• / 15
  • 下载费用:10 金币  

黄斑变性治疗方案.pdf

关 键 词:
黄斑变性治疗方案.pdf
资源描述:
1 15 2013 1 TREAT AND EXTEND SHERIF EMBABI MD Ain Shams University Cairo AMD Treatment Protocols Monthly injections standard of care Alternative individualized treatment strategies PRN treat and observe PrONTO protocol treat and observe Treat and extend or Inject and extend 1 15 2013 2 What is treat and extend The dosing strategy consists of an initial induction or loading sequence of at least three initial monthly injections If stable visual acuity an absence of macular hemorrhage and a dry OCT have been achieved at this point patients continue to receive regular maintenance injections at increasing intervals What is treat and extend At 6 weeks after the last of the 3 initial monthly injections visual acuity clinical findings and OCT changes are recorded again and patients receive an injection regardless of the presence or absence of disease activity 1 15 2013 3 What is treat and extend However the interval to the next visit and scheduled injection is based on an observed change in these parameters If there are no changes the next visit for examination and injection is scheduled for 8 weeks If there is a change the patient returns for another scheduled injection and examination after 4 weeks What is treat and extend The observation and scheduled treatment interval is extended hence the phrase treat and extend 10 weeks and sometimes 12 weeks was chosen as the longest interval between office visits and treatments 1 15 2013 4 What is treat and extend Baseline After 3 monthly 4 weeks injections Extended to 6 weeks intervals Extended to 8 weeks intervals Extended to 10 weeks intervals Back to 8 weeks What are the disadvantages of treat and observe PRN PrONTO This strategy does require monthly visits clinical examinations and OCTs This means more frequent visits which is a huge burden on the patient elderly and their families and health care system 1 15 2013 5 What are the disadvantages of treat and observe PRN PrONTO Patients uncertain and doctors too if or when they will need treatment And this may be a reason for some patients to skip visits What are the disadvantages of treat and observe PRN PrONTO Some patients managed with this strategy will return for assessments having already developed hemorrhages in the injection free interval with irreversible vision loss 1 15 2013 6 What are the disadvantages of treat and observe PRN PrONTO You treat only when you see fluid Unlike DME and RVO AMD is unforgiving disease Each time fluid accumulates this means CNV is growing and more photoreceptors loss What are the disadvantages of treat and observe PRN PrONTO In theory a dosing regimen that does not maintain the macula in a dry state could deny some patients the opportunity for further visual recovery 1 15 2013 7 What are the Advantages of Treat and Extend protocol To put it in a nutshell The Treat and Extend dosing regimen is a strategy intended to resolve macular exudation and maintain the macula in this dry state indefinitely with when possible fewer patient visits and treatments than monthly dosing What are the Advantages of Treat and Extend protocol Reduction of treatment burden by reducing the number of patient visits and the number of imaging studies performed by eliminating the need for the monthly visits necessitated by alternative dosing strategies 1 15 2013 8 What are the Advantages of Treat and Extend protocol Effective giving similar results to monthly injections but with fewer injections What are the Advantages of Treat and Extend protocol Just as effective and even better than PrONTO protocol patients on a treat and extend dosing regimen receive a mandated injection at each visit their eyes receive slightly more injections in 1st year but a similar number of injections as received by patients who completed 24 month follow up in the PrONTO study 1 15 2013 9 What are the Advantages of Treat and Extend protocol The significant reduction in patient visits of nearly 50 without an increase in the number of treatments could potentially decrease the burden on patients practitioners and the healthcare system as a whole What are the Advantages of Treat and Extend protocol Reduces the risk of new sight threatening submacular hemorrhages maintained VEGF suppression more aggressive than PrONTO Rare progression of GA overlying the neovascular lesions suggest additional long term benefits of the treat and extend dosing regimen less aggressive than monthly Rx 1 15 2013 10 What are the Advantages of Treat and Extend protocol Patients and doctors are more compliant because both parties know when will be the next scheduled injection No place for uncertainty Patient will be less inclined to skip visits because they know they will have an injection What are the Advantages of Treat and Extend protocol You can know what is optimal injection free interval for each individual patient without macular exudation Some patients could be 6 weeks others 8 or 10 weeks 1 15 2013 11 Evidence in literature TREAT AND EXTEND DOSING OF INTRAVITREAL ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR TYPE 3 NEOVASCULARIZATION RETINAL ANGIOMATOUS PROLIFERATION MICHAEL ENGELBERT MD PHD SANDRINE A ZWEIFEL MD K BAILEY FREUND MD RETINA 29 1424 1431 2009 Evidence in literature INJECT AND EXTEND DOSING VERSUS DOSING AS NEEDED A Comparative Retrospective Study of Ranibizumab in Exudative Age Related Macular Degeneration HASSIBA OUBRAHAM MD SALOMON Y COHEN MD PHD SEPIDEH SAMIMI MD DAVID MAROTTE MD INES BOUZAHER MD PIERRE BONICEL MD FRANCK FAJNKUCHEN MD RAMIN TADAYONI MD PHD RETINA 31 26 30 2011 1 15 2013 12 Evidence in literature LONG TERM FOLLOW UP FOR TYPE 1 SUBRETINAL PIGMENT EPITHELIUM NEOVASCULARIZATION USING A MODIFIED TREAT AND EXTEND DOSING REGIMEN OF INTRAVITREAL ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY MICHAEL ENGELBERT MD PHD SANDRINE A ZWEIFEL MD K BAILEY FREUND MD RETINA 30 1368 1375 2010 Evidence in literature A Treat and Extend Regimen Using Ranibizumab for Neovascular Age Related Macular Degeneration Clinical and Economic Impact Omesh P Gupta MD MBA Gary Shienbaum MD Avni H Patel MD Christopher Fecarotta MD Richard S Kaiser MD Carl D Regillo MD Ophthalmology 2010 117 2134 2140 1 15 2013 13 Evidence in literature LUCAS study Lucentis Compared to Avastin Study A Randomized Double Blind Prospective Multicenter Study Comparing the Effect of Intravitreal Injection of Bevacizumab Avastin to Ranibizumab Lucentis When Given to Patients With Exudative Wet Age related Macular Degeneration Norway Evidence in literature A total of 420 patients with objective evidence of wet AMD will be randomized to a double blind treatment with ranibizumab or bevacizumab over the course of 2 years still recruiting The treatment interval will be determined by protocol called inject and extend The shortest interval will be 4 weeks and the longest 12 weeks 1 15 2013 14 Treat and Extend Protocol Effective Indefinite strict control of AMD Practical to patient and doctor in every day practice More compliance Clear schedule More Economic less visits injections and imaging What would you choose If you were not previously using treat and extend to treat AMD patients in your practice would you consider it now 1 15 2013 15 Thank you
展开阅读全文
  微传网所有资源均是用户自行上传分享,仅供网友学习交流,未经上传用户书面授权,请勿作他用。
0条评论

还可以输入200字符

暂无评论,赶快抢占沙发吧。

关于本文
本文标题:黄斑变性治疗方案.pdf
链接地址:https://www.weizhuannet.com/p-11353317.html
微传网是一个办公文档、学习资料下载的在线文档分享平台!

网站资源均来自网络,如有侵权,请联系客服删除!

 网站客服QQ:80879498  会员QQ群:727456886

copyright@ 2018-2028 微传网络工作室版权所有

     经营许可证编号:冀ICP备18006529号-1 ,公安局备案号:13028102000124

收起
展开