1692 Final Material Flashcards
What is in the AREDS2 vitamin formulation?
10mg lutein, 2mg zeaxanthine, 500mg vitamin C, 400IU vitamin E, zinc 80mg with 2mg of copper
What is the original AREDS formulation?
15mg beta-carotene, 500mg vitamin C, 400IU vitamin E, 80mg zinc (requiring 2mg copper)
What appearance puts someone in the Early Stage AMD (AREDS Categories 1&2)
-few or no drusen to non-extensive area of small (<63microns) or intermediate (63-125 microns) drusen
What appearance puts someone in the Intermediate Stage AMD (AREDS Categories 3&4)?
- at least 1 large druse (>125 microns)
- extensive area of intermediate drusen, or non-central GA
- vision loss due to AMD (poorer than 20/32)
- any stage of AMD pathology accompanied by advanced AMD in the fellow eye
What puts someone in Advanced Stage AMD?
- needing tx for CNVM
- GA involving center of macula
- non-drusenoid RPE detachment, rhegmatogenous RD, hemorrhage under the retina or RPE, and/or subretinal fibrosis
What is Aflibercept (Eylea) and what conditions can it be used for?
decoy receptor for VEGF (trap) IVT injection, approved for wet AMD, also can treat CSME, PDR, CRVO, BRVO
What is Pegaptanib (Macugen) and what does it treat?
anti-VEGF aptamer IVT injection, approved for treating wet AMD
What is Ranibizumab (Lucentis) and what can it treat?
fab fragment of humanized mouse anti-VEGF antibody in IVT injections, approved for wet AMD but can also be used for CSME, CRVO, BRVO, and myopic retinal degeneration
What is Bevacizumab (Avastin) and what is it approved for and not approved for but can be used to treat?
a full antibody used to make Lucentis, approved for cancers in the body, used off-label for wet AMD, and also often used to treat PDR, CSR, CRVO, and BRVO
What is PDT laser and what can it treat?
Photodynamic therapy, used with a dye to visualize retina (verteporfin/visudyne), treats CSR and wet AMD
What is PRP laser and what can it treat?
pan-retinal photocoagulation laser, treats high risk PDR, and CRVO (ischemic)
What can focal/grid lasers treat? Scatter photocoagulation?
focal - CSME, targeting individual microaneurysms
grid - CSR, BRVO
scatter laser photocoagulation - BRVO
What is Brolucizumab (Beovu) and what is it approved to treat?
IVT injection that neutralizes VEGF-A, approved for wet AMD
What is a possible therapy for advanced Dry AMD?
Stem cell therapy for RPE cells
What is the Lucentis port delivery system and its advantage?
contains 100mg/mL of the medication, refilled every 15months and releases slowly over time, equivalent to monthly injections but last longer and more convenient for doctor and patient
What is the best recommendation for prevention of AMD in a patient with currently no AMD?
Highest levels of lutein and zeaxanthine and other carotenoids
What is the treatment for early AMD?
no proven treatment :(
What is the treatment for intermediate dry AMD?
AREDS vitamins
What is the treatment for advanced wet AMD?
VEGF inhibitor injections or PDT
What are the treatment options for CSME?
focal/grid laser with IVT triamcinolone if diffuse/extensive edema, or Lucentis/Eylea injections
What are the treatment options for PDR?
PRP laser, avastin/eylea
What are the treatment options for CME?
corticosteroids, acetazolamide, triamcinolone if associated with uveitis
What are the treatment options for CSR?
AVOID steroids, PDT laser, avastin, grid laser, or nothing if condition is self-resolving (tx more for chronic cases)
What are the treatment options for Optic Neuritis?
IV methylprednisolone 250mg q6hx3d followed by oral prednisone 1mg/kg/d x11d and taper over 3d
What are the treatment options for CRVO?
for non-ischemic –> tPA, IVT triamcinolone for macular edema
for ischemic –> IVT VEGF inhibitor to tx neo, or PRP laser
What are the treatment options for BRVO?
treat macular edema with grid laser or IVT triamcinolone, treat the neo with VEGF inhibitor or scatter laser
How do you treat Sympathetic ophthalmia?
1 - 1.5 mg/kg/d QD of prednisone po or IV for at least a year
immunosuppressives may be required
How do you treat Vogt-Koyanagi-Harada Syndrome?
high dose (1-2mg/kg/d) oral steroid (such a prednisone) for 6mo-1yr
if no response try other immunosuppressives (in escalating order):
-IV steroids before oral (methylpred up to 1g/d)
-cyclosporin po
-cytotoxic agents po (cyclophosphamide, chlorambucil, azathioprine)
-infliximab (TNFa inhibitor), methotrexate
How do you treat vitreoretinal traction?
vitrectomy or ocroplasmin (Jetrea) injection
What are the treatments for choroidopathies?
Systemic steroids or immunosuppressants, CNV in PIC and multifocal choroiditis tx w/antiVEGF or laser
What are the ocular side effects of systemic drug: alendronate?
episcleritis, scleritis, uveitis (incidence <1%)
What are the ocular side effects of systemic drug: amantadine?
microcystic edema, folds in descemet’s membrane, resolves with discontinuation of the drug
What are the ocular side effects of systemic drug: amiodarone?
corneal deposits (whorl keratopathy), optic neuritis, optic neuropathy
What are the ocular side effects of systemic drug: anticoagulants (aspirin, coumadin, clopidogrel, dabigatran)?
subconjunctival hemorrhage
What are the ocular side effects of systemic drug: antipsychotics (chlorpromazine, thioridazine)
cataracts, whorl keratopathy, RP, pigmentary retinopathy
What are the ocular side effects of systemic drug: isoniazid?
optic neuropathy, accommodation impairment
What are the ocular side effects of systemic drug: rifabutin?
acute anterior uveitis (unilateral, associated with hypopion)
What are the ocular side effects of systemic drug: ethambutol?
toxic optic neuropathy (1-5%), decreased central vision, visual field defects, decreased colour vision, progresses 1-2mo after discontinuation of drug
What are the ocular side effects of systemic drug: corticosteroids?
cataracts, increased IOP, opportunistic infections
-recommended eye exam f/u 3-4x per year
What are the ocular side effects of systemic drug: hydroxychloroquine?
bullseye maculopathy
monitor w/VF 10-2, OCT, mfERG, FAF
What are the ocular side effects of systemic drug: digoxin?
blurred vision, yellowed vision, decreased R-G and B-Y colour discrimination
What are the ocular side effects of systemic drug: interferons?
cotton wool spots and retinal hemes around the ONH, CME
monitor on eye exam f/u q3mo
What are the ocular side effects of systemic drug: isotrentinoin
blepharitis, conjunctivitis, dry eyes, irritation
What are the ocular side effects of systemic drug: sildenafil?
colour vision changes (cyanopsia), blurred vision, peripheral vision loss, photophobia, increased IOP, NAAION, 2-11% incidence
What are the ocular side effects of systemic drug: tamoxifen?
dry eye, cataracts, keratopathy, retinal deposits (can lead to macular edema)
What are the ocular side effects of systemic drug: tamsulosin?
intraoperative floppy iris syndrome <1%, blurred vision <2%
What are the ocular side effects of systemic drug: tetracyclines?
pseudotumor cerebri, papilledema
What are the ocular side effects of systemic drug: topirimate?
acute myopia, secondary angle closure, blurred vision, diplopia, visual disturbance
discontinue in patients with decreased VAs and pain
What are the ocular side effects of systemic drug: vigabatrin?
VF constriction >30%, nystagmus (13-15%), blurred vision (11-13%), diplopia (3-7%)
get baseline field and perimetry q3mo, VEP in young children
What are the side effects of tetracycline antibiotics in kids?
tooth discolouration under the age of 8 years old
What are the side effects of fluoroquinolone antibiotics in kids?
tendinous arthropathy
What are the side effects of aminoglycoside antibiotics in kids?
renal toxicity
What are the side effects of IV ceftriaxone/rocephin antibiotic in kids?
biliary sludging (infants)
