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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 (WAVE)

Primary Purpose

Central Retinal, Hemi Retinal & Brach Retinal Vein Occlusions

Status
Completed
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
0.5mg Ranibizumab
Targeted Pan Retinal Photocoagulation
Sponsored by
Charles C Wykoff, PhD, MD
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Central Retinal, Hemi Retinal & Brach Retinal Vein Occlusions focused on measuring CRVO, BRVO, HRVO, Macular edema, vein occlusion

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

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

Sites / Locations

  • Retina Consultants of Houston/The Medical Center
  • Retina Consultants of Houston
  • Retina Consultants of Houston

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Targeted Pan Retinal laser combined with 0.5mg ranibizumab

Ranibizumab 0.5mg

Arm Description

Cohort 1 (n=24), previously treated with at least 2 consecutive or more intravitreal injections of any anti-VEGF agent with persistent or recurrent macular edema will receive 6 loading doses of 0.5 mg ranibizumab followed by PRN treatment with ranibizumab 0.5 mg; after receiving the first loading dose of ranibizumab, the subject will have peripheral targeted-retinal photocoagulation (TRP) based on 200° wide field angiography with possibility of a second session of TRP at M4/M7, if non-perfusion persists based on angiogram.The 200°wide field angiography will indicate areas of peripheral ischemia which will be selectively treated, preserving areas of more perfused retina.

Cohort 2 (n=6), previously treated with at least 2 consecutive or more intravitreal injections of any anti-VEGF agent with persistent or recurrent macular edema will receive 6 loading doses followed by PRN monthly treatment with ranibizumab 0.5 mg.

Outcomes

Primary Outcome Measures

Total Number of Intravitreal Injections Over a 12 Month Period
Assess the number of intravitreal injections over 12 months.
Visual Acuity
Evaluate the mean change from baseline in ETDRS best-corrected visual acuity at 12 months. The ETDRS protocol is a widely accepted international standard for macular laser photocoagulation treatment. A higher score represents better functioning.

Secondary Outcome Measures

Retinal Ischemia
Quantify change in area of perfused and ischemic retina.
Foveal Avascular Zone
Assess change in foveal avascular zone area and largest diameter, measured during the early phase of the angiogram
Adverse Events
Incidence and severity of adverse events (ocular and non-ocular).
Neovascularization of the Iris, Optic Nerve and Elsewhere
Percent of patients that develop neovascularization of the iris, optic nerve and/or elsewhere.
Central Foveal Outcome
Mean change in Central Foveal Volume on High Resolution OCT.
Aqueous VEGF Levels
VEGF, other cytokines and ranibizumab levels in aqueous and serum samples at randomization and at the exit or early termination visit.
Visual Field
Goldman Visual Field changes at 6 and 12 months from baseline. Goldmann perimetry is a method used to map a patient's field of vision (central and peripheral). Changes will be assessed by manual digital quantification of GVF plots.

Full Information

First Posted
October 17, 2012
Last Updated
August 8, 2017
Sponsor
Charles C Wykoff, PhD, MD
Collaborators
Genentech, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT01710839
Brief Title
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
Acronym
WAVE
Official Title
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.
Study Type
Interventional

2. Study Status

Record Verification Date
August 2017
Overall Recruitment Status
Completed
Study Start Date
October 2012 (undefined)
Primary Completion Date
October 2015 (Actual)
Study Completion Date
October 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Charles C Wykoff, PhD, MD
Collaborators
Genentech, Inc.

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
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
Detailed Description
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.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Central Retinal, Hemi Retinal & Brach Retinal Vein Occlusions
Keywords
CRVO, BRVO, HRVO, Macular edema, vein occlusion

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Masking Description
Open label
Allocation
Randomized
Enrollment
30 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Targeted Pan Retinal laser combined with 0.5mg ranibizumab
Arm Type
Experimental
Arm Description
Cohort 1 (n=24), previously treated with at least 2 consecutive or more intravitreal injections of any anti-VEGF agent with persistent or recurrent macular edema will receive 6 loading doses of 0.5 mg ranibizumab followed by PRN treatment with ranibizumab 0.5 mg; after receiving the first loading dose of ranibizumab, the subject will have peripheral targeted-retinal photocoagulation (TRP) based on 200° wide field angiography with possibility of a second session of TRP at M4/M7, if non-perfusion persists based on angiogram.The 200°wide field angiography will indicate areas of peripheral ischemia which will be selectively treated, preserving areas of more perfused retina.
Arm Title
Ranibizumab 0.5mg
Arm Type
Active Comparator
Arm Description
Cohort 2 (n=6), previously treated with at least 2 consecutive or more intravitreal injections of any anti-VEGF agent with persistent or recurrent macular edema will receive 6 loading doses followed by PRN monthly treatment with ranibizumab 0.5 mg.
Intervention Type
Drug
Intervention Name(s)
0.5mg Ranibizumab
Other Intervention Name(s)
Lucentis
Intervention Description
intravitreal injections
Intervention Type
Procedure
Intervention Name(s)
Targeted Pan Retinal Photocoagulation
Other Intervention Name(s)
PRP, Pan Retinal Photocoagulation, TRP, Pan Laser
Intervention Description
Targeted Pan Retinal Photocoagulation based on wide field angiography
Primary Outcome Measure Information:
Title
Total Number of Intravitreal Injections Over a 12 Month Period
Description
Assess the number of intravitreal injections over 12 months.
Time Frame
12 months
Title
Visual Acuity
Description
Evaluate the mean change from baseline in ETDRS best-corrected visual acuity at 12 months. The ETDRS protocol is a widely accepted international standard for macular laser photocoagulation treatment. A higher score represents better functioning.
Time Frame
12 month period
Secondary Outcome Measure Information:
Title
Retinal Ischemia
Description
Quantify change in area of perfused and ischemic retina.
Time Frame
12 month period
Title
Foveal Avascular Zone
Description
Assess change in foveal avascular zone area and largest diameter, measured during the early phase of the angiogram
Time Frame
12 months
Title
Adverse Events
Description
Incidence and severity of adverse events (ocular and non-ocular).
Time Frame
12 months
Title
Neovascularization of the Iris, Optic Nerve and Elsewhere
Description
Percent of patients that develop neovascularization of the iris, optic nerve and/or elsewhere.
Time Frame
12 months
Title
Central Foveal Outcome
Description
Mean change in Central Foveal Volume on High Resolution OCT.
Time Frame
12 months
Title
Aqueous VEGF Levels
Description
VEGF, other cytokines and ranibizumab levels in aqueous and serum samples at randomization and at the exit or early termination visit.
Time Frame
12 Months
Title
Visual Field
Description
Goldman Visual Field changes at 6 and 12 months from baseline. Goldmann perimetry is a method used to map a patient's field of vision (central and peripheral). Changes will be assessed by manual digital quantification of GVF plots.
Time Frame
6 and 12 Months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
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
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Charles C Wykoff, PhD, MD
Organizational Affiliation
Retina Consultants Houston
Official's Role
Principal Investigator
Facility Information:
Facility Name
Retina Consultants of Houston/The Medical Center
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Facility Name
Retina Consultants of Houston
City
Katy
State/Province
Texas
ZIP/Postal Code
77494
Country
United States
Facility Name
Retina Consultants of Houston
City
The Woodlands
State/Province
Texas
ZIP/Postal Code
77384
Country
United States

12. IPD Sharing Statement

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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

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