retina drugs

what was the result of the macular photocoagulation study (MPS)

the study was terminated early because twice as many eyes vision recovered better than 20/40 compared to observation

what was the problem with laser photocoagulation

after 3 years recurrences still lead to loss of vision in treated pts

in laser photocoagulation what is focal treatment used to treat

macular edema due to focal leakage

in laser photocoagulation what is grid treatment used to treat

macular edema due to diffuse leakage

in laser photocoagulation what is pan retinal treatment used to treat

pre-proliferative & proliferative retinopathy

what is photodynamic therapy (PDT)

verteporfin (visudyne) hydrophobic substance administered in a lipid based formulation that has an affinity for low density lipoproteins

what effects does PDT have on choroidal neovascularization

vasoconstriction

blood cell aggregation

endothelial cell damage

why is PDT superior to conventional retinal laser

the inner & outer retinal layers overlying the choroidal neovascular membrane are relatively spared so it is repeatable to prevent recurrence

indications for PDT

predominately classic subfoveal choroidal neovascularization due to age related macular degeneration, pathologic myopia or presumed ocular histoplasmosis

how PDT works

IV administered and light activated by using non-thermal diode laser device and targets leaky vessels by binding to LDL & gets taken to CNVM

side effects of PDT

- photosensitivity (sunscreen will not be effective; need sunglasses, wide brimmed hate, gloves, etc)

- injection site reactions (pain, edema, rashes, hemorrhage)

- visual disturbance (blurred vision, flashes, decreased VA, scotoma)

contraindications of PDT

pregnant women

breast feeding women

pts younger than 18

pts with porphyria (group of liver disorders)

what is VEGF-A important for

wound healing

ovulation

blood pressure

pregnancy

skeletal growth

what is VEGF implicated in

diabetic retinopathy

retinal vein occlusion

exudative AMD

what is pegaptanib (macugen)

1st anti-VEGF for AMD that is a oligonucleotide aptamer that is specific to one isoform of VEGF-A (VEGF 165)

what is bevacizumab (Avastin)

anti-VEGF that is engineered from murine (mouse) antibodies that have been replaced by equivalent human gene that binds to all VEGF isoforms

what was bevacizumab established for

treatment for advanced colorectal cancer

what is ranibizumab (Lucentis)

humanized monoclonal antibodies that is only the fab portion (antigen binding portion) that binds to all VEGF isoforms

why does ranibizumab have a higher affinity than bevacizumab

its smaller so its less antigenic (eye is less likely to react) and better penetration

what is aflibercept (eyelea)

IgG backbone fused to extracellular VEGF receptor sequences of the human VEGFR1 & VEGFR2

how does aflibercept work

soluble decoy receptor it binds VEGFA with a greater affinity than its natural receptors

binds to both sides of the VEGF dimer forming an inert 1:1 complex (VEGF trap)

what is faricimab svoa (vabysmo)

humanized bispecific IgG antibody that binds both VEGFA & angiopoietin 2 (Ang2) using recombinant DNA from mammalian Chinese hamster ovary cell culture

inhibiting ang-2 is thought to do what

promote vascular stability & desensitize blood vessels to the effects of VEGFA

indications for anti-VEGF

neovascular (wet) age related macular degeneration

macular edema following retinal vein occlusion (RVO)

diabetic macular edema (DME)

diabetic retinopathy

myopic choroidal neovascularizaiton

how are anti-VEGF treatments given

intravitreal

adverse reactions of anti-VEGF

endophthalmitis

retinal detachments

increases IOP

arterial thromboembolic events: nonfatal stroke, nonfatal myocardial infarction, vascular death

fatal events in pts with DME & DR at baseline

contraindications of anti-VEGF

ocular or periocular infections

known hypersensitivity

pregnancy category C (except pegaptanib category B)

which part of the complement pathway does syfovre (pegcetacoplan injection) inhibit

C3

indications of syfovre (pegcetacoptan injection)

indicated for the treatment of geographic atrophy secondary to age related macular degeneration (AMD)

adverse effects of syfovre (pegcetacoptan injection)

ocular discomfort

neovascular AMD

vitreous floaters

conjunctival hemorrhage

vitreous detachment

retinal hemorrhage

punctate keratitis

intraocular inflammation

retinal vasculitis

which part of the complement pathway does izervay (avacincaptad pegol intravitreal solution) inhibit

C5

indication for izervay

for treatment of geographic atrophy secondary to AMD

why is izervay less likely to cause retinal vasculitis than syfovre

inhibition is lower in the pathway

adverse effects of izervay

conjunctival hemorrhage

IOP increase

blurred vision

choroidal neovascularization

eye pain

vitreous floaters

blepharitis

corticosteroids of mechanism of action

inhibition of synthesis of inflammatory mediators (PGs & interleukins)

inhibition of the VEGF gene

improved stability of the blood retinal barrier

indications for corticosteroids

CME after cataract extraction

posterior uveitis

diffuse diabetic macular edema that cannot be managed with laser photocoagulation

macular edema after CRVO

adverse reactions of intravitreal triamcinolone

increased IOP

ptosis

endophthalmitis

accelerated development of cataract

retinal detachment

adverse reactions of ozurdex (dexamethasone)

cataract

increased IOP

conjunctival hemorrhage

endophthalmitis

eye inflammation

retinal detachment

HTN

bronchitis

contraindications of corticosteroids

ocular or periocular infections

glaucoma

torn or ruptured posterior lens capsule

adverse reactions of retisert (fluocinolone acetonide intravitreal implant)

cataract **

increased IOP **

eye pain **

endophthalmitis

conjunctival hyperemia/hemorrhage

reduced VA

headache

choroidal detachment

hypotony

retinal detachment

vitreous hemorrhage/loss

contraindications of retisert

active viral, bacterial, mycobacterial & fungal infections of ocular surfaces