AMD 2 Flashcards
what are VEGFs for
angiogenic factor- development and maintenance of CNV
avastin- IVAN trial- avastin v lucentis
Bavacizumab- licensed for cancer 1.25mg is used- monoclonal antibody- binds to a lll isoforms of VEGfs. can be used off label in uk- but lucent is usually used
lucentis- V EXPENSIVEEEEEEEEE
Rhanibizumab- monoclonal antibody- inhibits all VEGfs- 0.5mg intravitreal injection- licensed by NICE use 3 injections for 3 months, then further injections depending on examination- usually 14 over 2 years
first is there any point- i.e. is there too much damage already done
luentis can be used for any types of wet AMD
also can be used in combination
macugen
Pegaptanib- specific VEGf- every 6weeks for 2 years- thought would have less side effcst- but not as efficient- not cost effetive- therefore not used
marina trial
716 px
either had 0.3, 0.5 and nothing
for 23months
see letters
anchor trial
423 px
23 months
o.3,0.5 PDT
pier
12 months
184 px
0.3, 0.5 and none
risks of lucentis
higher IOP
mild inflammation- endopthamitis- if infection gets in - bad
also due to injection- cataract? RD? Glaucoma?
increases chance of stroke/ heart attack/ thrombosis
summit
evaluates combination
of lucent is and PDT
other treatments for AMD
VEGF trap- receptor sight for VEGF therefore preventing VEGFs
Ischemia and AMD- blood flow in retina. is there any proof. thickening of RPE- bruchs membrane- increases distance o2 has to go- reduces oxygenation of retina. schema is thought to stimulate vegf factors
no concrete evidence. FL and indocyanine green angiography
laser doppler flowmety
colour doppler imaging
- deposits on bruschs membrane
how is an intravitreal injection given
outpatient
given in a clean room
local aneathedia
injection given 4mm posterior to limbus- through pars plana
ophthalmologist needs to wear mask and gloves- sterile
30g needle
lucentis is 0.5mg
check va afterwards
also give emergency contact number and any advise- any complications which could occur
too much injected
increases pressure- central artery is blocked
blocked
after an injection what do u do
important to have contact number
antibiotics
endopthalmalitis risk
reviews after 4wks- if pain, loss of vision, ref then see earlier
avastin v lucentis
lucentis- licensed- smaller molucel- expessive- rigorous quality corneal- no increases thrmboleic events
whereas evasion is unlicensed,larger molecule, cheaper, quality controlled by pharmacist, no increased thrombeonic events- however gastrointestinal event numbers are increased
NEW DRUG- EYLEA- FLIBERCEPT
effective as lucentis
lasts longer- 3 injections for 3 months then 2 monthly injections and review
don’t need to be monitored monthly
side effects similar to lucentis
combination therapies:
combing= less injections overall needed?
eg lucentis and PTD- it is better but high uveitis in these px
lucent is alone safer, and just as effective than combination
in polpoidal choroidopathy-particular type of AMD- here PDT+Lucentis is a good combo
veterporfin and PDT together
so less injections are given
doesn’t work tho
radiotherapy used in combination
radiotherapy against BV growth- works in cancer treatment-
used for treatment for CNV- not used anymore bc of side effects of radiation-
HOw: invasive surgery- small cut to insert a probe- zap leaking BV and this wipes out abnormal area. However radiation to surgeon??
radiotherapy with anti VEGF
ORAYA
Stereo-tactic
shines a localised beam into eye- low diode
this in combination with lucentis- means less dosages are needed- those who can’t come in regularly
ORAYA
couplping device touches eye with cl then radiotherapy is delivered px needs to keep still only works for certain sized CNV
other treatments for AMD-
slow release intra-ocular and extra-ocular drugs eye drops? oral agents? stem cell treatment? stratergies to remove drusen
therapy for drusen
drusen is extracellular debris which is cleared by RPE-
rpe is tightly bound- limited regernation
laser can absorb drusen
if u treat 1 eye- can effect other eye?
mothly monitoring of lucent is depends on
IOP, VA, side effects, other factors
monitoring px with
ambler chart
need to read with NV 33cm
can u see 4 corners first before looking for distortion
sx more obv than hardly there signs
who is at risk of early and- late amd-
AREDS study
three factors to asses progression- >125 microns of drusen
RPE abnormalities
late AMD in one eye.
Each eye has a score for drusen and pigment changes.
if score = 4, 50% chance of developing late AMD in the next 5 years
optoms need to reassure px
won’t go completely blind
need to tell px about charles-bonnet syndrome
we should give lv advice
and hops will give certificate for partially sighted/ blind
also advice on driving
what treatments for dry AMD
no medical treatment as of yt
trials looking at preventing progression
autoflourescene of RPE- to monitor
nutrition in AMD
anti-oxidants? - to reduce oxidative damage to retina which can occur in AMD
AREDS1 study showed a mild protective effect of zinc and multivitamins
AREDS 2- lutein and zeaxanthin, DHA +EPA- fish oils-
eat green veg
key thing to prevent AMD
Smoking
what should optoms advise:
if u smoke, don’t take supplements as some increase risk of cancer
have a balanced diet- leafy veg
nutriotional supplements in those who have a FH, los of one eye already
take multivitamins plus zin and lutein and zeoxanthin
10mg of leutin
