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Genigraphics® has been producing output from PowerPoint® longer than anyone in the industry; dating back to when we helped Microsoft® design the PowerPoint® software. US and Canada: 1-800-790-4001 Email: info@genigraphics.com [This sidebar area does not print.] High-Dose Omega-3 Fatty Acids for Cystoid Macular Oedema due to Chronic Uveitis or Branch Retinal Vein Occlusion Tassos Georgiou*, Dana M F Photiou, Despina Nikolaou, Anastasia Neokleous, Soulla Michael, Christina Ikonomou Ophthalmos Research and Educational Institute, Nicosia, Cyprus * Corresponding author at Ophthalmos Research and Educational Institute. Morfou 48, Engomi Nicosia, 2417 Cyprus. E-mail address: tassosgeorgiou@hotmail.com (Dr. Tassos Georgiou) The sample included 13 eyes (5 left, 8 right) of 11 patients (5 females, 6 males). Their average age was 58.9 years, ranging from 10 to 78 years, with a standard deviation of 19.6 years (i.e. 58.9±19.6). Introduction Material : The Inflammation Research Foundation, Marblehead, MA, supplied the omega-3 fatty acid concentrates for the study. The omega-3 concentrates consisted of purified ethyl esters rich in EPA (400 mg) and DHA (200 mg) per gram for the liquid formulation. The dosage used in these pilot studies was 10 ml of the liquid formulation providing approximately 3.4 grams of EPA and 1.6 grams of DHA per day. The dosage was divided into two daily doses of 5 ml each. Method: Five eyes with BRVO and 8 eyes with chronic uveitis that had macular oedema were treated with high doses of omega-3 fatty acids administered orally in liquid form. The best corrected visual acuity using the ETDRS electronic chart and macular thickness using the OCT scan was noted for a follow up of 1 year. Our open pilot study indicates that high- dose omega-3 fatty acids (5 grams of EPA and DHA per day) represents a potentially powerful new therapeutic approach in the treatment of cystoid macular oedema associated with branch retinal vein occlusion and chronic uveitis. The nearly 3 lines of vision improvement can be contrasted to the 1-3 lines of vision improvement with monthly injections of ranibizumab (2,3). We hypothesize that the high-dose omega-3 fatty acids have a strong anti-inflammatory and anti-angiogenic effects on the retina. Such effects have been observed in animal studies (4). The limitations of these preliminary studies are (a) the limited number of subjects studied, (b) the lack of a placebo-controlled treatment group, and (c) the blood levels of the omega-3 fatty acids and their anti-inflammatory metabolites (resolvins) where not measured to correlate with the improvement of the vision. Additional clinical trials to address these limitations are currently in progress. Methods and Materials Discussion Retinal diseases such a branch retinal vein occlusion (BRVO) and chronic uveitis can result in severe visual loss. The resulting cystoid macular oedema (CMO) causes damage to the photoreceptors and reduction of visual acuity. There is evidence that inflammation is a key mediator of both endothelial cell damage and blood retinal barrier breakdown (1). Primary treatment for BRVO is the intravitreal injections of anti-VEGF antibodies. The primary treatment for chronic uveitis is intraviteal injections of corticosteroids suggesting that macular oedema secondary to uveitis is the result of chronic inflammation. Current treatments for CMO for BRVO and chronic uveitis have many side effects including risk of blindness from infection, retinal detachment, cataracts and high intraocular pressure requiring surgery. We hypothesized that high-dose omega-3 fatty acids may provide an alternative treatment. This pilot study was done to support that hypothesis. Results Ophthalmos Research and Educational Institute The graph above shows that thickness has reduced, on average, at each time point in relation to the initial measurement. Looking at the above results, we can see that there was a significant reduction in oedema thickness compared to the initial thickness at all time points (all p-values<0.01). Looking at the above graph we can see that on average there is a gain in lines of vision and this gain in lines increases as time goes by. At twelve months there was 2.9 lines (14.5 letters) of visual acuity gain. The pie chart shows the number of injections that each eye had before starting treatment with EPA/DHA. 46.2% had no previous injections and 15% had 8 or more. During treatment with EPA/DHA none of the patients had intravitreal injections. Cases 78 year old female who had complicated cataract op 2 years previously. There was vitreous to the corneal wound. She was treated with steroids/NSAIDS drops and avastin injections previously. She was treated with 5g Omega 3 fatty acids on 16/1/12. The CMO gradually resolved and visual acuity improved by 1 line. 78 year old female who had complicated cataract op 2 years previously. There was vitreous to the corneal wound. She was treated with steroids/NSAIDS drops and avastin injections previously. She was treated with 5g Omega 3 fatty acids on 16/1/12. The CMO gradually resolved and visual acuity improved by 1 line. 64 year old Male with BRVO was treated with Avastin/kenalog injection on 23/1/12. The CMO returned on 2/4/12 as shown on OCT scan and he was started on Omega 3 fatty acids. The CMO gradually resolved and the visual acuity improved by 1 line. 1.Yoshimura T et al. Comprehensive analysis of inflammatory immune mediators in vitreoretinal disease. PLoS One. 2009; 4(12):e8158. 2.Campochiaro PA et al. BRAVO Investigators. Ranibizumab for macular oedema following branch retinal vein occlusion. Ophthalmology 2010; 117:1102-12. 3.Heier SJ et al. Ranibizumab for macular oedema due to retinal vein occlusions. Long term follow up in the HORIZON trial. Ophthalmology 2012; 119:802-809. 4.Connor KM et al. Increased dietary intake of omega-3 polyunsaturated acids reduces pathological retinal angiogenesis. Nature Medicine 2007; 13:868-873. References