News

Mouse model studies explore role of matrix metalloproteinase 9 (MMP9) in glaucoma-related axon loss. Initial findings revealed a significant difference in relative axon loss between the MMP9 knockout mice and wild-type control mice.

The year 2007 was successful for cataract surgery; many developments in technology and pharmaceuticals provided benefits to surgeons and their patients, and others to come promise even better things to come. Only the ongoing story of fee reductions from Medicare seems able to temper the positive outlook of cataract surgeons.

ISTA Pharmaceuticals Inc. has licensed North American rights to nasal dosage forms of bepotastine, an investigational product from Tanabe Seiyaku Co. Ltd. ISTA said it expects to complete the formulation of nasal bepotastine next year and begin clinical development in late 2008 or early 2009.

The winners of the fifth annual Ophthalmology Times Resident Writer's Award program were announced during the annual meeting of the American Academy of Ophthalmology.

Monocyte chemoattractant protein 1 (MCP-1) seems to be responsible for apoptosis of the photoreceptors in certain visual disorders. MCP-1 seems to have a critical role in mediating photoreceptor apoptosis after retinal detachment in an experimental murine model. Specifically, MCP-1 causes macrophages and microglia to accumulate and generate oxidative stress in the retina.

New research in a large family affected with autosomal dominant juvenile-and adult-onset primary open-angle glaucoma has shown that age of onset can predict severity of disease. Researchers also have demonstrated that at least one modifier gene or locus alters the severity of glaucoma caused by a particular myocilin mutation.

Outcomes from a long-term study of patients with small, suspicious choroidal melanoma suggest that observation is an effective strategy that is associated with very low melanoma-specific mortality rates and preservation of visual acuity.

A visual illusion known as the induced twinkle after-effect (TAE) can accurately identify the location and breadth of scotomas in those with retinal disease, according to a small study.

Combination therapy using photodynamic therapy and verteporfin (Visudyne, Novartis) as well as bevacizumab (Avastin, Genentech) can be effective in patients with age-related macular degeneration (AMD), particularly when patients are naïve to treatment, according to results from a patient registry.

A new lens-positioning system (Optiflex Surgical Assistant, Volk Optical) for vitreoretinal surgery has a wide field of view and features such as powered and manual controls designed to provide maximum focus capability.

Spectral-domain optical coherence tomography (OCT) collects data that are extensive and allow software to generate displays that are clinically far superior to the data obtained using time-domain systems, according to one ophthalmologist.

An advance in posterior segment imaging technology (Cirrus HD-OCT, Carl Zeiss Meditec) brings clinicians and researchers useful advantages compared with previous-generation optical coherence tomography (OCT) equipment and holds promise for valuable expanded capabilities in the future.

The less is more approach has been successful when applied to treating retinal disease with lasers. The best example of this is a laser therapy (2RT – Retinal Regeneration Therapy, Ellex) that uses extremely short (3-nanosecond) pulses of laser energy to stimulate the retinal pigment epithelium (RPE) to create a sort of renewal process within the retina.

A fusion protein that is an anti-vascular endothelial growth factor agent (VEGF Trap-Eye, Regeneron Pharmaceuticals) significantly reduced retinal thickness from baseline and significantly improved visual acuity in a double-masked, randomized trial with five dosing arms and both monthly and quarterly dosing intervals. Although improvements occurred in all dosing arms, the effects were more consistent in the monthly groups.

A small group of patients given 2.5-mg injections of bevacizumab (Avastin, Genetech) to treat age-related macular degeneration had less frequent injections and slightly better visual acuity than those receiving a 1.25-mg injection over an 8-month follow-up period.

An international, phase II, randomized, double-blind, sham-controlled study evaluated pegaptanib sodium (Macugen, OSI Eyetech/Pfizer) for the treatment of macular edema secondary to central retinal vein occlusion. Results after 30 weeks showed significant benefits of treatment for improving vision and reducing edema.

Two-year results of an exploratory study using an optical coherence tomography-guided variable dosing regimen with ranibizumab in patients with age-related macular degeneration showed that patients maintained visual acuity improvements achieved after an initial series of three monthly injections.

A phase I trial has begun investigating intravitreal injection with a complement inhibitor (POT-4, Potentia Pharmaceuticals) in patients with active choroidal neovascularization secondary to age-related macular degeneration. There is a solid scientific basis for developing complement inhibition as a therapeutic strategy, particularly for treating patients with early disease to prevent progression.

A novel method of delivering drug to the retina using Aerosolized nanoparticles delivered during the air-fluid phase of pars plana vitrectomy may allow ophthalmologists to intervene with the disease process. Research using the technology on pig eyes showed that it seems to provide an effective concentration of drug to the posterior segment tissues. This mode of drug delivery could be effective for treating various eye diseases during surgery.

The Rubeosis Anti-VEGF (RAVE) trial is investigating intravitreal ranibizumab (Lucentis, Genentech) for the treatment of eyes with ischemic central retinal vein occlusion. After receiving nine monthly injections, retinal edema was resolved in nine of 10 eyes, six eyes gained 4 lines in ETDRS visual acuity, and no eyes developed neovascular glaucoma.

With advances in the treatment of age-related macular degeneration, consideration is being given to modifying the frequent dosing that is characteristic of the most recent innovation, the vascular endothelial growth factor inhibitors. The long-term results of this strategy warrant investigation.

The effects of topical bromfenac 0.09% ophthalmic solution (Xibrom, ISTA Pharmaceuticals) on cystoid macular edema were evaluated in 17 eyes with associated retinal disease. After 6 to 28 weeks of treatment, the majority of eyes showed a positive response based on decreases in OCT-measured subfield thickening, cystic spaces, or both.

An extension study shows that long-term ranibizumab therapy is safe and well-tolerated.

Bevasiranib (Opko Health Inc.), the first small interfering RNA compound to be tested in humans, was well-tolerated and demonstrated good safety and biologic activity in phase II trials of patients with subfoveal exudative age-related macular degeneration (AMD) or diabetic macular edema. A phase III study investigating bevasiranib as maintenance therapy after ranibizumab (Lucentis, Genentech) treatment is under way in patients with AMD, and a second AMD protocol is under development.

Both anatomic and visual successes are possible when performing plasmin enzyme-assisted vitrectomy for primary and reoperated eyes with stage 5 retinopathy of prematurity. A review of cases performed over a 10-year period showed that about 70% of eyes had light perception vision or better, and nearly as many had successful reattachment.

The FDA has approved the fixed combination of brimonidine tartrate 0.2%/timolol maleate 0.5% (Combigan, Allergan). The product is considered a useful new option for add-on or replacement therapy in patients requiring additional IOP lowering.

Alcon Laboratories received an approvable letter from the FDA for 15 mg anecortave acetate depot suspension (Retaane) for the treatment of wet age-related macular degeneration (AMD). The letter advised Alcon that approval will require an additional clinical study. The company said it has no immediate plans to conduct a new study of anecortave acetate depot suspension for the treatment of wet AMD, due to the difficulty of recruiting patients for such a study in light of other treatments currently available.

The retina community is greatly concerned about Genentech Inc.'s decision to embargo sales of bevacizumab (Avastin) to compounding pharmacies, which divide the large vials into single-use injections for off-label use in treating wet age-related macular degeneration (AMD) and additional disorders.