Étude préliminaire sur l’efficacité de trois injections intravitréennes de bevacizumab dans le traitement de la dégénérescence maculaire liée à l’âge exsudative
“…Reported complications include, but are not limited to, corneal abrasion, corneal infiltrative keratitis, corneal stromal edema, retinal pigment epithelium tear, acute visual loss, lens injury, vitritis, vitreous hemorrhage, endophthalmitis, hypertension, and myocardial infarction. 15,16,117,121 The majority of these events occurred during the treatment of retinal disorders, so the side effect profile may be different when intravitreal administration is used for the reduction of corneal angiogenesis. In spite of these side effects, the intravitreal administration of bevacizumab has been performed for years with a low incidence of complications.…”
Section: Anti-vegf Therapy As An Intervention Against Corneal Anmentioning
Corneal neovascularization is a serious condition that can lead to a profound decline in vision. The abnormal vessels block light, cause corneal scarring, compromise visual acuity, and may lead to inflammation and edema. Corneal neovascularization occurs when the balance between angiogenic and antiangiogenic factors is tipped toward angiogenic molecules. Vascular endothelial growth factor (VEGF), one of the most important mediators of angiogenesis, is upregulated during neovascularization. In fact, anti-VEGF agents have efficacy in the treatment of neovascular age-related macular degeneration, diabetic retinopathy, macular edema, neovascular glaucoma, and other neovascular diseases. These same agents have great potential for the treatment of corneal neovascularization. We review some of the most promising anti-VEGF therapies, including bevacizumab, VEGF trap, siRNA, and tyrosine kinase inhibitors.
“…Reported complications include, but are not limited to, corneal abrasion, corneal infiltrative keratitis, corneal stromal edema, retinal pigment epithelium tear, acute visual loss, lens injury, vitritis, vitreous hemorrhage, endophthalmitis, hypertension, and myocardial infarction. 15,16,117,121 The majority of these events occurred during the treatment of retinal disorders, so the side effect profile may be different when intravitreal administration is used for the reduction of corneal angiogenesis. In spite of these side effects, the intravitreal administration of bevacizumab has been performed for years with a low incidence of complications.…”
Section: Anti-vegf Therapy As An Intervention Against Corneal Anmentioning
Corneal neovascularization is a serious condition that can lead to a profound decline in vision. The abnormal vessels block light, cause corneal scarring, compromise visual acuity, and may lead to inflammation and edema. Corneal neovascularization occurs when the balance between angiogenic and antiangiogenic factors is tipped toward angiogenic molecules. Vascular endothelial growth factor (VEGF), one of the most important mediators of angiogenesis, is upregulated during neovascularization. In fact, anti-VEGF agents have efficacy in the treatment of neovascular age-related macular degeneration, diabetic retinopathy, macular edema, neovascular glaucoma, and other neovascular diseases. These same agents have great potential for the treatment of corneal neovascularization. We review some of the most promising anti-VEGF therapies, including bevacizumab, VEGF trap, siRNA, and tyrosine kinase inhibitors.
“…As far as bevacizumab is concerned, some studies also recommend a loading dose [ 17 , 18 ], but in CATT study, the comparison between bevacizumab given as needed without loading phase and bevacizumab given monthly was inconclusive, so neither no inferiority nor inferiority was established between the two study groups [ 6 ].…”
Section: Early Diagnosis and Treatment Initiationmentioning
Individualized treatment regimens may reduce patient burden with satisfactory patient outcomes in neovascular age-related macular degeneration. Intravitreal anti-VEGF drugs are the current gold standard. Fixed monthly injections offer the best visual outcome but this regimen is not commonly followed outside clinical trials. A PRN regimen requires monthly visits where the patient is treated in the presence of signs of lesion activity. Therefore, an early detection of reactivation of the disease with immediate retreatment is crucial to prevent visual acuity loss. Several trials suggest that “treat and extend” and other proactive regimens provide a reasonable approach. The rationale of the proactive regimens is to perform treatment anticipating relapses or recurrences and therefore avoid drops in vision while individualizing patient followup. Treat and extend study results in significant direct medical cost savings from fewer treatments and office visits compared to monthly treatment. Current data suggest that, for one year, PRN is less expensive, but treat and extend regimen would likely be less expensive for subsequent years. Once a patient is not a candidate to continue with treatment, he/she should be sent to an outpatient unit with adequate resources to follow nAMD patients in order to reduce the burden of specialized ophthalmologist services.
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