On this episode of Retina Mentor Moments, John W. Kitchens, MD, sits down with Danny A. Mammo, MD, to discuss how physicians can integrate and expand patient cases into full studies, and review findings from recent studies on both uveitis and retinal disease.
Dr. Mammo is a vitreoretinal surgical and uveitis specialist at the Cole Eye Institute, Cleveland Clinic, in Cleveland, Ohio.
Transitioning from fellowship to faculty
Dr. Mammo completed a retina fellowship at the Cole Eye Institute in 2022 and explained the perks of working in the same location where he did his medical training, such as already having familiarity with the referring physicians and transitioning quickly to managing a high volume of patients.
He also discussed how working closely with uveitis specialists during his retina fellowship and seeking out mentorship early on as an attending gave him a broader understanding of uveitis, while simultaneously developing his skills as a vitreoretinal surgeon.
In the full interview, Drs. Mammo and Kitchens discussed how residents and fellows can make the most of their unique learning environment during training.
Clinical research in uveitis and retinal disease
Dr. Mammo noted that the majority of his research interests are inspired by his clinic and the patients he treats. For example, he took over managing uveitis patients with a high risk of intraocular pressure (IOP) elevation, such as those with glaucoma, ocular hypertension, and a history of steroid response, which inspired him to identify an alternative treatment to currently-used injectable steroids for these patients.
The effect of triamcinolone acetonide on IOP in patients with uveitic macular edema
Around this time, XIPERE (suprachoroidal triamcinolone acetonide injectable suspension, Bausch + Lomb and Clearside Biomedical) received US Food and Drug Administration (FDA) approval for the treatment of uveitic macular edema.1
Dr. Mammo compared the results from the phase 3 clinical trial (PEACHTREE [NCT02595398]) and extension study (MAGNOLIA [NCT025952001]) of XIPERE and noticed that patients tended to have a lower IOP response in comparison to the clinical trial data for intravitreal fluocinolone acetonide and dexamethasone implants.2,3
Consequently, he recommended suprachoroidal triamcinolone acetonide to certain higher-risk uveitis patients and contacted other uveitis specialists who were early adopters of the drug. They pooled the treatment outcomes from these high-risk uveitis patients into a multicenter, real-world study that Dr. Mammo presented at the annual American Society of Retinal Specialists (ASRS) conference this summer.3
For a discussion of the results of the study and advice on how to inject suprachoroidal triamcinolone acetonide, watch the full interview!
Fluocinolone acetonide implant for noninfectious uveitis
Dr. Mammo also discussed the 24-month safety outcomes from the CALM study, which was a phase 4 retrospective, real-world, registry study of an intravitreal 0.18mg fluocinolone acetonide implant (i.e., YUTIQ, Alimera Sciences) for the treatment of noninfectious uveitis.4 He went on to outline which types of patients are optimal candidates for the long-term fluocinolone acetonide implant.
Intravitreal injection intervals after rhegmatogenous retinal detachment repair
The pair then discussed a study published in Ophthalmology Retina, of which Dr. Mammo was the first author. The expressed purpose of the study was “to identify the characteristics of neovascular age-related macular degeneration (nAMD) in patients undergoing pars plana vitrectomy (PPV) following rhegmatogenous retinal detachment (RRD), including changes to injection intervals.”5
While the exact reason why remains unclear, they found that a notable portion (64.7%) of the patients in the study required fewer injections and/or had longer intervals between injections following retinal detachment surgery with vitrectomy.5 During the interview, Drs. Mammo and Kitchens discussed their hypotheses for this finding, and a similar trend that they have observed in patients with infectious endophthalmitis.
The relationship between proliferative vitreoretinopathy and keloids
Dr. Mammo was also the first author on another study that was recently published in Ophthalmology, examining the association between cutaneous keloids, hypertrophic scarring and fibrosis, and the risk of post-operative proliferative vitreoretinopathy (PVR) after RRD repair.6
This study was inspired by one of Dr. Mammo’s patients, who had significant PVR prior to RRD repair and developed conjunctival keloids shortly after the procedure. These symptoms, as well as the presence of many keloids on the patient’s body, motivated Dr. Mammo to investigate the potential connection between PVR and keloids/hypertrophic scars.
To learn more about the reason for this potential association and Dr. Mammo’s insights into leading a clinical study, make sure to watch the full interview.
Conclusion
Ophthalmologists are in a unique position to answer clinically relevant questions with studies due to the smaller size of the community, explained Dr. Mammo.
Most surgeons are only two to three degrees of separation away from one another—highlighting the opportunity for collaboration and data collection that can lay the foundation for further advancement in medical therapies, surgical procedures, and practice guidelines.
