Efficacy and Safety of Intravitreal Bevacizumab in the Treatment of Choroidal Neovascular Membranes Associated to High Myopia

Study Overview
=================
Brief Summary
-----------------
The purpose of this study is to determine the efficacy and safety of intravitreal injections of bevacizumab in High Myopia´s choroidal neovascularization versus the standard treatment of Photodynamic therapy.

Detailed Description
-----------------
Bad response in choroidal neovascularization in High myopia to Photodynamic therapy, which is the current approved treatment for that pathology, and the high incidence of this pathology in these patients, together with the great functional impact in their vision has fostered the search for new therapeutic strategies. Intravitreal bevacizumab has already been tested in small series of patients with choroidal neovascularization associated to high myopia, whether as first treatment option or after the failure of photodynamic therapy with good results. In the published series an improvement of visual acuity is described after 1-2 injections, with a reduction in the macular edema and a good safety profile. The lack of published trials that describe the efficacy of frequency of treatment in this pathology is the main reason for this trial.

Official Title
-----------------
Phase III Study of Efficacy and Safety of Intravitreal Bevacizumab in the Treatment of Choroidal Neovascular Membranes Associated to High Myopia

Conditions
-----------------
Myopia, Choroidal Neovascularization

Intervention / Treatment
-----------------
* Drug: Intravitreal Injection
* Drug: Photodynamic Therapy (Visudyne)


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patient at least 18 years old High Myopia with one of the following: 6 or more sphere diopters in the study eye Axial length of the eye greater than 26 millimeters Active subfoveal/juxtafoveal choroidal neovascularization confirmed by Fluorescein angiography and Ocular coherence tomography. Visual acuity loss of less than 6 months of evolution related to the neovascular lesion, as stated by investigator´s opinion. Patients previously treated with Photodynamic therapy are allowed to participate as long as the last treatment has been performed more than 3 months upon entering the study. Signed informed consent. Signed data protection consent. Women of childbearing potential must provide a negative pregnancy test at inclusion and must commit to the use of a contraceptive treatment during the whole study. Exclusion Criteria: Previous vitrectomy surgery in the study eye. Tractional maculopathy and/or epiretinal membrane evaluated by Ocular coherence tomography. Opacities that may not allow correct fundus assessment. Lack of integrity of the posterior lens capsule in pseudoaphakic patients. Patients that may not want/be able to complete the study, based in the investigator opinion.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intravitreal Bevacizumab<br>Intravitreal injections of bevacizumab | Drug: Intravitreal Injection<br>* Intravitreal injection of 1,25 mg in 0,05 ml<br>* Other names: Avastin;|
| Active Comparator: Visudyne<br>Photodynamic Therapy with Visudyne | Drug: Photodynamic Therapy (Visudyne)<br>* Photodynamic therapy on day 1 as described in standard clinical guidelines.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Improvement in Visual Acuity assessed by ETDRS |  | Every month during first year - Every three months during the second year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Central macular thickness with Ocular Coherence Tomography |  | Every month during first year - Every three months during the second year | 
| Complications that may arise from intravitreal injection |  | Every treatment visit - Once per month during the first 3 months. Reteatments depending on Visual acuitiy evolution and retinal thickness | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
High Myopia, Bevacizumab, Photodynamic therapy