Transcript Genigraphics Research Poster Template 24x48

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
Introduction
Results
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.
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).
Mean oedema thickness at different timepoints
600
Discussion
Mean gain in lines at each timepoint
3.1
Previous number of injections (% eyes)
500
2.6
15.3%
0 injections
400
2.1
1 injection
7.7%
46.2%
300
2 injections
7.7%
1.6
4 injections
200
23.1%
≥ 8 injections
1.1
100
Our open pilot study indicates that highdose 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
0
INITIAL
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.
6 wks
3 mos
4.5 mos
6 mos
9 mos
12 mos
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).
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.
* Corresponding author at Ophthalmos Research and Educational Institute.
Morfou 48, Engomi Nicosia, 2417 Cyprus.
E-mail address: [email protected] (Dr. Tassos Georgiou)
Ophthalmos Research and
Educational Institute
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.
0.6
6 wks
3 mos
4.5 mos
6 mos
9 mos
12 mos
Looking at the above graph we can see that on average there is a gain The pie chart shows the number of injections that
each eye had before starting treatment with EPA/DHA.
in lines of vision and this gain in lines increases as time goes by. At
46.2% had no previous injections and 15% had 8 or
twelve months there was 2.9 lines (14.5 letters) of visual acuity gain.
more.
During treatment with EPA/DHA none of the
patients had intravitreal injections.
Cases
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.
References
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.