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Understanding MOC Requirements
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April 11-13, 2019
Internal Medicine Meeting 2019
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ILLUSTRATION: Edema and pigment clumping are present in the macula. In the inferior temporal perimacular area, a large semi lunar retinal hemorrhage. There is also peripheral retinal pigment epithelial clumping. There is also moderate macular and perimacular edema. A fluorescein study would reveal the subretinal neovascular complex as the etiology of the hemorrhage and edema. Some cases may also show hard exudates (lipoprotein deposits). The view is slightly hazy because some of the hemorrhage has diffused into the vitreous.
DISCUSSION: Wet ARMD is due to a subretinal neovascular complex. The etiology is due to VegF factor elaborated by an ischemic retina. New vessels develop in response to an ischemic retina. New vessels leak fluid and bleed and during the reparative process, scars form. The cycle is then repeated.
Standard treatment for wet ARMD has been with focal laser if the neovascular net can be identified early (Amsler Grid and fluorescine angiography) and is non foveal. More recently the anti-VegF compounds, Avastin and Lucentis, periodically injected into the vitreous have resulted in the regression of the neovascular complex with 35-40% visual improvement. Many clinical trials have been initiated to assess the best treatment timing and dosage.
While significant strides have been made in the treatment of the "wet" form, ARMD remains the #1 cause of blindness in the United States.