EpistemisMetamorphopsia
Specialty: Ophthalmology.
Why it occurs
- Wet or exudative age-related macular degeneration (AMD)
- Diabetic macular edema or secondary to venous occlusion
- Epiretinal membrane (macular pucker)
- Full thickness macular hole
- Central serous chorioretinopathy
- Tractional or rhegmatogenous retinal detachment affecting the macula
Initial workup
Initial qualitative test with Amsler grid (to delimit the location of the macular defect); High-resolution Optical Coherence Tomography (OCT) of the macula (essential diagnostic test to assess the presence of subretinal and intraretinal fluids, tractional membranes or disruptions of the outer layers of the retina); multifocal digital retinography; Fluorescein angiography (FGA) or Angio-OCT (OCTA) to identify active anomalous vessels.
red flags
Sudden appearance of distortion in straight lines accompanied by a gray or black spot in the center of the visual field (central scotoma) or abrupt drop in central visual acuity, which critically indicates active choroidal neovascularization or macular detachment.
Standard management
- Aflibercept — intravitreal injection, vascular endothelial growth factor antagonist - anti-VEGF, standard dose of 2 mg monthly in the loading phase, decreasing the frequency according to the treat-and-extend regimen, indicated in wet AMD and macular edema
- Ranibizumab — intravitreal anti-VEGF collaborator, dose of 0.5 mg monthly according to clinical response
- Bevacizumab — anti-VEGF for off-label intravitreal use, dose of 1.25 mg, as an accessible therapeutic alternative in retinal vascular pathologies
- Triamcinolone acetonide (intravitreal injection, prolonged-release corticosteroid for refractory macular edema, monitoring intraocular pressure peaks).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Ophthalmology
- Listed causes
- 6
- Treatment options
- 4