Diabetic Macular Edema Clinical Trial
Official title:
Efficacy of Intravitreal Aflibercept Injection (IAI) Administered in a Treat and Extend Fashion in Patients With Center Involved Diabetic Macular Edema (DME) Previously Managed With 0.3 mg Intravitreal Ranibizumab
The purpose of this study is to determine the efficacy of intravitreal aflibercept injections administered in a treat and extend fashion in eyes that have persistent center involved diabetic macular edema following at least 4 intravitreal injections of 0.3 mg ranibizumab over 24 weeks.
This is a phase 4 prospective, nonrandomized, open label, interventional clinical trial to
determine the efficacy of intravitreal aflibercept (IAI) administered in a treat and extend
fashion in eyes that have persistent centered involved diabetic macular edema despite at
least 4 intravitreal injections of ranibizumab 0.3mg over 24 weeks prior to enrollment.
Patients will receive intravitreal injections of aflibercept (2mg/0.05cc) at baseline and
monthly until an eye has reached stability defined as: < 10% change in the Spectral Domain
Optical Coherence Tomography (SD OCT) central retinal thickness (CRT) reading from the
previous 2 visits (can include baseline) and less than a 5 letter decrease in Best Corrected
Visual Acuity (BCVA) from best BCVA from prior visits. Once an eye has reached stability
criteria, a treat and extend protocol will be used and treatment will be rendered on every
visit. The duration between treatments will be extended by 2 weeks from the last visit if SD
OCT extension criteria are met: < 10% change in CRT over 2 consecutive visits and < 5 letter
decrease in BCVA from baseline
If at any return visit subretinal and/or intraretinal fluid recurs that causes the CRT to
increase by > 10 % from its lowest level in the previous 2 consecutive visits, or CRT
increases by < 10% due to subretinal and/or intraretinal fluid but is associated with a
decrease of BCVA of > 5 letters from baseline then the eye will receive IAI and the treatment
interval will be decreased by 1 week. If the eye has not improved or worsened for at least 2
consecutive visits and the SD OCT central subfield thickness is ≥ 300 microns or visual
acuity is worse than 20/20, the following will be done:
Prior to the 24-week visit, an injection will be given. At and after the 24-week visit, an
injection will be given and modified grid laser can be given at the discretion of the
investigator within 7 days of IAI based on rescue criteria
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