetAMD), the leading cause of legal blindness in the United States.This disease is affecting people over the age of 65 with a prevalence of 1.6 million and 200000 new cases per year in the USA .While awaiting approval for ranibizumab from the Food and Drug Administration, ophthalmologists began treating neovascular AMD with off-label use of bevacizumab (Avastin, Genentech), since the drug had a target specificity similar to that of ranibizumab and was available at low cost for about 50$ per monthly injection Vs 1950$ for Lucentis monthly injection. Ranibizumab received the FDA approuval in 2006 to treat specifically the wetAMD,there was a huge debate about the cost effectiveness and the reimbursement of Lucentis in comparaison with Avastin for treating the eye disease. This paper explores the dilemma from different angles.First,it make the emphasize on the need of realizing a head to head comparative study between the two drugs and the means to finance and to launch this study since many roadblocks have been identified. Then, it explores and analyzes the Genentech reaction facing this problem and their strategy to emphasize on the higher risk of death with Avastin, as compared to Lucentis in one hand and in the other hand their strategy to extend the ophthalmologic indications for Lucentis, including diabetic macula edema (DME). Finally it explores what value should be put on safety in health technology assessments HTAs by developing that we can’t just consider the dollar value of medicine alone but we need to consider the cost of adverse events caused by the treatment and the cost of living with these adverse events

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Background: The purpose of the study was to assess caregivers’ compliance with the management protocol for chemical injury at St. John Eye Hospital, Jerusalem. Materia l and methods: Charts of all new chemical injury patients who presented to St. John Eye Hospital, Jerusalem, between January and December 2019 were retrospectively reviewed. Data categories collected included: Presentation, age, sex, injury, irrigation, lids, visual acuity, slit-lamp examination (SLE), management plan, and medications given. Data were stored and analysed using Excel. Results: Patients’ presentation date and time, sex, and age were recorded in over 90% of cases. The mechanism of injury and type of offending chemical were recorded in 65% of cases. The irrigating solution was identified in 50% of cases. Corrected visual acuity was recorded in both eyes in almost 50% of cases. Limbal ischemia was documented in 45% of cases, and intraocular pressure (IOP) was recorded in 25%. The management plan and explanation of the condition to patients were documented in less than 50% of cases. Antibiotics and steroids (drops/ointment) were prescribed in 92.5% of cases. Conclusi ons: The results of this study reveal that our documentation needs improvement for several parameters. Several recommendations were formulated: 1. Emphasize to caregivers that irrigation must be done first. 2. Corrected visual acuity should be attempted for both eyes in all cases, and reasons for not recording it should be documented. 3. It is important to document and record limbus details, iris details, and IOP in all cases.

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Purpose To find out clinical characteristics, therapeutic options, and visual outcome in symptomatic retinal artery macroaneurysm (RAMA) patients. Method Newly diagnosed cases of symptomatic RAMA from January 2015 to December 2019 were included. Fifteen eyes of 15 patients with mean age 62.46 years ± 14.89 (SD) fulfilled the inclusion criteria. Result Hypertension was present in 66.6% of the patients, and the commonest site was superotemporal (12 eyes, 80%). The most commonly employed treatment was Nd: Yag laser hyaloidotomy in 4 eyes (26.6%). Other treatments were intravitreal bevacizumab in 3 eyes (20%), focal laser with intravitreal bevacizumab in 3 eyes (20%), PPV with focal laser (13.3%) in 2, focal laser only in one (6.6%), PPV with focal and intravitreal bevacizumab in one (6.6%). The mean best-corrected visual acuity (BCVA) at baseline was 1.35 ± 0.84 LogMAR, which improved to 0.39 ± 0.53 LogMAR at the last follow-up. Presenting VA 0.77 (±0.40) improved to 0.20 (±0.17) p value (0.180) in intravitreal bevacizumab only group, 1.29 (±0.35) to 0.75 (±0.15) p value 0.66 in Nd: Yag laser group, 2.67 (±0.58) to 0.46 (±0.28) p value 0.019 in PPV group and did not improve in combined anti-VEGF and focal laser group due to dense hard exudates at the fovea in one and persistent cystoid macular edema in another case. Conclusion With regard to its presentation, which can vary tremendously, there are no approved guidelines for its treatment. The present study reinforces the need for a treatment guideline development. Customization of treatment should be considered depending on the clinical presentation of each case.

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