Stephanie Zhang
Richmond Woodward
Mass Eye & Ear
The morning of Macula 2025 continued with the retinal vascular diseases other than diabetic retinopathy session starting with Dr. Peter Campochiaro’s talk on gene therapy for AMD. He discussed two exciting gene therapies expressing anti-VEGF undergoing clinical trials, Ixo-vec and 4D-150 with promising phase 2 study data. In these trials, mild to moderate inflammation from the therapy was successfully controlled with topical steroid prophylaxis. Ongoing phase 3 studies are still needed to answer remaining questions on the duration of transgene expression, late immune reactions, and other unanswered questions with this new therapy.
Dr. Aleksandra Rachitskaya then presented her talk, “Macular Edema from RVO: Does It Matter Which Anti-VEGF.” She highlighted the importance of developing treatment for macular edema from RVO as RVO is the most prevalent cause of vision threatening retinopathy after diabetic retinopathy. She reviewed the anti-VEGF treatments available for RVO and noted that looking back at studies of what has been approved gives insight into how treatment can be improved. Staring with ranibizumab, Dr Rachitskaya summarized the BRAVO (BRVO) and CRUISE (CRVO) studies. Dr Rachitskaya then reviewed studies for aflibercept 2 mg, including the COPERNICUS (US) and GALILEO (Europe) studies. In the BALATON (BRVO) and COMINO (H/CRVO) phase 3 studies, faricimab was compared to aflibercept. Faricimab’s visual gains at 24 weeks were maintained at 72 weeks with treat and extend intervals. Among the new drugs is aflibercept 8 mg, which is FDA approved for DME and neovascular AMD but not yet for macular edema from RVO. Overall, these studies show the progress that has been made developing drugs to treat macular edema from RVO, with newer therapeutics offering potentially longer treatment duration that can benefit patients through extended dosing intervals.
Next, Dr. Jennifer Lim gave a captivating talk on challenges of managing sickle cell retinopathy. She discussed the need for better early screening as many patients are unaware of their disease status. There are also numerous medical and surgical challenges to the management of disease such as high rates of intraoperative vitrectomy complications like iatrogenic tears and postoperative recurrent detachments. She presented data from the APLS case series in which patients with stage 3 or 4 proliferative sickle cell retinopathy treated with avastin improved several lines of vision. More data will emerge from ongoing prospective studies.
This presentation was followed by the talk, “Treating MacTel: Just Anatomy or Function Too.” Dr. Emily Chew of the NIH reviewed research findings from the MacTel Network and gave an update on the exciting phase 3 studies of a surgically implanted capsule anchored to sclera to produce long term sustained levels of ciliary neurotrophic factor (CNTF). In preclinical models of retinal degeneration with a MacTel-like mouse model, it was found that photoreceptor loss could be rescued by intravitreal injection of CNTF. Based on these results, a CNTF-producing encapsulated cell therapy was developed. The capsule houses NTC-201-6A cells that are retinal pigment epithelial cells with a unique CNTF expression vector directing continuous CNTF release. While potential confounders include different baseline lesions, Phase 3 trials showed NT-501 vs sham preserved more photoreceptors through 24 months. Retinal sensitivity was preserved and reading speed was better preserved in participants receiving NT-501.
Dr. Yoshihiro Yonekawa concluded the session presenting on pediatric retinal vascular diseases, condensing an entire field into an engaging talk with excellent pearls for four diseases: ROP, FEVR, PFV, and Coats disease. He highlighted the key features of each disease— ridges for ROP, radial folds for FEVR, anterior-posterior stalk for PFV, and exudation in Coats— and kept the audience on their toes with a quiz at the end.
Read All Atlantic Coast Retina Club / Macula 2025 Articles:
Mystery Cases 1 & 2
Mystery Cases 3 & 4
Mystery Cases 5 & 6
Mystery Cases 7, 8, 9
Imaging, GA, and IRDs
Keynote Lectures
DR and DME
Choroidal Neovascularization
Retinal Vascular Diseases
Ocular Oncology
Special Topics & Women in Retina