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Anti VEGF: When, which effect?
Author(s) -
LOEWENSTEIN A,
FLEISSIG E
Publication year - 2013
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2013.3614.x
Subject(s) - retina , edema , optical coherence tomography , visual acuity , ophthalmology , retinal , medicine , hydrostatic pressure , macular edema , fluorescein angiography , external limiting membrane , tight junction , retinal pigment epithelium , chemistry , surgery , biology , biochemistry , physics , neuroscience , thermodynamics
Fluid accumulation in the retina is a multi‐factorial process that involves the breakdown of the blood‐retina barrier in retinal capillaries or the retinal pigment epithelium. Hydrostatic pressure gradient and the colloid osmotic pressure gradient lead to diffusion of fluid across capillary walls. Damage to tight junctions enhances the rate of capillary filtration, which exceeds the rate of fluid removal from the retina. Fluid accumulates in the outer plexiform layer and pools into cystic space. Accumulated fluid is visible on optical coherence tomography and fluorescein angiogram, but unlike clinical edema, its finding on imaging studies does not always correlate with changes in visual acuity. For that reason, periodical follow‐up is required. Decision to initiate treatment or re‐treatment to prevent progression to edema with subsequent deterioration of visual acuity may be difficult. Intravitreal injections with anti‐VEGF agents have become the first‐line treatment for macular edema. Combination therapy with corticosteroids may be successful in chronic edema that has been found to be somewhat resistant to treatment. Early treatment for macular edema was shown to be beneficial for optimal visual outcomes.Commercial interest