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Intravitreal Ranibizumab in Exudative Age-related Macular Degeneration With Posterior Vitreomacular Adhesion

Sponsor
Yonsei University (Other)
Overall Status
Completed
CT.gov ID
NCT01291121
Collaborator
(none)
30
Enrollment
1
Location
1
Arm
28
Duration (Months)
1.1
Patients Per Site Per Month

Study Details

Study Description

Brief Summary

The main objective is to determine the efficacy of intravitreal administration of Ranibizumab combined with intravitreous injection of expansile gas and induction of posterior vitreous detachment on best-corrected visual acuity and ocular coherence tomography (OCT) macular thickness in subjects with neovascular age-related macular degeneration (AMD) with posterior vitreomacular adhesion (VMA).

Secondary objectives are to assess the safety and tolerability of the intravitreal administration of Ranibizumab combined with intravitreous injection of expansile gas.

Condition or Disease Intervention/Treatment Phase
  • Procedure: Intravitreal expansile gas and ranibizumab injection
 N/A

Detailed Description

Age-related macular degeneration (AMD) is the leading cause of severe visual loss in industrialized countries. In recent years, the advent of anti-vascular endothelial growth factor (VEGF) therapies, such as ranibizumab and bevacizumab, has revolutionized neovascular AMD treatment and anti-VEGF has become the standard treatment for choroidal neovascularization (CNV) with a better visual outcome than previous therapies such as photodynamic therapy (PDT). However, one study reported that up to 45% of cases (20 out of 44 eyes) were non-responders showing resistance to anti-VEGF. In these cases, visual acuity did not improve and persistent subretinal fluid remained despite the usual monthly injection of anti-VEGF. A current focus of anti-VEGF treatment is how to determine which eyes will respond to treatment. To date, three genetic studies into the response to treatment for wet AMD have shown that specific genotypes for complement factor H and LOC genes are associated with treatment response. Previous studies have described the relationship between the posterior vitreous and the macula in AMD and have suggested that vitreomacular adhesion (VMA) plays an important role in the development of exudative AMD. In a recent paired eye study, we controlled confounding variables by selecting only patients with unilateral exudative AMD, and showed that eyes with exudative AMD had a significantly higher incidence of posterior VMA than paired normal eyes (P=0.0007). This result indicates that VMA is a possible risk factor for exudative AMD. In another recent study, Mojana and co-workers reported improvement in VA after 25-gauge trans pars plana vitrectomy (TPPV) with hyaloid removal in five patients who had a history of demonstrable VMA and poorly responsive CNV despite aggressive anti-VEGF therapy. We postulated that a subpopulation of exudative AMD cases do not respond to anti-VEGF therapy and that VMA may play a role in this resistance to therapy. The recent results of our study indicate that posterior VMA has a negative effect on visual outcome after intravitreal anti-VEGF treatment for exudative AMD. BCVA did not improve in eyes with posterior VMA despite anti-VEGF treatment. Posterior hyaloid removal by intravitreous injection of expansile gas and induction of posterior vitreous detachment may be considered as a treatment option in patients with VMA who are poor responders to anti-VEGF treatment.

Study Design

Study Type:
Interventional
Actual Enrollment :
30 participants
Allocation:
Randomized
Intervention Model:
Parallel Assignment
Masking:
None (Open Label)
Primary Purpose:
Treatment
Official Title:
Intravitreal Administration of Ranibizumab Combined With Intravitreous Injection of Expansile Gas and Induction of Posterior Vitreous Detachment in Treatment of Exudative AMD With Posterior VMA: a Pilot, Open Label, Comparative Study
Study Start Date :
Feb 1, 2011
Actual Primary Completion Date :
Feb 1, 2013
Actual Study Completion Date :
Jun 1, 2013

Arms and Interventions

Arm Intervention/Treatment
Active Comparator: group 1

Intravitreal ranibizumab 0.5mg only group

Procedure: Intravitreal expansile gas and ranibizumab injection
Intravitreal expansile gas (0.3 cc C3F8) and 0.5mg ranibizumab at day 0 Additional 3 monthly loading injection of intravitreal ranibizumab Additional injection of ranibizumab as needed

Outcome Measures

Primary Outcome Measures

  1. Changes from baseline in visual acuity and central macular thickness at 12 months [12 months]

    Efficacy of intravitreal administration of Ranibizumab combined with intravitreous injection of expansile gas and induction of posterior vitreous detachment on best-corrected visual acuity and ocular coherence tomography (OCT) macular thickness in subjects with exudative age-related macular degeneration (AMD) with posterior vitreomacular adhesion (VMA). Visual acuity measurement: logMAR visual acuity with early treatment of diabetic retinopathy study (ETDRS) chart, Macular thickness measurement: OCT

Secondary Outcome Measures

  1. Number of participants with nonocular complications [12 months]

    - Incidence of non ocular complications (thromboembolic events, non ocular hemorrhage, myocardiac infarct etc.)

  2. Number of participants with ocular complications [12 months]

    Incidence of ocular complications (increased intraocular pressure, endophthalmitis, central retinal artery occlusion etc)

Eligibility Criteria

Criteria

Ages Eligible for Study:
50 Years and Older
Sexes Eligible for Study:
All
Accepts Healthy Volunteers:
No
Inclusion Criteria:

  1. Age > 50 years old

  2. Exudative AMD proven by fundus photograph and fluorescein angiography (FA)with VMA proven by OCT

  3. Ability to provide written informed consent and comply with study assessments

Exclusion Criteria:

  1. Previous anti-VEGF treatment

  2. More than three prior treatment with PDT

  3. Previous subfoveal focal laser photocoagulation in the study eye

  4. Laser photocoagulation (juxtafoveal or extrafoveal) in the study eye within 1 month preceding day 0

  5. Subfoveal fibrosis or atrophy in the study eye

  6. History of vitrectomy surgery in the study eye

  7. Significant concurrent ocular or macular diseases in the study eye

  8. medical Hx such as myocardial infarction, cerebrovascular accident, ischemic cardiomyopathy, non ocular hemorrhage

  9. History of Ranibizumab hypersensitivity

  10. Presence of active periocular infection and/or endophthalmitis

Contacts and Locations

Locations

Site City State Country Postal Code
1 Yonsei University Health System, Severance Hospital Seoul Korea, Republic of 120-752

Sponsors and Collaborators

  • Yonsei University

Investigators

  • Principal Investigator: Hyuong Jun Koh, Professor, Department of ophthalmology, Yonsei University College of Medicine

Study Documents (Full-Text)

None provided.

More Information

Publications

Responsible Party:
Yonsei University
ClinicalTrials.gov Identifier:
NCT01291121
Other Study ID Numbers:
  • 4-2010-0623
First Posted:
Feb 8, 2011
Last Update Posted:
Jan 26, 2015
Last Verified:
Jan 1, 2015
Keywords provided by Yonsei University
Age related macular degeneration
Intravitreal ranibizumab
Intravitreal expansile gas injection
Additional relevant MeSH terms:
Macular Degeneration
Ranibizumab

Study Results

No Results Posted as of Jan 26, 2015