Efficacy of Biweekly Ranibizumab (0.5 mg) for Exudative Macular Degeneration Retinal Edema Refractory to Anti-VEGF

This is a 24 week, open-label, non-randomized, phase II study evaluating intravitreal
ranibizumab dosed every 14 days in subjects with exudative macular degeneration who have
persistent intraretinal or subretinal fluid despite chronic monthly anti-VEGF therapy (>6
months). Subjects must have had a minimum of 5 intravitreal anti-VEGF injections administered
every 4-6 weeks in the 6 months preceding enrollment.

Consented, enrolled subjects will receive multiple open-label intravitreal injections of 0.5
mg ranibizumab administered every 14 days (± 3 days). Subjects who have resolution of fluid
will convert to monthly ranibizumab for the remainder of the study. If fluid recurs, subjects
will return to biweekly treatment.

Patients will be assigned to receive treatment with either ranibizumab vial or PFSs so that
approximately 10 patients will be treated with each delivery method option, and syringe
preparation time (SPT) will be measured by an assistant who will be observing the procedure
and timing with an automated stopwatch.

Inclusion Criteria:

- Age > 50 years

- Exudative age related macular degeneration in study eye involving the fovea

- Best Corrected Visual Acuity (by ETDRS) letter score in study eye of < 85 and > 24
(approximate Snellen equivalent 20/20 to 20/320)

- Persistent intraretinal or subretinal fluid on SD OCT despite a minimum of 5
intravitreal anti-VEGF injections administered every 4-6 weeks in the in the 6 months
preceding enrollment in the study eye

- At least 30 days from last intravitreal anti-VEGF injection in the study eye

Exclusion Criteria:

- Patient who are receiving systemic anti-VEGF or proangiogenic therapy

- Patients on chronic high doses corticosteroid therapy (> than 10 mg of oral prednisone
or equivalent greater than 10 days)

- Patients on chronic immunosuppressant therapy

- Patients on drugs known to have toxic side effects on the retina e.g.
hydroxychloroquine

- History of intravitreal corticosteroids in study eye within 4 months of baseline

- Uncontrolled hypertension (defined as systolic >180 mm Hg and/or diastolic > 100 mm Hg
while patient is sitting)

- History of stroke or APTC event in the previous year

- Any intraocular surgery in study eye within 90 days of baseline

- Presence of vitreomacular traction in study eye

- Presence of significant epiretinal proliferation in study eye

- Evidence of active infection in either eye

- Uncontrolled glaucoma in the study eye defined as a pressure > 25 mmHg on maximal
medical therapy