Kender had another EUA today, to check on the bleeding I saw in his eye about a week and a half ago. It was visible to me because he has white areas inside his pupil where light reflects off the front edges of his retinal folds, and I saw that area in his right eye turn reddish-brown one weekend. Dr. Trese says he saw lots of blood and exudates. Kender also has glaucoma in that eye, with a pressure of 38 (normal is ~17). The glaucoma is probably caused by the blood blocking the normal fluid flow out of the inner eye. Dr. Trese also said that the appearance of the area behind the iris looks like there might be new blood vessels forming and growing there. It's hard for him to be sure, though, because little spots of blood and dilated blood vessels look much the same on examination.

Kender is being given Cosopt drops to help treat the glaucoma, and continues to need to wear eye protection. In three weeks, he'll have another EUA. If the glaucoma has not improved by then, it will need to be treated, which could cost him vision in that eye depended on the treatment Dr. Trese selects. The blood should be cleared up enough by then that Dr. Trese can confirm whether or not new growth is occurring. If not, he will do some laser cauterization to treat the exudates. If so, Kender will be at very high risk for further retinal detachments, and will become a candidate for treatment with a new experimental drug for FEVR patients called Macugen.

Macugen has previously been used on age-related macular degeneration, which can progress in a similar fashion to FEVR. It suppresses vascular endothelial growth factor, one of the primary hormones involved in the FEVR disease process. Dr. Drenser, one of Dr. Trese's partners, pioneered using this treatment on children with FEVR with good results. It's an injection directly into the eye, so obviously carries risks of its own. But if Kender is a candidate for this treatment, it means he is at high risk of losing his vision anyway, which means we have nothing to lose by trying it.

He's sleeping it off right now. I wish I were.