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

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

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

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

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

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

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

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

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

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

Other studies about Lucentis RESTORE extention RISE RIDE REVEAL RETAIN

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

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

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

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

Thank you