The Injectables: What, When, and Which One?

@#Vascular endothelial growth factor (VEGF) and inflammation. VEGF-A circulates normally in the body and is essential in endothelial cell growth. In the pathological state in the eye, hypoxia increases VEGF-A, promotes growth of neovascularization and accelerates the breakdown of blood-retinal barrier and build-up of fluid in or under the neurosensory retina and retinal pigment epithelium (RPE). It has 6 isoforms; the predominant isoform (most common of which) is VEGF 165 and is most linked to neovascularization in the eye. VEGF-A provided the rationale for targeted drug development. Anti-VEGF drugs are anti-angiogenic, anti-inflammatory, antifibrotic, and anti-permeable. The rationale for the use of steroids to treat macular edema is related to their ability to reduce capillary permeability, to inhibit the expression of VEGF gene, and to inhibit the metabolic pathway of VEGF.

Consensus on the intravitreal injection technique by the Vitreo-Retina Society of the Philippines

@#Vascular endothelial growth factor (VEGF) has been shown to play a central role in the pathophysiologic process underlying neovascular eye diseases. As such, anti-VEGF-based pharmacologic agents have emerged as a highly effective treatment modality for various visually debilitating retinal and choroidal vascular pathologies. The introduction of these pharmacologic agents directly into the vitreous cavity by means of an injection through the pars plana has become a widely performed ophthalmic procedure both locally and overseas.

Awareness and practice patterns of pediatricians regarding retinopathy of prematurity: A multicenter study

Objective@#To assess the level of awareness and practice patterns of pediatricians in various government and private hospitals in the Philippines regarding retinopathy of prematurity (ROP).@*Methods@#This is a prospective, multicenter, cross-sectional study of the practice profile and awareness of pediatricians of the Philippine Pediatric Society (PPS) ROP screening recommendations. Six hundred selfadministered questionnaires were distributed to pediatricians from 40 randomly selected government and private hospitals in the Philippines between July and September 2013. Frequency distribution for each data was noted. Association of referral rates, distribution of barriers, and availability of protocol among the subgroups were analyzed using chi square.@*Results@#A total of 409 eligible surveys were analyzed with a response rate of 68.1%. 92% of the respondents referred their at-risk preterm babies to ophthalmologists for ROP screening. Of those who referred, 57% considered a cut-off value of less than 32 weeks age of gestation, and 45% considered a cut-off value of less than 1500g birth weight. 47% referred at 4-6 weeks post-natal age, and 48% had a protocol for ROP screening. Only 19% were aware of the PPS ROP screening recommendations. The major barrier encountered was the inability of the families to follow up after discharge (41%). Higher referral rates were noted from private institutions (p=0.013) and tertiary hospitals (p=0.019), including those with a protocol on ROP screening (p=0.002).@*Conclusion@#Majority of the respondents referred their at-risk preterm babies for ROP screening. A significant proportion was unaware of the PPS ROP screening guidelines. More than half do not have an established protocol. There were variations in practice patterns of the pediatricians in referring babies at-risk for ROP. Based on these, there is still a need to increase awareness among pediatricians. A uniform, national, published guideline on ROP screening, establishment of referral systems, and training of qualified ophthalmologists are recommended.