Steroid in IPCV BY DR.PUSHKAR DHIR.pptx

Steroid in IPCV BY DR.PUSHKAR DHIR.pptx

• 1.
  Dr.Pushkar Dhir DHIR EYEHOSPITAL & POST GRADUATE INSTITUTE OF OPHTHALMOLOGY BHIWANI HARYANA
• 2.
  Systemic Steroids AsAn Aid To The Management Of Idiopathic Polypoidal Choroidal Vasculopathy (IPCV): A Descriptive Analysis Aditya Sudhalkar ,Divya Balakrishnan , Subhadra Jalali Raja Narayanan
• 3.
  To determine therole of systemic steroids in improving visual acuity, preventing recurrence and hastening pigment epithelial detachment resolution in IPCV patients.
• 4.
  • IPCV ischaracterized by polypoidal dilatations of the choroidal vasculature in the foveal or extrafoveal region, which results in hemorrhagic or exudative pigment epithelial detachments. • In the natural history of PCV, half of the patients had persistent leakage or repeated bleeding and a poor visual outcome. • Sho et al. also reported severe visual loss in 35% of eyes with IPCV. • The EVEREST trial showed that photodynamic therapy, alone or combined with anti-VEGF therapy was better than anti- VEGF monotherapy alone • The EVEREST study looked at the role of combination therapy with verteporfin based photodynamic treatment with or without intravitreal ranibizumab vs monotherapy with intravitreal ranibizumab • There is a lack of evidence regarding the most appropriate therapy or a combination there of for treatment of polyps.
• 5.
  • Retrospective computerassisted comparative case series of consecutive patients with documented IPCV who did and did not receive systemic steroids as part of their treatment regimen between 2007 and 2012. • Patients who had systemic con-traindication to steroid therapy were excluded from the steroid arm. • Data collected included demographics, the best corrected visual acuity, details of the ocular and systemic exam, the treatment offered, the follow-up period and the final visual and anatomic outcomes. • All patients received one or a combination of the following treatment modalities: anti-VEGF injections, frequency doubled Nd:Yag laser photocoagulation to polyps that were extrafoveal and photodynamic therapy to polyps that were <200 lm away from the foveal center
• 6.
  • Outcome measuresincluded the final BCVA, the time to resolution of the associated pigment epithelial detachment (PED, if present), the recurrence rate and the associated side effects • Inflammation is said to play a role in the pathogenesis of wet AMD (although it is still considered inconclusive). This study was undertaken with the aim of determining the role of oral steroids in IPCV, specifically whether it alters visual recovery, IPCV recurrence and PED resolution.
• 7.
  14 (GROUP A) ReceivedOral Steroids 26 (GROUP B) Dint Receive Oral Steroids 9/14 Got Laser & after 1 week Got Anti-VEGF Mean no.= 2.85 +/- 1.23 14/26 Got Laser & 1 week after Got Anti-VEGF Mean no= 2.60 +/-1.32 Follow up 48.24 =/- 9.75 Follow Up 43.21+/-11.32 Months 12/26 Got PDT 5/14 Received PDT 1/14 had persistent PED 7/26 had persistent PED Baseline VA 1.86 +/-1.24 3 Months VA 0.82 +/- 0.78 Both Groups had Large PED`s Baseline VA 2.12 +/- 1.48 3 Months VA 1.19+/-0.92 412+/-108 um 429+/-122 um
• 11.
  • This studyshows greater visual benefit in patients of PCV who received steroids as an adjunct to local therapy, contrary to other studies; • It should, however, be borne in mind that this analysis was retrospective • To conclude, oral steroids appear to improve visual outcomes and aid PED resolution in patients with IPCV when prescribed as an adjunct to treatment. • A randomized trial will help ascertain conclusively the role of steroids as an aid to IPCV management.
• 12.
  Thank you For feedback& Brickbats plz mail at • [email protected]/[email protected]