18 January 2013- According to A. Piñero, Professor in Ophthalmology at University of Seville, there are a variety of points which have been most discussed with relation to the treatment: the possible differences in the safety profile of the two drugs or the treating of a disease for many years. For this reason, over these years there has been discussion about whether the guideline for monthly injections proposed in trials is or would be the most appropriate, taking into account what this has meant for the burden of care.
As Piñeiro says, different forms of treatment guidelines have arisen over these years. For Dr. Arias, co-author with Dr. Monés of the article “New guidelines for the treatment and monitoring of patients with exudative age-related macular degeneration”, “the different protocols carry advantages and drawbacks, there is no ideal protocol. Personalised treatment is the best option”.
Studies show us how minimal injections and minimal visits do not avoid recurrence under any circumstances and it is because of this that authors like Dr. Monés believe that perhaps the only way to avoid recurrence will be to support proactive treatments which keep the lesion permanently numb.
“New guidelines for treatment and monitoring in patients with exudative age-related macular degeneration.”
Intravitreal injections of ranibizumab (Lucentis) are the treatment of choice for patients with exudative macular degeneration. Over recent years, various guidelines for treatment and monitoring have been tested with the aim of optimising efficacy and safety outcomes. In routine clinical practice, PRN (pro te nata) and “treat and extend” protocols or variations like the FUSION regimen are normally used. PRN protocols are based on regular monitoring of the patient and his or her retreatment when there are signs of reactivation of the lesion, determined fundamentally by the loss of visual acuity and persistent or recurrent macular fluid in the optical coherence tomography. “Treat and extend” or FUSION protocols are based on early retreatment of the lesion before there is reactivation in order to avoid the non-reversible losses of vision which may occur in recurrences of the disease.
An ideal protocol for treatment and monitoring which may be applied and reproduced in all cases as an alternative to the monthly regimen has not been found and therefore intravitreal treatment with ranibizumab must be individualised for each patient.
Archivos de la Sociedad Española de Oftalmología
Vol. 87 December 2012 Supplement 1