Controversy and the Management of Retinal Disease

Jason S. Slakter, M.D.

In spite of all the advances we have made, work still needs to be done to improve the outcome in patients with exudative AMD. Numerous clinical trials on this topic continue and others are being initiated. In this month�s Retinal Physician, Peter K. Kaiser, MD, describes one trial exploring the combination of photodynamic therapy plus intravitreal triamcinolone vs. a combination of Visudyne plus Macugen.

Dr. Kaiser is not alone. The evolution of multiple treatment options for the management of exudative AMD have led many physicians to begin to employ their own �formulas� for managing CNV. George A. Williams, MD, discusses the increasing trend for off-label use of monotherapy and combination therapies in AMD and the impact both from a cost point of view as well as the ethics of these treatment decisions.

Off-label treatments often spark controversy, but controversy is more the rule than the exception when presenting the latest information in both medical and surgical retinal disease management. For example, our peer-reviewed article describes current management of primary retinal detachment, including the mechanisms of the condition and the issues that exist in treatment. The controversy surrounding macular hole surgery is featured in this month�s �Face-Off� column, coordinated by Abdhish Bhasvar, MD.

Our exploration of AMD therapies continues with our presentation of the protocol for Macugen injection, along with recommendations for sterile injections from several retinal specialists, as well as a discussion on the need for antibiotics pre- and post-injection. We also present a review of current therapies for vitreous hemorrhage and the viability of Vitrase as a pharmacotherapeutic option in the management of this condition. In a related article, an update on the available technologies for ultrasound with physician commentary on their use in clinical practice is provided.

As always, we welcome your feedback, as well as articles and cases that you wish to submit.