Intravitreal Aflibercept Injection for Radiation Retinopathy Trial

Approximately 30 eyes will be randomized (1:1 ratio) into either Group 1 or Group 2. Slit
lamp exam and Indirect ophthalmoscopy will be performed at every study visit, where
retinopathy level will be assessed. SD-OCT will be performed at each visit. Fluorescein
angiogram will be performed at screen, week 26 and week 52. All other imaging studies will be
standard of care at the discretion of the investigator.

This trial will compare the results of 2 groups, with different treatment intervals, to
assess the safety of intravitreal Aflibercept injections (IAI) for the treatment of radiation
retinopathy. Patients in each group will be followed for a total of 52 weeks.

Group 1: 15 Patients will receive a loading dose of 3 IAI. They will receive 2 mg IAI at
screening/baseline, week 4, week 8, and week 12. A follow-up visit will occur at week 12. If
the extension criteria are met, the patient will be extended by 2 weeks. The patient will
continue to be followed per the treat and extend protocol described below.

Group 2: Patients will not receive a loading dose. They will receive 2 mg IAI at
screening/baseline followed by a visit at week 4. At week 4, if the extension criteria are
met, the patient will be extended by 2 weeks. The patient will continue to be followed per
the treat and extend protocol described below.

Treat & Extend Protocol Patients can be extended as long as they meet the following criteria
-

- Absence of retinal fluid (resolution of intraretinal and subretinal fluid on SD-OCT;
Small intraretinal cysts that do not distort foveal contour on SD-OCT are acceptable and
can be considered "dry".) AND

- Less than 5 ETDRS letter loss from previous visit due to new or persistent retinal
edema.

IAI will be rendered at every visit (treatment at the week 26 mandatory visit will be
administered based on the treat and extend status), no earlier than 4 days before the target
date and no later than 4 days after the target date. Each extension will be 2 weeks in
duration beyond the initial 4-week interval. If the extension criteria are not met on a
follow-up visit, the treatment interval will be reduced by 2 weeks. Follow up interval will
continue to be reduced by 2 weeks until the extension criteria are met or a 4-week interval
is reached.

All patients will have a mandatory study visit at Week 52 (final study visit). No study
treatment will be administered after week 50 or at a study termination visit. If a patient
receives treatment after week 48, they will return 4 weeks after the last clinic visit for
the final study visit (instead of at week 52).

Inclusion Criteria:

1. Age > 18 years of age

2. Clinically identifiable radiation retinopathy with evidence of fluid on SD-OCT causing
vision loss in the study eye

3. Undergone either ocular or orbital radiation for any primary ocular or orbital cancer
within clinical evidence of having radiation retinopathy

4. Willing and able to comply with clinic visits and study-related procedures

5. Provide signed informed consent

Exclusion Criteria:

A patient who meets any of the following criteria will be excluded from the study:

1. Metastatic cancer or any active primary cancer, at time of enrollment

2. Prior treatment with anti VEGF in the study within 60 days of screen in the study eye

3. Prior intravitreal or subconjunctival treatment with cortical steroids within 90 days
of screen in the study eye

4. Macular ischemia (defined as greater than 5 disc areas), as assessed by the
investigator

5. Media opacity obscuring a view of the fundus or any other reason for vision loss other
than radiation retinopathy.

6. Evidence of infectious ocular infection, in the study eye, at time of screening

7. Pregnant or breast-feeding women

8. Sexually active men* or women of childbearing potential** who are unwilling to
practice adequate contraception start of the first treatment, during the study, and
for at least 3 months after the last dose. Adequate contraceptive measures include
stable use of oral contraceptives or other prescription pharmaceutical contraceptives
for 2 or more menstrual cycles prior to screening; intrauterine device; bilateral
tubal ligation; vasectomy; condom plus contraceptive sponge, foam, or jelly, or
diaphragm plus contraceptive sponge, foam, or jelly.

- Contraception is not required for men with documented vasectomy. **Postmenopausal
women must be amenorrheic for at least 12 months in order not to be considered of
childbearing potential. Pregnancy testing and contraception are not required for
women with documented hysterectomy or tubal ligation.