No consensus exists for AMD treatment in Brazil

BRASILIA — Although no true consensus currently exists in Brazil for the treatment of age-related macular degeneration, current and new techniques are undergoing scrutiny and continuous development, with one new treatment showing particular promise, according to a surgeon speaking here.

Michel Eid Farah Neto, MD, discussed current and emerging AMD treatments at the Brazilian Congress of Ophthalmology.

"There is not a clear answer based on clinical studies" and practical application, Dr. Neto said.

Well-evaluated and commonly used treatments, such as laser, often are not as effective as many physicians would desire. Also, safer, more effective therapies recently developed have a high cost of treatment, he said.

"It is different for us to apply monthly injections" such as is recommended with Avastin (bevacizumab, Genentech) and Lucentis (ranibizumab, Genentech), Dr. Neto said. "In addition to high cost, it is inconvenient."

Dr. Neto presented two techniques that he has found helpful: one an adaptation of a current treatment and one a new treatment in clinical study.

The first technique involves delivering antiangiogenic intravitreal injections through a tunnelized method rather than a traditional perpendicular injection. This decreases the possibility of post-injection reflux.

"We do not create a path for the reflux," he said.

Dr. Neto also discussed 6-month data for patients treated with brachytherapy combined with bevacizumab, which is currently being evaluated internationally by NeoVista. The treatment involves performing a 25 gauge vitrectomy followed by 4 minutes of radiation and an injection of bevacizumab.

Dr. Neto said the approach showed promise. At 6 months, patients had gained an average of 13.4 letters of vision. For comparison, patients treated in the ANCHOR study, which looked solely at ranibizumab, had gained an average of 11.3 letters, he said.