Optical Coherence Tomography Angiography for Choroidal and Vitreoretinal Disorders – Part 2

Choroidal Neovascularization: Pathogenesis, Diagnosis, and Current Management Strategies

Author(s): Sanjay Marasini and Miguel A. Quiroz-Reyes * .

Pp: 217-244 (28)

DOI: 10.2174/9789815196658123010013

* (Excluding Mailing and Handling)

Abstract

Choroidal neovascularization (CNV) is characterized by the growth of new blood vessels from the choroid to the subretinal pigment epithelium, subretinal space, or both. Newer diagnostic and treatment methods, such as, Optical Coherence Tomography Angiography and anti-vascular Endothelial Growth Factors, are becoming increasingly effective for CNV diagnosis and management, respectively. Anti-VEGF (Ranibizumab, Bevacizumab, and Aflibercept) treatment has become the first-line treatment for CNV and has replaced other methods, such as laser photocoagulation and photodynamic therapy. The current literature has established similar safety and efficacy of the three drugs (Ranibizumab, Bevacizumab, and Aflibercept) in the treatment of CNV, especially when the visual loss is mild. However, Aflibercept has been reported to result in slightly better long-term visual outcomes. Newer molecules such as Brolucizumab and Faricimab show the potential to decrease the treatment frequency and increase efficacy due to better penetration and by increasing drug concentration in the retina, addressing the limitations of the currently available drug options.
However, their investigation was in the early stages and may have taken some time before being seen in the clinic. Innovative methods for continuous drug delivery to the vitreous through the use of dedicated ocular implants filled with anti-VEGF drugs for controlled release (port delivery systems) have also shown promising results in clinical trials. The development of this technique is expected to reduce the total number of injections and maintain stable vision. Different clinical trial protocols across studies remain an issue in addressing research questions related to dosing frequency and gaps.

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      240μsalphaeurekaselec_live_10_06_2022ContentAccess.php#647
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      • 11. app/Models/ContentAccess.php:647
      • 12. app/Http/Controllers/ChapterController.php:1478
      • 13. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
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      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1518
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 873355389 and j.to_ip >=873355389 )) and ((j.from_date <= 1739834410 and j.to_date >= 1739834410 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 21363) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 873355389 and j.to_ip >=873355389 )) and ((j.from_date <= 1739834410 and j.to_date >= 1739834410 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 21363) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 873355389 and j.to_ip >=873355389 )) and ((j.from_date <= 1739834410 and j.to_date >= 1739834410 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 21363)
      720μsalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 3649 and `b`.`banner_from_date` <= 1739834410 and `b`.`banner_to_date` >= 1739834410 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.03msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 3649
      • 3: 1739834410
      • 4: 1739834410
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='5b4a0c6d1fce0d5c39c28fbd19703fe5'
      200μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:260
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        qjnrMqYOu4ZM7Fb1yCJTesgPo1FWYRl28gb4q3d3
        uc_cart_id
        5b4a0c6d1fce0d5c39c28fbd19703fe5
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/21363" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/21363
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
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        request_cookies
        0 of 0
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        response_headers
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        ClearShow all
        Date ↕MethodURLData
        #12025-02-17 23:20:10GET/chapter/21363112192