Since its FDA approval, the ranibizumab ocular implant (Susvimo; Genentech, Inc) has become available as a sustained-delivery treatment option for adults with wet age-related macular degeneration (AMD), diabetic macular edema (DME), and diabetic retinopathy (DR).^1,2 By continuously releasing medication over 6 months, the implant reduces the frequency of intravitreal injections, providing an alternative approach for patients requiring long-term anti-VEGF therapy.^1,2

The New York Eye and Ear Infirmary of Mount Sinai (NYEE) was the first center in New York City to offer the implant, according to Gennady Landa, MD, with his team performing their first procedure there last year. Landa is vice chair, clinical integration of ophthalmology, Mount Sinai Health System; director of retina service, NYEEI; and associate professor of ophthalmology, vitreoretinal surgeon at NYEEI in New York, New York.

Now, with additional experience, Landa has practical observations and guidance to share regarding patient selection, surgical technique, and long-term monitoring. In this Q&A conversation with the Eye Care Network, Landa discusses how the implant has influenced treatment approaches, highlights surgical pearls learned from early cases, and outlines considerations for integrating the ranibizumab ocular implant into routine retinal practice.

Note: Transcript edited for clarity and length.

From a surgical and patient-selection standpoint, how has the ranibizumab ocular implant changed your approach to managing treatment burden in patients with wet AMD, and what key anatomic or clinical factors guide your decision to recommend implantation?

Gennady Landa, MD: By adding the [ranibizumab ocular implant] to the repertoire of treatment options for wet AMD, it has introduced a meaningful alternative to repeated intravitreal injections, offering continuous VEGF suppression while reducing treatment burden.

In general, I consider ideal candidates to be proven anti-VEGF responders with a high visit burden who have healthy conjunctiva and Tenon’s tissue, no history of prior conjunctival or glaucoma surgery, low inflammatory or intraocular bleeding risk, and the ability to reliably adhere to scheduled refill-exchange follow-up.

What have been the most significant surgical pearls or challenges you’ve encountered with its implantation, and how have refinements in technique influenced outcomes and complication rates?

Landa: The key surgical lesson with the [ranibizumab ocular implant] for me is careful patient selection, particularly ensuring healthy conjunctiva to allow for reliable closure. Intraoperatively, this includes completing adequate choroidal laser, creating an appropriately sized incision to avoid periprosthetic leakage, and achieving meticulous Tenon’s and conjunctival closure to minimize the risk of implant exposure and endophthalmitis.

Early challenges centered on conjunctival erosion and infection risk, but refinements in surgical technique, device design, and procedural standardization have improved consistency and reduced complication rates.

As data evolve, how do you see the ranibizumab ocular implant fitting into the treatment algorithm for DR and DME, particularly compared with traditional intravitreal injection strategies?

Landa: In DME and DR, I view the [ranibizumab ocular implant] as an important option for carefully selected, chronic, injection-dependent patients who respond well to anti-VEGF therapy but struggle with the burden of frequent visits, rather than as a first-line treatment. Compared with standard intravitreal injections, it trades procedural simplicity for greater durability and a reduced visit burden.

Based on your real-world experience, what long-term efficacy, safety, and patient-adherence considerations should retina specialists weigh when integrating ranibizumab ocular implant into retinal practice?

Landa: Retina specialists should integrate the [ranibizumab ocular implant] with a long-term mindset: careful patient selection (good conjunctiva/Tenon’s, low inflammatory/bleeding risk, no major conjunctival/glaucoma surgery in the target quadrant); thorough patient education (red-flag symptoms and urgency); strict refill-exchange adherence; and vigilant monitoring for early adverse events, because the durability benefits come with implant-specific risks that depend heavily on tissue health and follow-up reliability.

In terms of patient experience, the Pagoda patient-preference data³ support the burden-reduction rationale: using a validated questionnaire, 83% of patients reported preferring [the implant’s] continuous delivery over intravitreal injections, and ~75% cited reduced treatment burden as the main reason—signals that can translate into better long-term adherence when paired with a disciplined surveillance and refill workflow.

Gennady Landa, MD
E: doctor.landa@gmail.com
Landa is vice chair, clinical integration of ophthalmology, Mount Sinai Health System; director of retina service, New York Eye and Ear Infirmary of Mount Sinai (NYEEI); and associate professor of ophthalmology, vitreoretinal surgeon at NYEEI in New York, New York.

References

1. FDA approves Genentech’s Susvimo for diabetic retinopathy. News release. May 22, 2025. Accessed February 20, 2026. https://www.gene.com/media/press-releases/15062/2025-05-22/fda-approves-genentechs-susvimo-for-diab#

2. FDA approves Genentech’s Susvimo as the first and only continuous delivery treatment for the leading cause of diabetes-related blindness. News release. February 4, 2025. Accessed February 20, 2026. https://www.gene.com/media/press-releases/15050/2025-02-04/fda-approves-genentechs-susvimo-as-the-f#

3. Khanani AM. Port Delivery System (PDS) with ranibizumab in patients with DME: Primary analysis results of the phase III Pagoda trial. Presented at: The Bascom Palmer Eye Institute Angiogenesis, Exudation, and Degeneration Annual Meeting; February 10-11, 2023; virtual.