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
Condition: Central Retinal, Hemi Retinal & Brach Retinal Vein Occlusions
MeSH terms: Retinal Vein Occlusion
Intervention: 0.5mg Ranibizumab; Targeted Pan Retinal Photocoagulation
Intervention description: intravitreal injections; Targeted Pan Retinal Photocoagulation based on wide field angiography
Intervention MeSH terms: Ranibizumab
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Masking description: Open label
Enrollment: 30.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: CRVO; BRVO; HRVO; Macular edema; vein occlusion

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
    

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