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Vitreo Retinal Diseases-I Free Papers - aioseducation

Vitreo Retinal Diseases-I Free Papers - aioseducation

70th AIOC Proceedings,

70th AIOC Proceedings, Cochin 2012of 4 years. Mean time interval from birth to injection was 9.18 weeks (3 to 16weeks). Prospective study of 18 eyes with ROP treated with IB (0.625mg/0.05ml)with/without laser. Following injection, there was a dramatic response in thedilatation of the pupil with the pupil not able to dilate previously in all eyes.There was regression of neovascularization in all eyes. Reinjection was notrequired in any eyes. No eyes had any progression in any disease or requiredany more intervention. There was complete disappearance of rubeosis in alleyes following a single injection of Avastin.Regression of persistent foetal vasculature was also observed in 2 eyes. Allpatients were subjected to Neuro developmental analysis by the expert pediatricneurologist at the end of 1 year post avastin injection with (DevelopmentQuotient - DQ). Functional outcome was assessed by the electo physiologistwith the Electo-Retinogram (ERG) and Visually Evoked Potential (VEP) at theend of 1 year post avastin injection to assess the functional outcome.17 eyes (16.6%) had local adverse events: 8 eyes (8%) had self-resolving subconjunctivalhemorrhage, 6 eyes (6%) had persistent peripheral avascularretina, 2 eyes (2%) had transient vitreous hemorrhage and 1 eye (1%) hadperipheral fibrous avascular membrane. 1 patient had some degree ofpsychomotor developmental delay in D-Q Analysis.DISCUSSIONLaser or cryotherapy has been the gold standard in treating severe ROP.However even following optimal treatment there are many eyes that have avery poor visual prognosis. Recently, VEGF has been recognized to play arole in the pathogenesis of severe ROP. The safety and efficacy of intravitrealanti-VEGF drugs like bevacizumab (Avastin TM ), pegaptanib (Macugen TM )and ranibizumab (Lucentis TM ) in various retinal vascular diseases have beenestablished.The choice of bevacizumab was deliberate to try to minimize the possibility ofsystemic complications. The molecular weight of bevacizumab is 149 kd, thatof VEGF-trap (investigational) is 110 kd, and that of ranibizumab (Lucentis;Genentech, Inc.) is 48 kd. It is especially undesirable to inject a small moleculethat might easily penetrate into the undifferentiated peripheral retina andcause local damage. In addition, a small molecule could potentially traversethe retinal barrier completely and escape into the circulation in amounts morelikely to cause systemic complications. Only 1:1,000 of the bevacizumab level inthe treated eye has been shown (in rabbits) to be present in the nontreated eyeor in the blood. In adults, the intravitreal half-life of bevacizumab is 5.6 days,that of VEGF-trap is 4.4 days, and that of ranibizumab is 3.2 days. Injection ofsubstances into the preterm vitreous, which is very viscous compared withthe more liquefied aging vitreous, likely increases this half-life considerably1050

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