Page 84 - NAME OF CONDITION: REFRACTIVE ERRORS

Laser photocoagulation: laser photocoagulation is usually reserved for CNV outside the
fovea and for treatment of the variants of exudative AMD, including retinal angiomatous
proliferation (RAP) and polypoidal choroidal vasculopathy.
Photodynamic therapy (PDT)
Indications:
1. Sub foveal predominant classic CNVM (classic CNVM >50% of the area of entire
lesion)
2. Small pure occult CNVM
3. Large occult CNVM with definitive decrease n visual acuity.
4. Mixed lesions

Technique :vertiporfirin (6 mg/kg BW) is infused intravenously over 10
minutes.non thermal laser is applied for CNVM for 83 sec ,spot size 1000µ larger
than greater linear dimension of the lesion to ensure complete closure.

Trans puppilary thermotherapy: uses infra red laser beam to induce neovascular tissue
regression by hyper thermia but not coagulation.
Technique : over lapping one minute application of 3mm diode laser beam ovar the
area of neovascular tissue ,adjust the power so that retinal blanching does not
develop befre45 seconds.

Anti angiogenic agents:
(i) Bevacizumab
(ii) Ranibizumab
(iii) Pegatinib sodium.
These medications are VEGF antibodies and antibody fragments, respectively. They can help
to induce regression of new vessel.

 Regular follow up once in 6 months if patient is in dry AMD stage. No specific
treatment. Patient is taught about Amsler grid and its use in this stage.

 Anti oxidant and Zinc supplementation if patient is in intermediate AMD stage.
 Referral to higher centre for treatment if patient is in exudative AMD stage.
 Rehabilitation with low vision aids if there is atrophy or scarring.

Standard Operating procedure

a. In Patient: Not necessary
b. Out Patient: Yes. For investigations and diagnosis.
c. Day Care: Yes. For treatment.

d) Referral criteria:
 Exudative AMD
 Difficulty in diagnosing with FFA
84