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Vitreo Retinal Diseases-I Free Papers - aioseducation

Vitreo Retinal Diseases-I Free Papers - aioseducation

Vitreo

Vitreo Retinal Diseases Free Papers1(a) 1(b) 1(c)Figure 1: (a) Shows the pretreatment FA showing a subfoveal predominantly classic CNVand OCT shows a fibrovascular PED with serous macular detachment; (b) Post loadingdose of Bevacizumab residual activity of the CNV on FA and minimal serous maculardetachment with fibrovascular PED on OCT. (c) Final FA and OCT after 2 additional dosesof Bevacizumab, showing RPE window defects and FVPED. OCT shows no residual serousmacular detachment.Figure 2: (a) Shows thepre treatment FA showingjuxtafoveal classic CNVand the OCT showing apre RPE fusiform lesion.(b) Post treatment withIVTA with thermal laser,FA showing scarring ofthe CNV with no residualactivity. OCT showshyperreflectivity in thejuxtafoveal region withno residual intraretinaledema or serous maculardetachment.2(a)2(b)DISCUSSIONAlthough the clinical course of subfoveal CNV secondary to AMD is welldocumented in the literature, sparse information exists on both the naturalhistory and treatment of CNV in the pediatric age group. Due to the rareoccurrence of this entity, there are not many published reports in the availableliterature; it poses challenges in the management. Von Eiken et. al. reportedphotodynamic therapy to be successful in 1 case of a 5-year-old girl withsubfoveal CNVM. The successful use of anti-VEGF therapies in youngerpatients, most notably in neonates with retinopathy of prematurity, hasallowed for application of this treatment to other pediatric conditions. Cakirand colleagues reported two children with choroidal neovascular membranethat regressed following treatment with bevacizumab with documented1057

70th AIOC Proceedings, Cochin 2012improvement in visual acuity. Avery has discussed the potential uses of anti-VEGF agents in pediatric diseases. He also raised concern and demandedcaution in the use of these powerful agents, especially bevacizumab, whichhas a long systemic half-life.In our series however none of the patients developed any adverse effect.Adverse effects are typically uncommon and therefore unlikely to be seen withrelatively small numbers of patients. In our series 64.28% of the total patientsachieved stabilization or improvement of vision. As this result includes allthe treatment groups in the study, compounded with the small samplesize and the substantial lack of literature, these results cannot be overtlygeneralized. However it seems that pediatric CNV fare off better than its agerelated counterparts. Amongst the patients who received Bevacizumab, theimprovement in visual acuity could have been attributed to the dose used inour series (2.5mg/0.1ml). However, Bashshur et. al. administered 3 injections of2.5 mg/0.1 mL every 4 weeks as per their protocol in CNV from AMD. Still thisis just an extrapolation and it is wise to be exert caution for the overzealous inthe use of these agents in pediatric cases.This series suffers from many shortcomings. One is that it is retrospective.Another is that it is not a randomized treatment trial so the inherentweaknesses in the article cannot be avoided. Visual acuity was measured ina non standardized fashion using the Snellen chart. Since no single treatmentprotocol was followed the data from our series cannot be directly extrapolatedto other available data.Table 1: Change in the BCVA in patients (Parentheses show theLogMAR equivalent as per the AJO guidelines)Patients Baseline Final BCVA Change in FollowBCVA BCVA Up (Months)1 6/18 (0.5) 6/18 (0.5) 0 532 6/60 (1) 6/9 (0.2) 8 73 6/18 (0.5) CF 1 (2.7) -6 164 CF 1 (2.7) 5/60 (1) 0 65 6/12 (0.3) 6/60 (1) -7 276 6/18 (0.5) 6/36 (0.8) -3 897 CF 1 (2.7) 6/36 (0.8) 3 428 6/9 (0.2) 6/9 (0.2) 0 79 6/18 (0.5) 6/6 (0) 5 610 6/60 (1) 5/60 (2.7) -1 611 6/36 (0.8) 6/6p (0) 2 3812 1/60 (2.7) 5/60 (2.7) 0 713 6/36 (0.8) 3/60 (2.7) -3 3014 4/60 (2.7) 3/60 (2.7) 0 841058

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