MAR 2014

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/276058

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Page 168 of 210

E W MEETING REPORTER 166 expensive, inconvenient, uncom- fortable and even painful for patients, increases the risk for c omplications. Dr. Verma described two alterna- tives: a PRN approach, and the treat and extend (TAE) protocol. Both these approaches require an initial three injections of anti- VEGF spaced four weeks apart. The difference comes after the third in- jection. F ollowing the PRN approach, the patient's eye is evaluated monthly using OCT and vision testing, and additional IV anti- VEGF injections are given as needed (hence, PRN). Using the TAE protocol, injec- tions are given at intervals extended by two weeks following each subse- q uent injection; that is, the fourth injection is given six weeks after the third; the fifth, eight weeks after the fourth; the sixth, 10 weeks after the fifth; and so on. An injection is thus given regardless of any OCT or visual testing results at the time of follow up. The advantage of the TAE proto- col, said Dr. Verma, is that while it reduces the number of injections and therefore the inconvenience and cost to the patient, it neverthe- less achieves results comparable to monthly injections. Clearly, IV injections—whether for anti-VEGF treatment or other therapies—are somewhat invasive: Foreign bodies are injected directly into the eye. Complications— specifically their prevention—are therefore an important concern. One way to prevent complica- tions is to consider all IV injections as surgical procedures—i.e., per- formed in the operating theater, with proper draping and adequate povidone-iodine coverage. In more than 8,000 cases, Dr. Verma and his colleagues routinely performed IV injections as surgical procedures; not one of their patients experienced significant complica- tions. In contrast, Dr. Verma has seen two cases referred from outside clin- ics in which the procedure had been performed in-office. In both cases, the patients suffered the devastating complication of endophthalmitis. Moreover, in the literature, he said, five or six epidemics around the world have been traced to IV injections performed in-office. In addition, Dr. Verma, together with Shalabh Sinha, MD, and a number of experts from India, have written a book covering all aspects of every kind of intravitreal injec- tion—not just anti-VEGF treatment, but everything from enzymatic vitreolysis to the controversial use of intravitreal antibiotics. The book, Intravitreal Injections, released at this meeting, is intended to provide a comprehensive guide to the various intraocular and intravit- real agents delivered into the eye, discussing the agents and the guide- lines for their appropriate use, along with the methodology of intravitreal injection, with chapters on newer agents to provide an understanding of future developments. Experts: Keratoprosthesis viable option to save vision Keratoprosthesis implantation is a viable possibility in a variety of growing indications, such as repeat M arch 2014 View it now ... EWrePlay.org Anthony Aldave, MD, chaired a course on the role and use of keratoprosthesis, including appropriate patient selection, surgical technique, and postoperative management. Dr. Aldave specifically spoke about complications. Reporting live from AIOC 2014, Agra, India www.EWrePlay.org – Video Archives AIOS 2014 164-169 MR AIOC_EW March 2014-DL2_Layout 1 3/6/14 4:30 PM Page 166

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