Ophthalmology

RGX-314 gene therapy offers patients the potential for a lower treatment burden with one subretinal injection of a gene therapy delivering an anti-vascular endothelial growth factor protein.

Advances in optical coherence tomography (OCT) and OCT angiography (OCTA) may enable more objective and accurate diagnosis of ROP in the future.

Early results of a phase Ib/II study investigating light-activated AU-011 (Aura Biosciences) for treatment of small-medium choroidal melanoma show good safety and evidence of efficacy for this novel tumor-targeted therapy.

Management of patients with loss of light perception after open-globe injury has historically been to observe or enucleate the eye with the goal of reducing the risk of sympathetic ophthalmia. Existing data, however, support rethinking that paradigm and instead considering surgery for carefully selected patients who have a chance for recovering vision.

OCT angiography (OCTA) is a revolutionary new tool that adds value to clinical practice. It provides unique insights about retinal and choroidal vasculature compared with conventional OCT along with the advantages of conventional dye-based techniques, said Philip J. Rosenfeld, MD, PhD, at the 2017 Retina Subspecialty Day meeting.

Clinical trials are an indispensable ordeal that are the gold standard for assessing risks and benefits of treatments, said Frederick L. Ferris III, MD.

Development of technologies for sustained drug delivery is a topic of great interest among retina specialists considering the number of chronic conditions that are managed with repeated intravitreal injections.

Results from 3 years of follow-up in the phase III trial investigating treatment with adeno-associated viral vector delivery of human RPE65 (voretigene neparvovec, Spark Therapeutics) show this gene therapy has an acceptable safety profile.

The fluocinolone acetonide 0.2 mcg/day implant (Iluvien, Alimera Sciences) offers an additional option for treating diabetic macular edema that reduces the need for subsequent therapy with anti-vascular endothelial growth factor or steroid treatment.

The visual outcomes after anti-VEGF therapy administered to treat diabetic macular edema in the “real world” do not achieve those reported in randomized clinical trials. Eyes with better baseline visual acuity are disproportionately affected.

Take-Home Message: A pearl for preventing endophthalmitis following intravitreal injections: avoid eyelid contact with the injection site after the last application of povidone iodine.

Brimonidine Drug Delivery System (Brimo DDS) in an intravitreally administered, sustained-release implant (Allergan) shows promise as a treatment for geographic atrophy (GA), secondary to age-related macular degeneration in a phase IIa clinical trial.

Topline results from phase III studies investigating intravitreal brolucizumab (Novartis) for treatment of neovascular age-related macular degeneration (nAMD) support the potential of this novel anti-VEGF antibody to meet the real-world need for an alternative agent with a sustainable therapeutic regimen.

Take-Home Message: The Telescopic Intra-Ocular Lens for Visually Impaired People Revolution system is promising to improve the vision in patients with maculopathies.

ALG-1001 (Luminate, Allegro Ophthalmics) has a number of different mechanisms of action that benefit patients chronically treated with anti-vascular endothelial growth factor drugs and those who are treatment naïve.

Patients with diabetic retinopathy have a high risk of developing macular edema after cataract surgery. Intravitreal injections of aflibercept might result in fewer patients developing macular edema in this patient population.

Adaptive optics (AO) is providing new insights about retinal structure and may help to identify potential areas for treatment of retinal diseases, said Mina Chung, MD.

There is no doubt that inflammation is a component of age-related macular degeneration (AMD), and yet the role of corticosteroid treatment in the management of eyes with AMD remains uncertain, said Marc de Smet, MD, PhD.

Ultra-widefield imaging has become an important component of a thorough eye exam and is taking on a larger role in retina and comprehensive ophthalmology.

A recently released ultra-widefield fundus camera takes images in true color and captures high-resolution imagess rom the macula to the far periphery.

Study results provide new information about the risk and strategies for preventing tractional retinal detachment (TRD) development or progression in eyes with severe proliferative diabetic retinopathy (PDR) receiving intravitreal bevacizumab (Avastin, Genentech) prior to vitrectomy.

Glucose entrapment in the retinal pigment epithelium is responsible for central vision loss in retinitis pigmentosa. Injecting wild-type rods into the eye to restore glucose transportation or injecting glucose into the subretinal space can facilitate cone regeneration.

Achieving the best visual outcomes in challenging cases is a high priority in surgical retina. However, meeting that goal involves a high level of creativity, especially in complex cases associated with other ocular comorbidities.

Intraoperative optical coherence tomography (OCT) is becoming widely available, and its adoption is increasing, but improvements in the technology are needed to maximize its readiness for prime time, according to Justis P. Ehlers, MD.

Suprachorodial hemorrhage can be managed effectively with a conservative approach, but if surgical intervention becomes necessary, timing is critical for optimizing the outcome and minimally invasive techniques can be considered, said John W. Kitchens, MD.

Anti-vascular endothelial growth factor (VEGF) therapy is highly successful, but as Raj Maturi, MD, pointed out, also has some limitations.