Choroidal Neovascularization Induces Retinal Edema and its Treatment Addresses this Problem

405 After some years of experience with treatment of choroidal neovascularization (CNV) with intravitreal injections, BLOCKINwe BLOCKINnow BLOCKINbetter BLOCKINunderstand BLOCKINhow BLOCKINCNV BLOCKINalters vision and how treatments work. A clear‑sighted observation BLOCKINwill BLOCKINclarify BLOCKINthat BLOCKINCNVs BLOCKINare BLOCKINable BLOCKINto BLOCKINalter BLOCKINthe retina BLOCKINand BLOCKINits BLOCKINpigment BLOCKINepithelium, BLOCKINand BLOCKINat BLOCKINthe BLOCKINsame BLOCKINtime induce an external blood retinal barrier breakdown. This BLOCKINbreakdown BLOCKINis BLOCKINresponsible BLOCKINfor BLOCKINretinal BLOCKINedema BLOCKINfurther aggravating BLOCKINthe BLOCKINretinal BLOCKINdysfunction. Available treatments for CNV target to stop their growth but are not yet able to significantly reverse alterations related to CNV. There is one exception: external blood retinal barrier breakdown. Indeed anti‑vascular endothelial growth factor (anti‑VEGF) treatments BLOCKINhave BLOCKINa BLOCKINpowerful BLOCKINeffect BLOCKINon BLOCKINthis BLOCKINbarrier BLOCKINwith reduction BLOCKINof BLOCKINall BLOCKINcomponents BLOCKINof BLOCKINretinal BLOCKINedema BLOCKINincluding intraretinal BLOCKINand BLOCKINsubretinal BLOCKINfluids. BLOCKINBy BLOCKINtreating BLOCKINthe BLOCKINedema, anti‑VEGF treatments are able to improve vision in some BLOCKINpatients. BLOCKINThis BLOCKINeffect BLOCKINis BLOCKINalso BLOCKINused BLOCKINfor BLOCKINmonitoring BLOCKINthe impact BLOCKINof BLOCKINtreatment BLOCKINon BLOCKINCNV: BLOCKINleakage BLOCKINseems BLOCKINto BLOCKINprecede CNV growth in most eyes treated with anti‑VEGF treatments. BLOCKINFluid BLOCKINrecurrence BLOCKINor BLOCKINworsening BLOCKINis BLOCKINmonitored and BLOCKINused BLOCKINas BLOCKINthe BLOCKINmain BLOCKINindicator BLOCKINfor BLOCKINrepeat BLOCKINinjections. Intravitreal injections of anti‑VEGF agents are expected to stop the growth of CNV and dry up the retina. BLOCKINAnti‑VEGF BLOCKINagents BLOCKINmay BLOCKINbe BLOCKINcombined BLOCKINwith BLOCKINanother treatment BLOCKINin BLOCKINorder BLOCKINto BLOCKINattain BLOCKINseveral BLOCKINobjectives: BLOCKINto BLOCKINreduce the BLOCKINsize BLOCKINof BLOCKINthe BLOCKINCNV BLOCKINand BLOCKINfurther BLOCKINimprove BLOCKINvision, BLOCKINto BLOCKINreduce the burden of treatment by decreasing the number of injections or to improve vision by treating the edema more effectively. When the two first objectives are the BLOCKINaim BLOCKINof BLOCKINclinical BLOCKINinvestigations, BLOCKINthe BLOCKINthird BLOCKINobjective BLOCKINis rarely BLOCKINbrought BLOCKINup. BLOCKINThere BLOCKINmay BLOCKINbe BLOCKINa BLOCKINgood BLOCKINreason BLOCKINfor BLOCKINthat: effects of such treatment would be difficult to predict in BLOCKINcurrent BLOCKINpractice. BLOCKINAdding BLOCKINa BLOCKINdrug BLOCKINcapable BLOCKINof BLOCKINrestoring the external blood retinal barrier by reducing leakage from CNV may, for example, prevent the recurrence of retinal edema when anti‑VEGFs are no more effective BLOCKINenough BLOCKINand BLOCKINCNVs BLOCKINare BLOCKINbecoming BLOCKINactive. BLOCKINThis may prevent vision fluctuations but at the same time deprive the ophthalmologist from the precious signs of detecting CNV activity. Complex and unexpected interactions between several drugs acting on vessels should BLOCKINalso BLOCKINbe BLOCKINadded BLOCKINto BLOCKINthe BLOCKINequation.