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Lucentis in the Treatment of Diabetic Macula Oedema

This presentation aims to improve understanding of Lucentis and its role in treating visual impairment caused by diabetic macula oedema. It covers topics such as the mechanism of action, efficacy, safety, and practical guide to administering Lucentis.

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Lucentis in the Treatment of Diabetic Macula Oedema

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  1. Dr Dan Bwonya Mengo Hospital, The Role of Lucentis in the treatment of Visual impairment due to Diabetic Macula Oedema

  2. Objective of the Presentation • To improve our understanding on: • What is Lucentis (RANIBIZUMAB)? • What is Diabetic Macula Oedema (DME) • Mechanism of action of Lucentis on DME • Rationale for the use of Lucentis • Efficacy and safety of Lucentis • How to use Lucentis in clinical setting

  3. What is Lucentis? • Humanised monoclonal antibody that binds to VEGF-A • Antibodies – • 5types, IgG is >75% • Monoclonal : • single clone, for specific antigen & produced from B cells in large quantities

  4. Diabetic Macula Oedema • Pathological accumulation of fluid in the intra-retinal layers of the macula • Results from damage of BRB from VEGF • DME is leading cause of VI among Diabetic patients • If not treated > 50% will loss 12lines of VA in 2yrs

  5. Rational for use of Lucentis • VEGF concentrations are Elevated in eyes with DME • VEGF disrupts BRB causing hyper permeability • Reverses some of the damage caused by the effect of excess VEGF

  6. Mode of action of Lucentis • Binds and has high affinity for VEGF-A Isoforms (110,121,1650) • Prevents VEGF to bind to its VEGFR • Inhibits angiogenesis • Revervses some effects of VEGF over expresion

  7. Efficacy and Safety of Lucentis • Registration Trials where Resolve and Restore RESOLVE trial • Compared safety and efficacy of 2 doses of Lucentis (0.3mg and 0.5mg) • Results: • Patients gained significantly more letters at 12 months with treatment Vs sham

  8. Efficacy and Safety of Lucentis cct RESTORE study, • Compared efficacy and safety of Lucentis as adjunct therapy or monotherapy • Results: • Patients gained signifincantly more letters with Lucentis to either monotherapy or adjunct to laser therapy

  9. Efficacy and Safety of Lucentis cct DRCR.net Protocal I trial • Demonstrated that Lucentis 0.5mg combined with prompt Laser or differed laser of DME provide rapid and sustained VA gain in 12M READ-2 study • Demonstrated 0.5mg Lucentis monotherapy or combined with laser Vs laser monotherapy showed rapid and sustained VA gain over 2yrs

  10. Safety of Lucentis • Well tolerated in patients • Associated side effects • UTI, Cardiovascular and celebravascular accidents • Ocular side effect like: pain, redness, infection, cataract and raised IOP

  11. Other studies about Lucentis • RESTORE extention • RISE • RIDE • REVEAL • RETAIN

  12. Initiating treatment • Following diagnosis of DME • Give minimum of three treatment of Lucentis • Re-assess patient VA • Then modulate treatment accordingly

  13. When to stop treatment • Decided on BCVA and Macula OCT • If 3 consecutive treatment given without VA gain

  14. Practical guide in administering Lucentis • Dilate Pupil • Apply Topical anaesthesia • Clean per ocular skin and lids with 10% Povidone- Iodine • Drape patient • Apply sterile lid speculum • Instil 5% povidoni iodine • ophthalmicsolution and wait for 90 seconds • Rinse the eye with saline solution

  15. Practical guide in administering Lucentis • Direct the patients to look away the injection site. • Mark an injection site at 3.5 – 4.00mm posterior to Limbus • Avoid horizontal meridian • Aim at the centre of the globe

  16. Thank you

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