AMD Flashcards
What are the off-label indications for anti-VEGF therapy?
POHS, PCV, RAM, CME
What other considerations should be made when using anti-VEGF?
Comorbid eye disease, systemic disease, or fellow eye disease
When encoutering retina hemorrhage on DFE in an wet AMD pt without IRF/SRF on OCT what does this mean?
Active disease requiring further evaluation with FA and subsequent treatment
What are the risks that should be covered with informed consent for anti-VEGF therapy?
Endophthalmitis, SO droplets, inflammatory reactions, and retinal detachment
What are reasonable alternatives to anti-VEGF therapy?
Though limited: thermal laser photocogaulation, PDT, and observation
T or F: subconjunctival lidocaine offers excellent anesthesia with same risk of infection as viscous lidocaine
False: lower infection rates with subconjunctival lidocaine than viscous lidocaine
can expect subconjunctival hemorrhage, possible ptosis and diplopia
To minimize contamination of the injection field with oropharyngeal flora what precautions should be taken?
Mask use/minimzing speaking during procedure
What is a reasonable alternative to 5% betadine for endophthalmitis prophylaxis?
0.1 % chlorhexadine
What are the instructions for the patient/caregiver post injection?
Avoiding eye rubbing, administering potentially contaminated eye drops the day of an injection, and recognize signs and symptoms of endophthalmitis, RD, corneal abrasion, and vitreous hemorrhage
(increasing ocular pain, foreign-body sen- sation or discomfort, light sensitivity, severe and diffuse eye redness, worsening central or peripheral vision, or photopsia).
What consideration should be made for patient with recent arterial thromboembolic event (stroke or MI)?
Consider delaying the intravitreal injection or choosing a drug with less systemic absorption, based on clinical judgment.
Some studies have reported no association between intravitreal anti-VEGF injections and cerebrovascular events or myocardial infarction, whereas other studies have reported that intravitreal anti-VEGF injections are associated with an increased risk of cerebrovascular accidents or myocardial infarctions.
What physical exam findings should be cause for postponing a scheduled intravitreal injection?
Cellulitis, chalazion, hordeolum, blepharitis, conjunctivitis, and corneal infections or corneal ulcers.
If there is an active exter-nal infection, postponing the injection until the infection has been treated and cleared is recommended unless, in the best judgment of the injecting physician, the benefits of the injection clearly outweigh the increased risk of endophthalmitis.
Intravitreal injections are contraindicated in patients with active ocular and periocular infections.
What are known responses to anti-VEGF in AMD and PDR that will alter treatment course?
Inflammation, RPE tear in PED and progressive traction or complex RD in PDR
Besides suboptimal responses to medication that lead to a change in medication what else should prompt this?
Tachyphylaxis - repeated administration of a specific medication can result in a decreased therapeutic response. consider increasing the frequency of injections of the same medication or switch to a new drug
Why should the fellow eye be monitored?
One study of patients receiving intravitreal injections for unilateral wet
AMD found a conversion rate of 24% from dry AMD to wet AMD in fellow eye within 96 weeks. Earlier detection of conversion from dry AMD to wet AMD results in better visual outcome.
Make sure you have the right diagnosis. Example AMD vs PCV, Central serous retinopathy also produces SRF and pigment epithelial detachments and can mimic CNV
What do you do with drusenoid PED or vitelliform-like lesion?
FA, OCTA, and fundus autofluorescence may be helpful in demonstrating the absence of CNV, thus avoiding the need for intravitreal injections.
Not all older patients presenting with ME and features of AMD have wet AMD. Macular edema could be secondary to diabetes, pseudophakic cystoid ME, systemic or topical medi- cations, uveitis, or other age-related diseases such as epiretinal membran
