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World Ophthalmology Congress 2010

Macular edema related to diabetes and venous thrombosis:
New therapies improve visual acuity for the first time

Berlin, June 2010 – New therapy approaches for patients suffering from swelling of the central retina (macular edema) associated with diabetic retinopathy and vein occlusion are available. Ophthalmologists inject an antibody or a small cortisone implant into the patients’ eyeballs. This brings about a notable improvement in their visual performance. The German Society of Ophthalmology (DOG) calls attention to this in the run-up to the World Ophthalmology Congress (WOC^® 2010). The world’s largest congress on the topic of ophthalmology takes place in Berlin at the beginning of June.

There is only one single “drain” for the blood coming from the retina: the central vein. If this vein or one of its branches is blocked by a thrombosis, it leads to severe visual impairments and even blindness. “After diabetic retinopathy, retinal vein occlusion is the most common disease of the blood vessels in the eye,” states Professor Dr. med. Gabriele Lang of the University Eye Hospital in Ulm/Germany and program director of the WOC^® 2010. This disease is particularly prevalent in old age. “Beyond the age of 80, 4.6 percent of the population is affected,” Lang declares. Laser therapy is currently the standard therapy. However, this has only a limited impact.

The results of treatment with the antibody ranibizumab are significantly more favorable. “It was developed as an inhibitor of the vascular endothelial growth factor (VEGF) associated with age-related macular degeneration,” the expert explains in the run-up to the WOC^® 2010. When a vein occlusion occurs, blood components escape from the vessels and lodge themselves in the retina. This causes swelling of the macula, the area which produces the sharpest vision on the retina. As a result, visual acuity is impaired.

In two recently published studies, ranibizumab was tested on vein occlusion. In both studies the patients were given injections with the antibody or placebo injections over a period of six months. 397 patients with a branch vein occlusion took part in the BRAVO Study. Here, the antibody injections noticeably improved visual acuity. “After six months, those patients who received a dosage of 0.5 mg of ranibizumab were able to read 18.3 letters or 3.7 lines more on the vision chart on average. Those patients who received placebo injections gained seven letters or 1.4 lines on average,” Lang reports. In the CRUISE Study, carried out on 392 patients with central vein occlusion, there were also clear improvements.

Under the name of Lucentis^®, ranibizumab is approved for the treatment of age-related macular degeneration (AMD) in Germany. “Ophthalmologists
are able to use Lucentis^® off-label on their patients suffering from retinal vein occlusion,” Lang states. Patients must wait for the second therapy approach, however. The drug dexamethason with the brand name Ozurdex^® was already approved in the USA in 2009. The expert definitely expects the European Medicines Agency (EMEA) to follow suit soon. “It is a small implant which is also injected into the eye,” Lang explains. There, it constantly releases an extremely effective cortisone-like drug that reduces swelling in the macula. “In 20 to 30 percent of 1,300 patients visual acuity increased by three lines on the vision chart after two months,” says Lang.

In May 2010 the manufacturers of Lucentis^® announced that according to the 1-year data of the so-called RESTORE Study, therapy for diabetic macular edema using ranibizumab is significantly more effective than laser therapy. Experts from around the world will discuss these promising new developments in the treatment of retinal diseases at the WOC^® 2010.

Literature:
BRAVO-Studie: Campochiaro PA et al: Ranibizumab for macular edema following
branch retinal vein occlusion, Ophthalmology 2010 Apr 14. [Epub ahead of print]

CRUISE-Studie: Brown DA et al: Ranibizumab for macular edema following central retinal vein occlusion, Ophthalmology 2010 Apr 8. [Epub ahead of print]

Haller JA et al: Randomized, sham-controlled trial of dexamethasone intravitreal
implant in patients with macular edema due to retinal vein occlusion. Ophthalmology 2010 [Epub ahead of print]