Idiopathische Chorioretinopathia centralis serosa (ICCS) Makulödem was tun? AAD 23.3.2011
Idiopathische Chorioretinopathia centralis serosa (ICCS)
Idiopathische Chorioretinopathia centralis serosa (ICCS) AKUTE ICCS Laserkoagulation Reepithelialisierung? Verschluß von Choriocapillarisgefäßen? Schnellere Resorption (3-4 Wochen) Kein Einfluß auf Rezidivhäufigkeit Kein Einfluß auf Visusprognose Indikation? Spontanverlauf: Gute Pognose (5% < 0,6) 20-30 % Rezidiv, < 20 % Partnerauge Berufliche Erfordernisse, > 6 Monate Persistenz
Chronische ICCS
Half-fluence PDT bei chronischer ICCS Yannuzzi et al. RETINA 2003, 2010
JDM Gass, BA Blodi Ophthalmology 1993 Makuläre Teleangiektasien Typ 2
Makuläre Teleangiektasien Typ 2 Blue reflectance Autofluorescence MPOD Charbel Issa P, Staurenghi G, Holz FG, Scholl HPN. Invest Ophthalmol Vis Sci 2008
MacTel Type 2 MacTel Type 1
Anti-VEGF-Tx idiopathische makuläre Teleangiektasien Typ 2 Charbel Issa P, Holz FG, Scholl HPN. Ophthalmology 2007;114:1736-1742
Ranibizumab for Type 2 Idiopathic Macular Telangiectasia Type II - RAMA-Study Single-center, prospective, uncontrolled 12-month trial of nonproliferative MacTel II Patients (N = 10) Unilateral Tx Primary endpoint Month 0 1 2 3 4 5 6 7 8 9 10 11 12 Ranibizumab 0.5 mg Serial investigations study eye and fellow eye Primary outcome measure: Visual acuity Spectralis Spectral-domain OCT Microperimetry SLO fundus autofluorescence, blue reflectance VFQ 25
Ranibizumab Effekt auf Telangiektasie V1 / 40 sec. V2 / 58 sec. V3 / 100 sec. V1 / 40 sec. V7 / 80 sec. V4 / 41 sec. V6 / 65 sec. V7 / 80 sec.
RAMA RT change from baseline OCT-Spectralis: visit 0 vs. visit 7 study eye
Ranibizumab
254µm 148µm 163µm 155µm Outer retina: -8µm Inner retina : -106µm
Lokalisation retinale Verdünnung?
Anti-VEGF-Therapie MacTel 2 proliferatives Stadium
Baseline 1 month post anti-vegf Tx 1 month post 2nd anti-vegf Tx VA 20/200 VA 20/60
www.mactelresearch.org
Makulaödem bei Venenverschlüssen
LASERKOAGULATION Makulaödem bei Venenverschlüssen VAV Persistierendes Ödem mit wenig Blut ZVV Keine Wirkung auf den Visus
Zentralvenenverschluß
Makulaödem bei Venenverschlüssen Sheathotomy Radial optic neurotomy (RON) Laserinduzierte Anastomose Hämodilution
Central Retinal Vein Occlusion Therapeutic approaches Direct injection of tpa into the retinal vein Weiss JN Ophthalmic Surg Lasers 2000;31:162-5 Bynoe LA and Weiss JN Am J Ophthalmol 2003;135:382-4 Feltgen N, Junker B, Agostini H, Hansen LL. Ophthalmology 2007;114:716-23
Central Retinal Vein Occlusion Effect of VEGF-inhibition VA 0,25 0,2 0,15 0,1 0,05 0 08/08 12/08 02/09 03/09 06/09 07/09 08/09
BRAVO trial (BRVO): mean change from baseline BCVA Mean number of injections in PRN period: 2.7 ranibizumab, 3.6 crossover group Ho AC et al. ARVO Annual Congress 2010, poster 6452.
CRUISE trial (CRVO): mean change from baseline BCVA Mean number of injections in PRN period: 3.3 ranibizumab, 3.7 crossover group Ho AC et al. ARVO Annual Congress 2010, poster 6452.
Europe Austria, France, Germany, Hungary, Italy, Latvia Japan South Korea USA, Canada Israel India Colombia Singapore COPERNIC US 61 Centers 189 Patients Australia GALILEO 62 Centers 177 Patients
CRVO (COPERNICUS): Mean Change in Visual Acuity over 52 Weeks ETDRS letters Week *P < 0.001 vs. Sham LOCF; full analysis set; sham n=73; 2q4 n=114;
CRVO (COPERNICUS): Mean Change in Central Retinal Thickness Week µm LOCF; full analysis set; sham n=73; 2q4 n=114; * P < 0.001 vs. Sham
Ozurdex: Mean BCVA change from baseline DEX-PS-DDS 700 μg vs. Sham DEX-PS-DDS 350 μg vs. Sham p<0.001* p<0.001* p<0.001* p<0.001* p<0.001* p<0.001* p=0.006* p=0.005* Sham (n=426) Mean BCVA improvement Mean BCVA (no. Improvement of letters) Letters 12 10 8 6 4 2 DEX-PS-DDS 350 μg (n=414) DEX-PS-DDS 700 μg (n=427) 0 Baseline Day 30 Day 60 Day 90 Day 120 Day 150 Day 180 Study day *Significant (p 0.05) vs. Sham 1. Allergan Data on File.
Ozurdex: Mean BCVA change from baseline: BRVO/CRVO *Significant (p 0.05) vs. Sham BRVO Sham (n=279) DEX-PS-DDS 350 μg (n=260) DEX-PS-DDS 700 μg (n=291) Mean BCVA improvement ( no. of letters) 12 9 6 3 0 * * * Baseline Day 30 Day 60 Day 90 Day 150 Day 180 Study day CRVO Sham (n=147) DEX-PS-DDS 350 μg (n=154) DEX-PS-DDS 700 μg (n=136) Mean BCVA improvement (no. of letters) 12 9 6 3 0-3 * * * Baseline Day 30 Day 60 Day 90 Day 150 Day 180 Study day 1. Allergan Data on File.