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    <recommendedItem id="20090101_19_1184"
                     title="Intravitreous Pegaptanib Could Halt Vision Loss"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Ophthalmology/GeneralOphthalmology/tb/13802?impressionId=1265801253587"
                     
       SAN FRANCISCO, April 17 -- Intravitreous injections of pegaptanib (Macugen) may help prevent further vision loss from central retinal vein occlusion, but does little to reverse it, researchers found.
              &lt;p&gt; 
              &lt;p&gt;Patients injected with the drug to treat macular edema from central retinal vein occlusion were no more likely to gain at least 15 letters on a visual acuity test than those who got sham injections (&lt;em&gt;P&lt;/em&gt;=0.48 for the 0.3-mg dose and &lt;em&gt;P&lt;/em&gt;=0.35 for the 1-mg dose). 
              &lt;p&gt; 
              &lt;p&gt;Despite disappointing findings for the primary endpoint of this randomized phase II trial, secondary analyses suggested some benefits from pegaptanib, John J. Wroblewski, M.D., of Cumberland Valley Retina Consultants in Hagerstown, Md., and colleagues reported in the April issue of the &lt;em&gt;Archives of Ophthalmology&lt;/em&gt;.
              &lt;p&gt; 
              &lt;p&gt;Substantially fewer pegaptanib-treated patients lost 15 or more letters in visual acuity compared with controls (9% at 0.3 mg and 6% at 1 mg versus 31% with sham, &lt;em&gt;P&lt;/em&gt;=0.03 and &lt;em&gt;P&lt;/em&gt;=0.01, respectively).
              &lt;p&gt; 
              &lt;p&gt;The vascular endothelial growth factor (VEGF) antagonist was also associated with nonsignificant trends for less central retinal thickness and neovascularization.
              &lt;p&gt; 
              &lt;p&gt;&quot;This is the first randomized, controlled, 30-week, pharmacologic trial that has shown any treatment benefit for central retinal vein occlusion compared with sham,&quot; the researchers noted.
              &lt;p&gt; 
              &lt;p&gt;They said they were particularly encouraged because until now, none of the treatments secondary to the condition that were suggested by uncontrolled studies have panned out.
              &lt;p&gt; 
              &lt;p&gt;Another anti-VEGF drug, bevacizumab (Avastin), has also been shown to improve short-term visual acuity and macular edema secondary to central retinal vein occlusion in small, uncontrolled studies.
              &lt;p&gt; 
              &lt;p&gt;But &quot;it is uncertain if all anti-VEGF drugs will share similar safety profiles in the context of retinal vein occlusions,&quot; Dr. Wroblewski&apos;s group said.
              &lt;p&gt; 
              &lt;p&gt;Pegaptanib is a selective inhibitor of VEGF, whereas some preclinical experiments suggested that nonselective inhibition increased apoptosis of retinal neurons in ischemic conditions such as central retinal vein occlusion, they said.
              &lt;p&gt; 
              &lt;p&gt;The dose-ranging, multicenter study included 98 patients who had been diagnosed with central retinal vein occlusion over the previous six months.
              &lt;p&gt; 
              &lt;p&gt;They were randomly assigned to receive intravitreous injections of either 0.3-mg or 1-mg pegaptanib, or a sham, every six weeks for 24 weeks.
              &lt;p&gt; 
              &lt;p&gt;At 30 weeks, there was no difference in the number of patients who reached the primary endpoint of a 15 or more letter gain in visual acuity from baseline with 0.3- or 1-mg pegaptanib compared with sham injections (36% and 39% versus 28%, &lt;em&gt;P&lt;/em&gt;=0.48 and &lt;em&gt;P&lt;/em&gt;=0.35, respectively).
              &lt;p&gt; 
              &lt;p&gt;But pegaptanib improved mean visual acuity at both the 0.3- and 1-mg dose with an average gain of 7.1 and 9.9 letters, respectively, whereas the control group lost an average of 3.2 letters (&lt;em&gt;P&lt;/em&gt;=0.09 and &lt;em&gt;P&lt;/em&gt;=0.02). 
              &lt;p&gt; 
              &lt;p&gt;While none of the secondary anatomical outcomes showed significant differences between groups, there were signals for benefit with VEGF inhibition.
              &lt;p&gt; 
              &lt;p&gt;At the 0.3- and 1-mg doses, pegaptanib resulted in 95 and 31 ?m lower mean reduction in retinal thickness at the center point, compared with sham injections, from baseline to week 30 (both &lt;em&gt;P&lt;/em&gt;=NS).
              &lt;p&gt; 
              &lt;p&gt;The drug also tended to be associated with less retinal or iris neovascularization (3% at both doses versus 9% with sham, &lt;em&gt;P&lt;/em&gt;=0.29).
              &lt;p&gt; 
              &lt;p&gt;The researchers noted no new safety signals with pegaptanib and no serious ocular adverse events, sustained intraocular pressure, or systemic adverse event risk.
              &lt;p&gt; 
              &lt;p&gt;&quot;Pegaptanib may provide a clinically important treatment option for patients with macular edema following central retinal vein occlusion,&quot; such that a phase III clinical trial seems warranted, the researchers concluded.
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt; This study was supported by (OSI Pharmaceuticals) Eyetech and Pfizer.
              &lt;p&gt; 
              &lt;p&gt;Dr. Wroblewski and a co-author reported being consultants to (OSI Pharmaceuticals) Eyetech. Other researchers reported being consultants to or employees of (OSI Pharmaceuticals) Eyetech, Jerini Ophthalmic, and Pfizer. One researcher reported officership in, ownership in, and compensation from (OSI Pharmaceuticals) Eyetech.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_3442"
                     title="AAO: Myopia May Minimize Diabetic Eye Damage (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAO/tb/16671?impressionId=1265801253587"
                     
      &lt;p&gt;SAN FRANCISCO  --  Nearsightedness may paradoxically reduce the chances of retinopathy for patients with diabetes, researchers affirmed.&lt;/p&gt;
&lt;p&gt;The more myopic the eye, the lower the risk of any severity of diabetic retinopathy (&lt;em&gt;P&lt;/em&gt;=0.041 to &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001), Laurence S. Lim, MD, of the Singapore National Eye Centre, and colleagues reported here at the American Academy of Ophthalmology meeting.&lt;/p&gt;
&lt;p&gt;In their population-based study, myopia of -0.5 diopters or worse was associated with a significant 37% reduced risk of diabetic retinopathy overall and 53% lower risk of moderate retinopathy compared with farsightedness.&lt;/p&gt;
&lt;p&gt;These results for the first time confirm what most ophthalmologists have long suspected, Lim said. &quot;It&apos;s a very common clinical impression.&quot;&lt;/p&gt;
&lt;p&gt;Rather than a circumstantial link, his group speculated that the shape of the eye can be protective.&lt;/p&gt;
&lt;p&gt;As the eye gets longer, the retina gets stretched out and can atrophy. While this would cause vision problems under other circumstances, atrophy lowers the metabolic needs of the retina  --  a plus under diabetic conditions with reduced blood flow supplying oxygen to the retina.&lt;/p&gt;
&lt;p&gt;&quot;It matches the blood supply better,&quot; Lim said, noting that insufficiency can stimulate neovascularization.&lt;/p&gt;
&lt;p&gt;Other contributors may be the greater frequency of posterior vitreous detachment and vitreous syneresis in myopia, which &quot;removes the vitreous scaffold for neovascularization and also improves oxygen circulation in the vitreous cavity.&quot;&lt;/p&gt;
&lt;p&gt;The researchers analyzed findings from the Singapore Malay Eye study, which was a population based, cross-sectional study of adults ages 40 to 79.&lt;/p&gt;
&lt;p&gt;Among the 3,280 participants in the study, 20.6% had diabetes identified from physician diagnosis, self-reported use of antidiabetic medications, or a blood glucose level of at least 200 mg/d.&lt;/p&gt;
&lt;p&gt;As refractive error declined across the range from farsighted to normal to mild and then moderate nearsightedness, the risk of any diabetic retinopathy  --  determined from retinal photographs  --  dropped by 41% (&lt;em&gt;P&lt;/em&gt;=0.009 for trend) and that of moderate severity by 82% (&lt;em&gt;P&lt;/em&gt;=0.015).&lt;/p&gt;
&lt;p&gt;Vision-threatening retinopathy  --  defined as severe nonproliferative diabetic retinopathy, proliferative diabetic retinopathy, or clinically-significant macular edema  --  showed the same pattern, although the drop was not significant.&lt;/p&gt;
&lt;p&gt;Another first from the study was the correlation between retinopathy and the actual dimensions of the eye, rather than just vision categories.&lt;/p&gt;
&lt;p&gt;Every diopter decrease in spherical equivalent was linked to a 10% drop in overall diabetic retinopathy risk (&lt;em&gt;P&lt;/em&gt;=0.002), a 17% lower risk of moderate retinopathy (&lt;em&gt;P&lt;/em&gt;=0.001), and a 23% reduced risk of vision-threatening retinopathy (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Likewise, longer axial length was associated with up to a 23% reduced risk of diabetic retinopathy overall, with a 14% lower risk with every millimeter increase (&lt;em&gt;P&lt;/em&gt;=0.041).&lt;/p&gt;
&lt;p&gt;And the deeper the anterior chamber, the lower the risk, although the change was significant only for the more severe, moderate (&lt;em&gt;P&lt;/em&gt;=0.001 for trend), and vision-threatening (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for trend) forms of diabetic retinopathy.&lt;/p&gt;
&lt;p&gt;Each millimeter increase in depth was associated with a 68% lower risk of moderate retinopathy and an 86% lower risk of vision-threatening retinopathy (both &lt;em&gt;P&lt;/em&gt;=0.001).&lt;/p&gt;
&lt;p&gt;The results suggested that nearsighted patients with diabetes may need less frequent screening for retinopathy, Lim said.&lt;/p&gt;
&lt;p&gt;&quot;Ultimately we hope to come up with a risk score so the clinician can decide how closely to follow the patient,&quot; he said.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by the National Research Council in Singapore.&lt;/p&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_2_652"
                     title="AAO: Triple Therapy Leads to Lasting Improvement in Macular Degeneration"
                     score="-0.006"
                     href="