Widefield Angiography Guided Targeted-retinal Photocoagulation Combined With Anti VEgf Intravitreal Injections for the Treatment of Ischemic Central Retinal Vein Occlusion, Hemi Retinal Vein Occlusion, and Branch Retinal Vein Occlusion



Status:Completed
Conditions:Peripheral Vascular Disease, Ocular
Therapuetic Areas:Cardiology / Vascular Diseases, Ophthalmology
Healthy:No
Age Range:18 - Any
Updated:4/21/2016
Start Date:October 2012
End Date:October 2015

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A Phase IV Open Label Trial of the Safety, Tolerability and Efficacy of 0.5mg Ranibizumab Intravitreal Injections Combined With Wide Field Angiography Guided Panretinal Photocoagulation vs. 0.5mg Ranibizumab Intravitreal Injection Monotherapy in Subjects With Ischemic Central Retinal Vein Occlusion, Hemi Retinal Vein Occlusion, and Branch Retinal Vein Occlusion Who Incompletely Respond to at Least 2 Consecutive Intravitreal Injections in the Past 4 Months.

To see if Lucentis 0.5mg combined with Targeted Pan Retinal photocoagulation will decrease
the total number of intravitreal injections in a year for ischemic central retinal vein
occlusion, hemi-retinal vein occlusions and branch retinal vein occlusions compared to
standard of care

The WAVE trial is a phase IV, open label, 12-month trial of intravitreal ranibizumab 0.5 mg
in patients (n=30) with ischemic CRVO, HRVO and BRVO who have been previously treated with
ranibizumab or any other anti-VEGF intravitreal injection therapy, who are incomplete
responders to 2 or more consecutive intravitreal anti-VEGF injections in the past 4 months.
Randomization is 1:4, 1=control, ranibizumab only, 4=treatment arm. In total, 6 subjects
will be randomized to control and 24 randomized to treatment arm.

Cohort 1- 24 Subjects previously treated Patients will receive 6 doses of ranibizumab 0.5
mg, followed by PRN intravitreal injection of ranibizumab 0.5 mg based on pre-defined
retreatment criteria for up to 11 total injections.

Wide field angiography guided peripheral targeted-retinal photocoagulation (TRP), will be
divided into 2 sessions if needed, one at the 2 weeks post injection visit and another later
at M4/V7, if repeat wide field angiogram indicates areas not sufficiently treated in the
first TRP session

Cohort 2- 6 Subjects, previously treated patients will receive 6 doses of ranibizumab 0.5
mg, followed by PRN intravitreal injection of ranibizumab 0.5 mg based on pre-defined
retreatment criteria for up to 11 total injections.

Inclusion Criteria:

- Age > 18 years

- Visual acuity between 20/25 and 20/800, ETDRS best corrected visual acuity

- Ability to provide written informed consent and comply with study assessments for the
full duration of the study

Patients previously treated with any ITV anti-VEGF:

• With at least 2 consecutive monthly intravitreal injections of anti-VEGF medications
with presence of persistent or recurrent macular edema in the past 4 months

Exclusion Criteria:

- IOP over 30 mm Hg

- Any previous retinal laser photocoagulation to the study eye

- Previous intravitreal injection in the study eye of any corticosteroid treatment

- Previous vitrectomy in study eye (posterior or anterior associated with vitreous loss
in cataract surgery)

- Intracapsular cataract extraction

- Any previous radiation treatments to head/neck that the principal or sub investigator
feels is clinically relevant

- Inability to assess iris or angle neovascularization (corneal opacity precluding
gonioscopy)

- Significant cardiovascular disease or cancer that would prevent follow-up visits or
completion of the 12 month study

- Significant diabetic retinopathy in the fellow eye (diabetic macular edema,
proliferative diabetic retinopathy, or high-risk non-proliferative diabetic
retinopathy)

- Participation in another simultaneous medical investigator or trial

- Ocular disorders or concurrent disease in the study eye that may confound
interpretation of study results, compromise visual acuity or require medical or
surgical intervention, including history of retinal detachment, macular hole, or
choroidal neovascularization of any cause (e.g., DME, AMD, ocular histoplasmosis, or
pathologic myopia)

- Structural damage to the center of the macula in the study eye prior to CRVO, HRVO
and BRVO likely to preclude improvement in visual acuity following the resolution of
macular edema, including atrophy of the retinal pigment epithelium, subretinal
fibrosis, laser scar(s)

- Vitreomacular traction or clinically significant epiretinal membrane in the study eye
evident biomicroscopically or by OCT (vitreomacular attachment OK)

- Infectious blepharitis, keratitis, scleritis, or conjunctivitis (in either eye) or
current treatment for serious systemic infection

- Spherical equivalent of the refractive error in the study eye of more than -8
diopters myopia (For patients who have had refractive or cataract surgery in the
study eye, preoperative spherical equivalent refractive error of more than -8
diopters myopia is not allowed)

- Uncontrolled Blood pressure: defined as systolic pressure > 180mmHg and/or diastolic
pressure of >110 mm Hg (sitting) during the screening period

- Uncontrolled diabetes mellitus

- Renal failure requiring dialysis or renal transplant

- Pregnancy (positive pregnancy test) or lactation

- Premenopausal women not using adequate contraception. The following are considered
effective means of contraception: surgical sterilization or use of oral
contraceptives, barrier contraception with either a condom or diaphragm in
conjunction with spermicidal gel, an IUD, or contraceptive hormone implant or patch.

- History of other disease, metabolic dysfunction, physical examination finding, or
other findings giving reasonable suspicion of a disease or condition that
contraindicates the use an investigational drug, might affect interpretation of the
results of the study, or render the subject at high risk from treatment complications

- History of allergy to fluorescein, not amenable to treatment

- Inability to obtain fundus photographs or fluorescein angiograms of sufficient
quality to be analyzed by the principal investigator (PI) and/or the
sub-investigator.

- History of allergy to humanized antibodies or any component of the ranibizumab
formulation
We found this trial at
3
sites
Katy, Texas 77494
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Katy, TX
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Houston, TX
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The Woodlands, Texas 77384
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The Woodlands, TX
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