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Course Title: Macular edema: when to treat and when to referRon P. Gallemore, M.D., Ph.D.Founder and Director, Retina Macula InstituteAssistant Clinical Professor, Jules Stein Eye Institute, UCLA School of Medicine4201 Torrance Blvd., Suite 220Torrance, CA 90503Ph #: 310-944-9393e-mail: RonGallemoreMD@ ObjectivesLearn to identify macular edema in the clinicUnderstand the main causes of macular edemaappropriate testing for macular edema Review Latest Medical advances for managing macular edema Review latest surgical advances for managing macular edemaUnderstand how new advanced imaging techniques facilitate diagnosis and management of retinal diseaseUnderstand when to refer and how to co-manage pts with retinal disordersLearning to identify Macular Edema in the clinicLook for diagnoses associated with macular edemaEpiretinal membraneRetinal vein occlusionDrusenDiabetic retinopathyUveitisClinical findings suggesting edema is presentDistortion on Amsler grid (metamorphopsia)Loss of foveal reflexWatske-Allen testMain causes of macular edemaBiochemistryFactors associated with inflammationProstaglandins, leukotrienes, other cytokinesVEGF family of moleculesCarbonic anhydrase Treatments target these biochemical pathwaysMedical advances for retinal managementFront line options for youNSAIDS: when to start how to monitor your patientsWhen to referSteroids: when to start how to monitor your patientsWhen to referUse of the strong steroidEliminate treatment failures - Combination therapies for macular edemaTopical cocktail of strong steroid, NSAID, and CAI dropsSpironolactine and Epilactone for CSRPDT, anti-VEGF therapy for CSRPDT, anti-VEGF and DEX implant for recalcitrant wet AMDDEX implant, anti-VEGF, NSAID for recalcitrant ME with DR and RVOSurgical advances for retinal managementNew InstrumentationThe nickel/titanium loop for membrane peelingValved Cannula Systems27 gauge vitrecomy for complex casesDrug-assisted vitrectomy Trienscence steroid injection for identifying vitreoretinal interface Role of Avastin in minimizing complicationsChemical vitrectomy with JetreaNew techniquesPrevent shrinkage and slippage: Direct silicone-liquid exchangesTriescence for membranesSimpler buckles save time and improve outcomesNew advanced imaging techniques for retinal disorders OCT imaging for diagnosis occult retinal and systemic disordersRetinal vascular occlusionsOptic neuropathiesSteroid-induced maculopathiesVitromacular traction, epiretinal membranes and macular holesGlaucoma Noninvasive OCT angiographyB-scan – an old dog for new disorders Referral and Co-managementOffice exam and diagnostic testing can be used to identify high risk patientsRole of OCTEdemaMembranesMacular atrophyOptic atrophyNeurodegenerative disordersDrug toxicityRole of visual fieldsGlaucoma associated with retinal disordersRetinal degenerationsMalingeringRetinal detachmentOptic neuropathies Ophthalmoscopy and OPTOS imaging: what to look forPeripheral pigmentary changesElevated vesselsHemorrhagesMass lesionWhen is Prompt referral warranted Symptomatic patientUnexplained vision lossTraumaUnexpected findings: Mass, inflammation, infection, hemorrhageGeneral eye doc should facilitate follow-up of testing, monitoring of changes and re-referral when the need arises.ReferencesGallemore RP, Jumper M (2000) Ins and Outs of Silicone Oil Review of Ophthalmology 9/01/00Gallemore RP, Jumper JM, McCuen BW 2nd, Jaffe GJ, Postel EA, Toth CA. (2000) Diagnosis of vitreoretinal adhesions in macular disease with optical coherence tomography. Retina. 20(2):115-20.Gallemore RP, Thomas EL, Boyer DS (2002) Minimally Invasive Vitreoretinal Surgery Review of Ophthalmology. 9(11): 11/19/02Gallemore RP, Boyer DS (2002) Buckle, vit or bubble: RD management options. Review of Ophthalmology 9(04):4/15/02Shlomit Schaal, MD, PhD; Ahmet Ozkok, MD; and Brooke Nesmith, MD, JD27-Gauge Vitrectomy Surgery: Smaller is better. Retina Today March 2014: 25-32.Gallemore RP (2006) NSAIDs in Treatment of Retinal Disorders. Review of Ophthalmology, 13(11): 11/15/2006 RP. (2014) Dexamethasone Intravitreal Implant Following RVO: Rescue, Adjunct or Primary Therapy? Retinal Physician 11(4): 16-19Sharareh B, Gallemore RP et al (2013) RECALCITRANT MACULAR EDEMA AFTER INTRAVITREAL BEVACIZUMAB IS RESPONSIVE TO AN INTRAVITREAL DEXAMETHASONE IMPLANT IN RETINAL VEIN OCCLUSION. Retina. 33(6):1227-1231, June 2013.Spade R Clinical Advantages of Swept-Source OCT and New Non-Damaging Laser Treatments. Rev of Ophthalmol 21(3):1-3 ................
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