ASRS meeting goes on despite blackout

NEW YORK – Just 2 days after the historic blackout that affected this city and much of the Northeast, the registration desk opened here for the American Society of Retina Specialists annual meeting.

Paul E. Tornambe, MD, (left), president of the ASRS, and Eugene de Juan Jr., MD, (right), vice president of the ASRS, welcomed attendees to the American Society of Retina Specialists meeting in New York.

“This will not be a meeting you will soon forget,” said Paul E. Tornambe, MD, president of the ASRS, noting both the events surrounding the meeting and the anticipated offerings from physician presenters.

“Hopefully, some pearls we will be able to give you, you can take home to use in your practice to help make a difference for the people that you treat. That’s why we are here,” Dr. Tornambe said.

The 5-day meeting featured presentations on several retinal drugs in development, as well as updates on currently used therapies. Surgical techniques including membrane peeling, combination procedures and novel uses of photodynamic therapy were also discussed. Film festival awards and other honors were presented to a host of distinguished attendees.

“Putting the program together was quite exciting – seeing the amount of work that our society is doing. We have more than 200 presentations. There are more than 600 of us here now,” said Eugene de Juan Jr., MD, vice president of the ASRS and program chairman for the meeting.

Dr. Tornambe, in a jovial mood despite the inconvenience of the blackout, concluded his opening remarks with some wordplay.

“I know this is going to be … an ‘electrifying’ meeting, and it is probably the first meeting I’ve been at that I haven’t gotten into hot water yet,” he said, alluding to the fact that even by Sunday morning the hotel had not had hot water restored.

Following are some of the highlights of the meeting. This article is an overview and is not meant to be an exhaustive record of the presentations. Many of these items originally appeared on the OSN SuperSite as live coverage from the meeting.

Anecortave acetate well tolerated, surgeon says

Drs. Aiello, Tasman receive honors

NEW YORK — Great men are dedicated, compassionate and humble, as are the recipients of the American Society of Retina Specialists’ annual awards, said Paul E. Tornambe, MD, president of the ASRS. At this year’s ASRS meeting, Dr. Tornambe presented Lloyd M. Aiello, MD, of Boston, with the Gertrude D. Pryon Award, for great achievements toward restoring or preserving sight. The Retina Research Foundation sponsors the award, a $15,000 research grant and a $5,000 personal award. William S. Tasman, MD, a Philadelphia surgeon credited with “major advancements” in the fields of retinopathy of prematurity (ROP) and diabetic retinopathy, was this years’ Founders Award recipient. During his lecture, Dr. Aiello noted that diabetic retinopathy “is avoidable, and future efforts must be focused on prevention, intervention and restoration of sight.” These efforts must be directed toward understanding the underlying molecular mechanisms of the disease, reducing complications, controlling concurrent systemic diseases and treating patients with less invasive therapies, he said. Dr. Tasman spoke about a study of 47 “baby boomer” patients with ROP. This long-term study of 86 eyes, he said, showed a high rate of myopia in these patients (61.5% vs. 20% in the general U.S. population). He also discussed the possibility of success following cataract surgery in this patient group and the potential for other complications such as neovascular glaucoma. “ROP is not a static disease and must be followed throughout the patient’s lifetime,” he said. Other award recipients included Hans R. Grieshaber, MD, who received the Award of Appreciation for his philanthropic support of the ASRS. Dr. Tornambe received the Crystal Apple Award for being a positive role model and motivator of young specialists.

Long-term use of anecortave acetate can prevent severe vision loss and inhibit lesion growth in patients with wet age-related macular degeneration, according to Henry Hudson, MD, FACS.

Dr. Hudson presented 24-month phase 2/3 study data on Retaane (anecortave acetate, Alcon). “A 15-mg treatment of Retaane has the potential to safely and effectively preserve sight in and deliver tangible benefits to wet AMD patients,” he said.

The study included 128 patients at 18 sites, of whom 76 completed 12 months of therapy and 55 completed 24 months. Of the treated patients, 73% had stable or improved vision from baseline to 24 months after treatment. None of the patients with predominantly classic choroidal neovascularization lesions had severe vision loss, defined as a loss of more than 6 lines of visual acuity.

Alcon has initiated a phase-3 trial at more than 50 sites in the United States, Europe, Australia and Canada, with about 500 patients enrolled. The phase 3 trial will be a head-to-head comparison of Retaane and Visudyne (verteporfin photodynamic therapy) for the treatment of classic wet AMD.

Phase-2 data on Lucentis promising for AMD, surgeon says

Most patients given the drug ranibizumab for treatment of wet age-related macular degeneration either maintained or improved their vision through 6-month follow-up, according to a surgeon speaking here.

Jeffrey S. Heier, MD, of Boston, presented the results of the study. Dr. Heier said 64 patients with neovascular age-related macular degeneration were enrolled in the phase 1b/2 study of the anti-angiogenesis drug. The patients presented with minimally classic choroidal neovascularization (CNV), predominantly classic CNV or active lesions following photodynamic therapy.

Twenty-five patients received a dosage or four Lucentis (ranibizumab, Genentech) injections of 300 µm each; 28 patients received 500 µm of Lucentis in four escalating dosages; and 11 received “usual care.”

Dr. Heier told participants at the meeting that patients in both treatment groups achieved a mean improvement in visual acuity of nine letters at the end of 98 days. Forty patients who elected to undergo a second treatment regimen demonstrated a further mean visual improvement of 12.8 letters with the 300-µm dosage of Lucentis and 15 letters with the 500-µm dosage, he said.

Nine patients in the “usual care” group chose to switch to the Lucentis group at the end of the 98-day period, Dr. Heier added. While in the usual care group, these patients demonstrated an average loss of 5.1 letters, but by day 210 they had improved 7.3 letters in the 300-µm dosage group and by 3.2 letters in the 500-µm dosage group.

Regarding the safety of the drug, “Lucentis was well tolerated,” Dr. Heier said, adding that transient inflammation was the most common side effect. Other complications, including cases of endophthalmitis, central retinal vein occlusion and uveitis, resolved completely, he noted.

The study was an off-label use of the VEGF inhibitor, Dr. Heier said. Genentech is currently enrolling patients for two phase-3 trials.

Combination of ILM removal, vitrectomy can resolve macular edema

Removing the internal limiting membrane while performing vitrectomy may offer patients with severe refractory macular edema a permanent resolution, according to a surgeon speaking here.

Ferenc Kuhn, MD, PhD, of Birmingham, Ala., and colleagues in Hungary conducted a review of 30 consecutive eyes that underwent vitrectomy with ILM peeling, followed for a mean of 7 months. All of the eyes had undergone previous laser therapy, but none received intraoperative laser therapy or steroid injections at the time of vitrectomy.

“The driving force is the unsuccessful previous treatment,” Dr. Kuhn said of the study’s inclusion criteria.

ILM removal resulted in complete resolution of the edema in 90% of the eyes and partial resolution in 10% without recurrence, Dr. Kuhn told attendees.

Of the 30 eyes, 76% had improved visual acuity, with a mean improvement of 3.3 lines. For the 7% of patients in whom visual acuity worsened, cataract formation was responsible, Dr. Kuhn said.

Combined vitrectomy with ILM peeling may offer an alternative to laser treatment, which halts the progression of the edema but does not improve vision, and Kenalog (triamcinolone acetonide, Bristol-Myers Squibb) injections, which can be followed in the long term by relapses, Dr. Kuhn said. The effect of this procedure is slower, he added, but is more likely to result in permanent results.

Younger patients show best response to PDT, surgeon reports

Eleven surgeons receive ASRS Film Festival awards

NEW YORK — Surgeons were recognized not only for their skills in the operating room but also for their skills behind a camera here at the American Society of Retina Specialists meeting. Mark Forchette, global director of vitreoretinal marketing for Alcon, joined David R. Chow, MD, to present the 2003 Film Festival awards at the ASRS meeting. The judges watched a record 6 hours of film, Dr. Chow said, before choosing 11 winners based on originality, educational content, audiovisual quality, writing, editing and effectiveness. Didier Ducournau, MD, of Nantes, France, received the highest award, “Best in Show,” for his film, “Juxtapapillary Cyst-Like Lesions of RPE and Choroidal Origin.” Ten winners also received the “Rhett Buckler” award. They were: Orit Vidne-Hay, MD, of New York, for “Ocular Amyloidosis”; Ferenc Kuhn, MD, PhD, of Birmingham, Ala., for “Is This the Right Instrument for Intraocular Foreign Body Removal?”; Carl C. Awh, MD, of Nashville, Tenn., for “Lord of the Lens Rings”; Stanley Chang, MD, of New York, for “Scleral Transparency in High Myopia”; Cesare Forlini, MD, of Ravenna, Italy, for “‘Pole to Pole’ Surgery in Trauma Case”; Salil S. Gadkari, MD, for “It’s Not Done!”; Jerzy Nawrocki, MD, of Lodz, Poland, for “Vitreous Surgery with the Use of Trypan Blue Staining for PVR Retinal Detachment”; Wai-Ching Lam, MD, FCRSC, of Toronto for “Laser Photocoagulation of Threshold Retinopathy of Prematurity”; and Andre C. Maia, MD, of São Paulo, Brazil, for “Blues.” Alcon sponsored the awards, which were reviewed by a panel of ASRS judges.

Patients age 30 and under may have greater success after photodynamic therapy than patients in other age groups, according to a surgeon speaking here.

In a retrospective study of nine eyes of eight patients, Joseph M. Civantos, MD, of Joliet, Ill., found that younger patients needed fewer PDT re-treatments and achieved greater visual acuity than older patients.

All of the patients presented with classic choroidal neovascularization (CNV) and small lesions, Dr. Civantos noted. The patients had CNV due to ocular histoplasmosis, multifocal choroiditis, Best’s disease, chorioretinal scarring or idiopathic origins.

On average, the patients required 1.8 PDT sessions per eye, Dr. Civantos told attendees. In comparison, patients in the Treatment of Age-Related Macular Degeneration with PDT (TAP) needed 4.4 sessions, while those in the Verteporfin in PDT (VIP) study required 4.1 sessions, he noted.

Visual acuity improved for eight of the patients and remained unchanged for one patient. The mean preoperative visual acuity was 20/50, which improved to 20/30 postoperatively, according to Dr. Civantos. TAP patients improved from 20/160 to 20/80, and VIP patients improved from 20/100 to 20/50, he added.

Surgeon: Use sutures to prevent silicone oil toxicity in aphakic eyes

Retention sutures may help prevent silicone oil toxicity in patients with partial or complete aniridia, according to a surgeon speaking here.

Ronald C. Gentile, MD, explained that the risk of toxicity has “always been a contraindication” for using silicone oil after iridectomy in patients with aphakia. But that might change, he noted, with the use of a polypropylene suture technique to prevent corneal touch.

In this technique, polypropylene sutures are placed at 1-mm intervals across the anterior chamber postoperatively to simulate an iris diaphragm, Dr. Gentile said. The sutures prevent silicone oil from entering the anterior chamber even while the patient is supine, he noted. Dr. Gentile confirmed this using ultrasound biomicroscopy.

Six eyes underwent the suture technique. The technique failed in two eyes that developed hypotony but was successful in four, Dr. Gentile said. The sutures prevent silicone oil from entering the anterior chamber even while the patient is supine, he noted. Dr. Gentile confirmed this using ultrasound biomicroscopy.

Six eyes underwent the suture technique. The technique failed in two eyes that developed hypotony but was successful in four, Dr. Gentile said.

Study shows vitrectomy may protect eyes from AMD

Eyes that undergo vitrectomy may have decreased risk of developing age-related macular degeneration, according to Tongalp H. Tezel, MD.

Dr. Tezel told attendees that eyes that underwent vitrectomy with posterior hyaloid separation had a decreased odds ratio for developing AMD.

Dr. Tezel’s study tracked the incidence of AMD in the eyes of 222 patients who were treated for either macular holes or macular puckers. During a mean follow-up of 22 months, the study compared the patients’ vitrectomized eyes to their nonvitrectomized fellow eyes.

Dr. Tezel said three vitrectomized eyes and seven nonvitrectomized eyes developed AMD. Using Kaplan-Meier product limit estimates, Dr. Tezel estimated a 0.13 probability of developing AMD after vitrectomy compared to a 0.30 probability if vitrectomy is not performed.

The possible reasons behind this difference, “may include the relief of traction on the retinal pigment epithelium sensory retina complex, down-regulation of angiogenic stimulus due to increased oxygen diffusion and release of anti-angiogenic cytokines during or after the surgical trauma,” Dr. Tezel said.

Study: ‘Best’ acuity outcomes may bias reports

“Best” or “final” outcomes are often reported but rarely defined, according to a study of the three most commonly cited ophthalmic clinical journals.

“The background for this (study) is we felt that ‘best’ and ‘final’ vision might have the potential to overestimate good vision or underestimate bad vision, but a condition may gain or lose vision beyond the time that the vision is recorded,” said David A. DiLoreto Jr., MD, PhD, here at the American Society of Retina Specialists annual meeting.

An evaluation of 527 clinical studies published in the American Journal of Ophthalmology, Archives of Ophthalmology and Ophthalmology between January and December 2000 found that 195 reported visual acuity as an outcome measure. Of those, one reported “best” visual acuity, six reported both “best” and “final” visual acuities and 113 reported only “final” visual acuity.

“Only two of the 120 articles that used either best or final visual acuity briefly commented on the potential bias of reporting vision this way,” Dr. DiLoreto said.

“Our recommendation would be that authors, reviewers and editors recognize the potential shortcomings of vision reported this way. If best or final visual acuity outcomes must be used, the rationale for their use must be justified,” he said.

This presentation was the winner of the 2003 Bausch & Lomb Fellows’ Forum Research Award.

For Your Information:

• The 2004 meeting of the American Society of Retina Specialists will be held Aug. 16-20, 2004, at the Hotel Del Coronado in San Diego. For registration information, contact Cordie Miller at (530) 566-9181; fax: (530) 566-9192; cordie@vitreoussociety.org.