Possible Treatments for Inflammation in AMD

Two weeks ago, I discussed a study that showed inflammation in the neovascular membranes of patients with wet AMD who had been treated with Avastin.® Inflammation promotes neovascularization so it makes sense to try to limit or even eliminate this inflammation. Eliminating inflammation could make the treatment with Avastin® or Lucentis® more effective or at least perhaps decrease the number of injections needed to control the leakage from the new blood vessels.

Inflammation also occurs in dry AMD. Controlling it may reduce the progression of atrophy which is actually a more common cause of visual loss than new blood vessels in this disease.

The problem is that we don’t know the exact type or mechanism of this inflammation so we don’t know what the best way to control it is. Corticosteroids like prednisone work to control a variety of types of inflammation. The problem with oral prednisone is that only a small part of it gets into the eye and it causes osteoporosis, hypertension, and even diabetes especially when used for long periods. Therefore it’s not a good choice especially in older patients.

A corticosteroid called, Kenalog® is often injected into the eye. It is a depot form of medication that is white and therefore causes dense floaters. Usually though, the floaters sink to the bottom of the vitreous and out of the way of the line of sight. The medication lasts three months. It generally will cause a cataract. It will also cause glaucoma in at least 30% of patients that can be severe.

Dr. Calvin Grant presented a poster at the 2008 annual meeting of the Association for Research in Ophthalmology, (ARVO), in Fort Lauderdale. Dr. Grant placed his wet AMD patients on Xibrom® which is non-steroidal anti-inflammatory in an eyedrop form. It is used twice a day. The company that manufactures Xibrom has evidence that it makes its way through the front of the eye back to the retina. Dr. Grant thinks that the concomitant use of this drop with Avastin® or Lucentis® increases the success rate and decreases the need for re-injections. The advantage of this medicine is that it is easy to use as an eyedrop and has few side-effects. The disadvantage is that Medicare hasn’t reimbursed for it since there are cheaper non-steroidal drops that may be just as good. Dr. Grant used it because he thought it may be better at getting back into the retina.

I also counsel AMD patients to take a full 325mg aspirin a day with the approval of their doctor.