Results of a study by investigators at the Johns Hopkins University School of Medicine’s Wilmer Eye Institute showed that intraocular injections of ranibizumab significantly reduced foveal thickness and improved visual acuity in patients with diabetic macular edema (DME). The results demonstrate that vascular endothelial growth factor (VEGF) is an important therapeutic target for DME.

In the nonrandomized study, 10 patients with chronic DME received intraocular injections of 0.5 mg of ranibizumab, a specific antagonist of VEGF, at baseline and at one, two, four and six months. The primary outcome was change in foveal thickness between baseline and seven months; secondary outcome measures were changes from baseline in visual acuity and macular volume.

Mean values at baseline were 503 microns for foveal thickness, 9.22 mm(3) for macular volume and 28.1 letters (20/80) read on an Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity chart. At seven months (one month after the fifth injection), the mean foveal thickness was 257 microns--a reduction of 246 microns (85 percent of the excess foveal thickness present at baseline). The macular volume was 7.47 mm(3), which was a reduction of 1.75 mm(3) (77 percent of the excess macular volume at baseline). Mean visual acuity was 40.4 letters (20/40), an improvement of 12.3 letters. The injections were well-tolerated with no ocular or systemic adverse events.

The authors of this study suggest that a randomized, controlled, double-masked trial is needed to test whether intraocular injections of ranibizumab provide long-term benefit to patients with DME.

Researchers at the University of Toronto’s Hospital for Sick Children conducted a retrospective chart review of patients diagnosed with juvenile idiopathic arthritis (JIA) to determine whether treatment with tumor necrosis factor alpha (TNFalpha)-blocking agents alters the incidence of new-onset uveitis.

The authors of the study reviewed the charts of 1,109 patients with a diagnosis of JIA seen at the clinic between January 1, 1996, and June 30, 2003, seeking diagnosis of uveitis and treatment with TNFalpha inhibitors. They performed Cox regression analysis with anti-TNFalpha treatment as a time-dependent covariate for risk of development of uveitis and identified 70 patients treated with anti-TNFalpha without a prior diagnosis of uveitis. Two of these 70 patients (2.9 percent), both treated with etanercept, had development of new-onset uveitis during anti-TNFalpha therapy. One had juvenile psoriatic arthritis diagnosed 4.1 years before onset of uveitis. The other had extended oligoarticular JIA diagnosed 6.4 years before onset of uveitis.

The investigators found no statistically significant difference in the risk for development of uveitis between patients with or without anti-TNFalpha treatment. They concluded that in patients with JIA, anti-TNFalpha treatment did not alter the risk for development of new-onset uveitis. However, anti-TNFalpha therapy with etanercept did not prevent the development of uveitis.