Controversy and the Management of Retinal
S. Slakter, M.D.
In spite of all the advances we have made, work
still needs to be done to improve the outcome in patients with exudative AMD.
Numerous clinical trials on this topic continue and others are being initiated.
In this month�s Retinal Physician, Peter K. Kaiser, MD, describes one trial
exploring the combination of photodynamic therapy plus intravitreal
triamcinolone vs. a combination of Visudyne plus Macugen.
Dr. Kaiser is not alone. The evolution of multiple treatment options for the
management of exudative AMD have led many physicians to begin to employ their
own �formulas� for managing CNV. George A. Williams, MD, discusses the
increasing trend for off-label use of monotherapy and combination therapies in
AMD and the impact both from a cost point of view as well as the ethics of these
Off-label treatments often spark controversy, but controversy is more the rule
than the exception when presenting the latest information in both medical and
surgical retinal disease management. For example, our peer-reviewed article
describes current management of primary retinal detachment, including the
mechanisms of the condition and the issues that exist in treatment. The
controversy surrounding macular hole surgery is featured in this month�s
�Face-Off� column, coordinated by Abdhish Bhasvar, MD.
Our exploration of AMD therapies continues with our presentation of the protocol
for Macugen injection, along with recommendations for sterile injections from
several retinal specialists, as well as a discussion on the need for antibiotics
pre- and post-injection. We also present a review of current therapies for
vitreous hemorrhage and the viability of Vitrase as a pharmacotherapeutic option
in the management of this condition. In a related article, an update on the
available technologies for ultrasound with physician commentary on their use in
clinical practice is provided.
As always, we welcome your feedback, as well as articles and cases that you wish
Retinal Physician, Issue: September 2005