黄斑变性治疗方案.pdf

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1、1/15/2013TREATANDEXTENDSHERIFEMBABI,MDAinShamsUniversity,CairoAMDTreatmentProtocolsMonthlyinjections:standardofcareAlternativeindividualizedtreatmentstrategies:PRN(treatandobserve)PrONTOprotocol(treatandobserve).TreatandextendorInjectandextend.11/15/2013Whatistreatand

2、extend?Thedosingstrategyconsistsofaninitialinductionor‘‘loading’’sequenceofatleastthreeinitialmonthlyinjections.Ifstablevisualacuity,anabsenceofmacularhemorrhage,andadryOCThavebeenachievedatthispoint,patientscontinuetoreceiveregularmaintenanceinjectionsatincreasinginterv

3、als.Whatistreatandextend?At6weeksafterthelastofthe3initialmonthlyinjections,visualacuity,clinicalfindings,andOCTchangesarerecordedagain,andpatientsreceiveaninjectionregardlessofthepresenceorabsenceofdiseaseactivity.21/15/2013Whatistreatandextend?However,theintervaltothen

4、extvisit(andscheduledinjection)isbasedonanobservedchangeintheseparameters.Iftherearenochanges,thenextvisitforexaminationandinjectionisscheduledfor8weeks.Ifthereisachange,thepatientreturnsforanotherscheduledinjectionandexaminationafter4weeks.Whatistreatandextend?Theobserv

5、ationandscheduledtreatmentintervalisextended(hencethephrase‘‘treatandextend’’)10weeksandsometimes12weekswaschosenasthelongestintervalbetweenofficevisitsandtreatments.31/15/2013Whatistreatandextend?BaselineAfter3monthly(4weeks)injectionsExtendedto6weeksintervalsExtende

6、dto8weeksintervalsExtendedto10weeksintervalsBackto8weeksWhatarethedisadvantagesoftreatandobserve(PRN/PrONTO)Thisstrategydoesrequiremonthlyvisits,clinicalexaminations,andOCTs.Thismeansmorefrequentvisitswhichisahugeburdenonthepatient(elderly)andtheirfamiliesandhealthcares

7、ystem!41/15/2013Whatarethedisadvantagesoftreatandobserve(PRN/PrONTO)?Patientsuncertain(anddoctorstoo!)iforwhentheywillneedtreatment?!Andthismaybeareasonforsomepatientstoskipvisits!Whatarethedisadvantagesoftreatandobserve(PRN/PrONTO)?Somepatientsmanagedwiththisstrategywil

8、lreturnforassessmentshavingalreadydevelopedhemorrhagesintheinjection-freeintervalwithirre