Update from the 30th Annual Meeting of the Macula Society

The 30th annual meeting of the Macula Society was held May 30-June 2, 2007 in London. The meeting was attended by experts in macular disease from around the world. There were a number of papers updating the positive results of the various Lucentis® trials including reports from the following studies: PRONTO, ANCHOR, Extension Study 2508, HORIZON, and PIER. The Extension Study showed that intraocular injections of Lucentis were well tolerated for up to four years and that the positive visual results were maintained.

Dr. Carmen Puliafito presented an update from the PRONTO study. In PRONTO, patients with wet AMD were treated with three monthly injections of Lucentis. An injection was given at baseline, month one, and month two. Then the patients were followed monthly. An optical coherence tomography (OCT) exam was done at every visit and a fluorescein angiogram was done every three months. The patient received another injection of Lucentis only if:

They lost 5 or more letter of vision from the last visit
New neovascularization or hemorrhage was seen on clinical exam or fluorescein angiography
The OCT showed persistent or recurrent fluid in or under the retina
The OCT showed a increase central retinal thickness of 100µ or more
The OCT showed an increase in the height or breadth of a retinal pigment epithelial detachment.

It is not always possible to flatten a retinal pigment epithelial detachment with Lucentis so patients were not retreated if there was no fluid in the retina and the pigment epithelial detachment was stable.

The visual results from the PRONTO study were basically the same as the results from the MARINA and ANCHOR studies which means that on average, patients gained two lines of vision after two years of follow-up. Patients in the PRONTO study needed, on average, 5 injections per year for two years. Some patients needed only three injections and then were stable whereas other patients needed injections every month. At any given monthly visit, patients had about a one in three chance of needing another injection.

Most retinal experts are using variations of the PRONTO scheme meaning patients get three injections of Lucentis or Avastin® and are then followed if they are stable and without fluid. If patients have stable vision and no fluid, many retinal experts will gradually lengthen the time between appointments to two or even three months.

There is more to come soon from the Macula Society Meeting.

1. Puliafito, C., Rosenfeld, P., Lalwani, G., Fung, A., Michels, S., Dobovy, S., Feuer, W. “An OCT-Guided Variable-Dosing Regimen with Ranibizumab (Lucentis) in Neovascular AMD: Two Year Results of the PRONTO Study.”