There is a cyst in the retina for my father. Which medicine will be suitable for him?

Question

Hi doctor,

My father, who is 76 years old, has been diabetic for the last 25 years. He takes medicine and controls it within the range throughout. Around 20 years back, he had a cataract operation in both the eyes. There is no IOL. His eye problem started before two years. Due to which, there is blurred vision. In the left eye, he has some vision, but in the right eye, the vision is very poor. According to the physicians, there is a cyst on the retina and for which they advise to inject Accentrix or Avastin. I am sending his FFA and OCT report. Kindly give your expert advice on the treatment and in which eye it is needed earlier. Among the two medicines, which is more suitable for my father?

Answer 1

Hi,

Welcome to icliniq.com.

After seeing the photos (attachment removed to protect patient identity), I can see sub-RPE (retinal pigment epithelium) drusens and pigment epithelial detachment in both the eyes. There is also intraretinal cystic fluid. These findings are suggestive of wet age-related macular regeneration (Wet AMD). It is actually an aging process and outer retinal layer becomes unable to clear debris. There are two types, one is dry AMD and other is wet AMD. In wet AMD, CNV (choroidal neovascularization) or PEDs (pigment epithelial detachments) developed and for which injections called anti-VEGF (anti vascular endothelial growth factor) are injected into the eye. Mostly, three types of injections are available with names as follows. Eylea - Aflibercept (newer and expensive). Lucentis - Ranibizumab (less expensive when compared to Eylea). Avastin - Bevacizumab (cheapest). They are all effective with a small difference. But, the economic factor is important because everybody cannot afford Eylea injection. There may be a need of many injections, according to the response, either monthly or twice a month. So, I think that intravitreal injection is needed in right eye as fluid is seen on OCT (optical coherence tomography). You can discuss with your doctor about the injection according to your affordability. Other things that can help are quit smoking (if he is a smoker), control hypertension and cholesterol level, use green vegetables and nutrient supplements like tablet Xanthine or Vision plus (multivitamin) once daily. Remember, the visual outcome is never guaranteed and we cannot predict the number of injections needed for the treatment.