In the study, treatment with PDT plus Lucentis was superior to Lucentis alone for achieving regression of polyps at month six. Anti-VEGF therapy is the standard of care for wet macular degeneration, but thermal laser occasionally plays a role for extramacular or peripapillary choroidal neovascularization.
I will almost always start these patients on anti-VEGF therapy, to which they usually respond well. For cases that continue to progress, however, laser can be a useful adjunct.
When photocoagulation is an option—and when it works—it can help decrease the injection burden for patients, and potentially decrease the frequency of visits. Its maker, Novartis, hopes that the drug may be able to demonstrate efficacy comparable to q8w Eylea but with q12w dosing.
In the study, 10 eyes of 10 patients received a regimen of Cosopt b. Eight eyes received Eylea and two received Lucentis. The mean CST decreased from The mean maximum subretinal fluid height decreased from The mean logMAR visual acuity was 0. Because of the success of this pilot study, several other researchers and I are conducting a larger-scale study using the same drug. In the study, subjects are randomly assigned to receive Cosopt or placebo along with their normally scheduled anti-VEGF injections at regular intervals as was done prior to enrollment.
Some studies have suggested that outflow through the anterior chamber may play a role. The hypothesis is that, by decreasing aqueous production with Cosopt, outflow may also be reduced, possibly slowing the rate at which the anti-VEGF is cleared. This may allow the latter drug a longer working time. In conclusion, though anti-VEGF drugs have revolutionized the treatment of wet AMD, like driving on a straight road, we must often make adjustments along the way.
There is minimal level-one evidence to guide us when treating suboptimal responders to anti-VEGF monotherapy. I hope this review of current strategies helps you face these challenging cases with greater confidence. Shah practices at Ophthalmic Consultants of Boston. Shah is a sub-investigator in clinical trials sponsored by Regeneron and Genentech, and consults for Regeneron.
Ranibizumab and bevacizumab for neovascular age-related macular degeneration. N Engl J Med ; Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med. Ranibizumab for neovascular age-related macular degeneration. Intravitreal aflibercept VEGF trap-eye in wet age-related macular degeneration.
Br J Ophthalmol. Aflibercept treatment for patients with exudative age-related macular degeneration who were incomplete responders to multiple ranibizumab injections TURF trial. Br J Ophthalmol ; Noninfectious inflammation after intravitreal injection of aflibercept: clinical characteristics and visual outcomes.
Am J Ophthalmol ; Accessed 10 July Switching treatment for neovascular age-related macular degeneration from bevacizumab to ranibizumab: Who is likely to benefit from the switch? Depending on the type of insurance they have, some people receiving Avastin may have to pay part of this cost.
No matter which treatments are recommended, ask your doctor about:. With the most-up-to-date information, you and your doctor can decide on a treatment plan that makes the most sense for you and your unique situation. You can learn more about Avastin, how it works, and how it is used to treat advanced-stage breast cancer in the Breastcancer.
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Was this article helpful? Can we help guide you? How does this work? Learn more. In the latest round, an FDA panel unanimously ruled that the drug should no longer be approved for the treatment of metastatic breast cancer. FDA panels cast votes all the time, but this one stood out for the drama: In two days of testimony before the decision, women told the panel that Avastin saved their lives. Denying the drug to other women, they said, would be like handing out a death sentence.
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