Wednesday, November 01, 2006

歐洲視網膜醫師的觀點

在最近一期英國眼科醫學雜誌(British Journal Ophthalmology) ,有關於脈絡膜新生血管(choroidal neovascularization)造成老年性黃斑部病變 (age related macular degeneration) ,目前最好治療方法的整理。

Evolving European guidance on the medical management of neovascular age related macular degeneration

PDT-V (光動力療法:靜脈注射 Verteporfin 藥物後,再使用689 nm 紅光雷射)適用於:

1. Subfoveal lesions with predominantly classic CNV
2. Occult with no classic CNV with evidence of recent disease progression and a lesion size ≤ 4 Macular Photocoagulation Study (MPS) disc areas (DA)
3. Juxtafoveal classic CNV so close to the fovea

Anti-angiogenic agents(抑制血管內皮細胞生長因子等藥物)適用於:

1. Subfoveal lesions with any proportion of classic CNV
2. Occult with no classic CNV
3. Juxtafoveal classic CNV so close to the fovea

Pegaptanib: 0.3 mg, 6 weeks, 9 times per year, at least 2 years. 六週眼內注射一次,一年注射九次

* All CNV subtypes
* FA: weeks 30 and 54. 30 及 54周時,再作螢光眼底攝影
* Concomitant use of PDT-V with predominantly classic CNV
* Granted by FDA and EMEA


Ranibzumab: 0.3 or 0.5 mg, monthly, 12 months. 一個月眼內注射一次,一年注射十二次

* Minimally classic or occult CNV
* Predominantly classic CNV
* Ranibzumab combined with PDT-V

可能併發症:(少見)

1. Ocular adverse event: uveitis, endophthalmitis (葡萄膜炎,眼內炎)
2. Non-ocular adverse event: CVA, AMI (中風,心肌梗塞)


Laser photocoagulation 氬氣雷射

1. Well demarcated juxtafoveal CNV
2. Extrafoveal classic CNV
3. 50 % persistent or recurrent CNV within 3 years of therapy
4. Significant and immediate vision loss


治療時需參考一星期內的螢光眼底攝影。

追蹤期間,至少要再作螢光眼底攝影,及檢查最佳矯正視力
。若視力惡化提早回診。

是否常規追蹤 OCT, ICG: 評估中


Choice of therapy 治療的選擇

Extrafoveal classic CNV

* Laser photocoagulation 氬氣雷射

Juxtafoveal classic CNV

* Laser photocoagulation 氬氣雷射
* PDT-V or Pegaptanib or Ranibzumab: So close to fovea; predominantly or minimally classic with occult CNV

Subfoveal lesions

* Predominantly classic CNV

o PDT-V or Pegaptanib or Ranibzumab: Monotherapy for predominantly classic CNV, with or without occult CNV

* Minimally classic CNV

o Pegaptanib: Minimally classic subfoveal CNV of any size
o PDT-V: Small (≤ 4 Macular Photocoagulation Study (MPS) disc areas (DA)
o Ranibzumab

* Occult with no classic CNV

o Pegaptanib
o PDT-V: with evidence of recent disease progression and a lesion size ≤ 4 Macular Photocoagulation Study (MPS) disc areas (DA)
o Ranibzumab


CNV and RPED (網膜色素上皮層剝離)

* No treatment recommended. 尚無有效治療


Failure to respond to therapy 何謂治療無效

* Failure to respond to laser photocoagulation
o Angiographic evidence of persistent or recurrent CNV

* Failure to respond to PDT-V
o 3 sessions: morphologically worsening and a decrease in VA 連續作三次仍無作用

* Failure to respond to Pegaptanib
o 3 intravitreal injections. 連續眼內注射三次仍無作用


Combination of therapies 合併治療

* Under investigation 仍在研究中


Discontinuation of therapy 何時停止治療

* Laser photocoagulation
o No leakage

* PDT-V: every 3, 6, 12 months. 每三,六,十二個月評估

o Minimal fluorescein leakage from CNV (<50%>
o Scar-like (fibrosis)
o Minimal or no subretinal fluid on OCT


Ranibzumab 目前台灣已可專案申請使用,Pegaptanib 且等明年。

8 comments:

May Kuo said...

You have to be careful about the copyrights issues, though it's a good summary. Please quote the generics, not the brand names, as possible as you can next time you'd like to share such an information in your blog. I should have thanked you for posting such a message on the web, however I'm really worried now.

blinddoc said...

May

Thanks!

scipao said...

參考一下囉,關於運動對黃斑部病變的研究。

http://scipao.blogspot.com/2006/11/blog-post_4405.html

blinddoc said...

scipao

適度運動有益身體健康

只是在烈日下勿忘防曬

謝謝你熱心指教

May Kuo said...

Dear Blinddoc,

Sorry that I did not make my point clear. Prior written permission from BJO might be needed when posting such a summary on the web.
On the other hand, recommendations in public for the off-label use of some drugs in the treatment of the indications not approved by the health authorities would raise some legal issues and cause you a great trouble as well though you're a good doctor.
You have to protect yourself as your blog is a public domain.

May 11/3/'06

blinddoc said...

旨在告訴大家最近歐洲視網膜醫師的結論

在此不作任何治療的推薦或建議

請有疑問或需要的民眾就近詢問醫師

LJ said...

很好的整理很實用
謝謝您的用心

blinddoc said...

師兄

很高興有所幫助
謝謝您一路相挺