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

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