08 Sep, 2022

Associate Professor Anthony Kwan has recently performed innovative sight-saving surgery for wet age-related macular degeneration (AMD) on the very first patient in Queensland. This first patient in Queensland (the 14th in Australia) underwent a new type of surgery, the implantation of a prolonged delivery device, to treat wet AMD.

Wet AMD is an advanced form of age-related macular degeneration that can cause rapid and severe vision loss and, eventually, blindness. A growth factor called vascular endothelial growth factor (VEGF), a protein produced by cells that regulates the formation of blood vessels, is thought to be involved in the formation and leakiness of abnormal blood vessels. These abnormal blood vessels leak blood or fluid in the macula (the central part of the retina responsible for sharp, detailed central vision) and form scars that cause central vision to get worse and may result in permanent blind spots in people with wet AMD. Anti-VEGF is a medicine that blocks the growth factor VEGF and can slow the growth of and leakage from the abnormal blood vessels in the eye and may prevent or slow vision loss.

Currently, the primary treatment for wet AMD is regular injections of anti-VEGF directly into the eye. These injections are administered indefinitely at regular intervals (commonly between four to twelve weekly depending on the disease activities). The frequency of these injections is time-consuming and poses an emotional and financial burden to the patients and their families.

Surgery on patient with wet age-related macular degeneration
Surgery on patient with wet age-related macular degeneration

Following successful international clinical trials, the Food and Drug Administration (FDA) in the USA approved a new treatment for wet AMD in 2021. This new treatment is the surgical implantation of an implant (the Port Delivery System, PDS) that can slowly release the anti-VEGF medication within the eye (over 24 to 36 weeks). This device is not approved for clinical use in Australia at present. This trial at QEI is focused on assessing the good or bad effects of anti-VEGF delivered by this PDS on participants with wet AMD. The implant is slightly longer than a grain of rice. The eye implant will be covered by the thin, transparent mucosa covering the eye (conjunctiva) and is usually not visible to others as the upper eyelid hides it. The implant, intended to remain life-long in the eye unless removed for medical reasons, releases anti-VEGF continuously over a long period into the eye, and our study doctor can refill it. There are now 73 sites worldwide, including Australia, Italy, Brazil, Austria, Belgium, the UK, Spain, Taiwan, Switzerland and France, which offer this treatment on a clinical trial basis.

QEI is the only site in Queensland able to offer this device to specialised selected trial patients. The selected trial patient will undergo a surgical implantation procedure in the operating room in this research project. The PDS implant is pre-filled with anti-VEGF medication, which slowly releases the medication inside the eye. Part of the trial is determining the optimum duration between refills. Therefore, participants will have the implant refilled at either 6 or 9-month intervals.

It has been over a month since the implantation procedure. Associate Professor Kwan states, “The operation has been a success, and the patient is doing exceptionally well with no complication. The patient’s vision is maintained, and he is happy to be part of this ground breaking treatment. We are looking forward to recruiting more patients in the coming months.”


Click here to read the full article in Insight.