Prophylactic Intravitreal 5-Fluorouracil and Heparin to Prevent PVR in High-risk Patients With Retinal Detachment.

Study Overview
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Brief Summary
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This study investigates the effectiveness of a simple treatment to prevent proliferative vitreoretinopathy (PVR). Intraoperative intravitreal 5-fluorouracil (5-FU) and low molecular weight heparin (LMWH) is used as a prophylactic therapy in high-risk patients with primary rhegmatogenous retinal detachment (RRD). Our major motivation is to reduce the incidence of PVR in the group that receives the trial drug.

Detailed Description
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Proliferative vitreoretinopathy (PVR) is a common cause for postoperative failure after vitreoretinal surgery for primary RRD. There is no standard-therapy to prevent PVR. Several attempts using chemotherapeutic agents have been undertaken to prevent this proliferation-process, but none of these was introduced into routine clinical practice. Until recently, it has been challenging to identify patients with high risk for postoperative PVR formation. This is especially important, because in this trial treatment with the trial drug will be restricted to patients at high risk for PVR only. Patients are assigned to the following treatment arms (1:1): (A) Intraoperative adjuvant application of 5-fluorouracil (5-FU) and low molecular weight heparin (LMWH) via intraocular infusion during routine pars plana vitrectomy (PPV) in high-risk patients for proliferative vitreoretinopathy (PVR) with primary rhegmatogenous retinal detachment (RRD). Versus: (B) Routinely used intraocular infusion with balanced salt solution (BSS) during routine PPV.

Official Title
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Prophylactic Intravitreal 5-Fluorouracil and Heparin to Prevent PVR in High-risk Patients With Retinal Detachment.

Conditions
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Rhegmatogenous Retinal Detachment, High-risk for Proliferative Vitreoretinopathy (PVR)

Intervention / Treatment
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* Drug: 5-fluorouracil and low molecular weight heparin
* Drug: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Primary rhegmatogenous retinal detachment (< 4 weeks) in study eye Scheduled for pars plana vitrectomy for retinal detachment repair without combined cataract surgery in study eye Elevated protein levels in anterior chamber fluid (laser-flare value ≥ 15.0 pc/ms) in study eye Female or male patient ≥ 18 years of age Written informed consent Exclusion Criteria: Retinal detachment lasting > 4 weeks in study eye Traumatic retinal detachment in study eye Giant retinal tears in study eye (size > 3 clock hours) Visual pre-existing PVR grade C in study eye Retinal dystrophies in study eye Scheduled for combined pars plana vitrectomy and cataract surgery for retinal detachment repair in study eye Chronic inflammatory conditions in study eye Active retinal vascular disease in study eye Proliferative diabetic retinopathy in study eye Manifest uveitis in study eye Endophthalmitis in study eye Perforating and non-perforating trauma in study eye Malignant intraocular tumor in study eye Aphakia in study eye Uncontrolled glaucoma or ocular hypertension in study eye (intraocular pressure ≥ 30 mmHg despite IOP lowering therapy) Previous intraocular surgery except uncomplicated cataract surgery with posterior chamber lens implantation in study eye Cataract surgery in study eye ≤ 3 months ago Previous retinal procedures (laserpexy, cryopexy, intravitreal gas-injection, anti-VEGF or corticosteroid-injection) in study eye ≤ 6 months Other uncontrolled ophthalmologic disorders Single eyed patients (BCVA of fellow eye > 1.0 log MAR, < 0.1 decimal, < 1/10 tenth, or < 6/60 Snellen fraction [m]) Evidence or history of alcohol, medication or drug dependency within the last 12 months. Evidence or history (within the last 12 months) of neurotic personality, psychiatric illness that requires or required treatment, epilepsy or suicide risk. Systemic disorders not compatible with adjuvant application of 5-FU and LMWH via intraocular infusion, or not compatible with the local or general anesthesia Any therapy with immunosuppressant or chemotherapy ≤ 3 months and during the trial period Participation in another trial of IMPs or devices parallel to, or less than 3 months before screening, or previous participation in this trial. Known to or suspected of not being able to comply with the protocol. Inability to understand the rationale of this trial or the study aim Any dependency of the patient to the Investigator or the trial site, e.g. employees with direct involvement in the proposed trial or in other trials under the direction of this Investigator or trial site, as well as family members of the employees or the Investigator. Positive urine pregnancy test, pregnancy or breastfeeding mother. Women of child bearing potential without satisfactory contraception, i.e. hormonal contraceptives for at least 14 days before trial enrolment, IUD, double barrier (women of child bearing age must be counselled about the use of adequate contraception).

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Adjuvant therapy with 5-FU and LMWH<br>Intraoperative adjuvant application of 5-fluorouracil (5-FU) and low molecular weight heparin (LMWH) via intraocular infusion during routine pars plana vitrectomy (PPV) in high-risk patients for proliferative vitreoretinopathy (PVR) with primary rhegmatogenous retinal detachment (RRD). | Drug: 5-fluorouracil and low molecular weight heparin<br>* Intraoperative adjuvant application of 5-fluorouracil (5-FU) and low molecular weight heparin (LMWH) via intraocular infusion during routine pars plana vitrectomy (PPV).<br>|
| Placebo Comparator: Standard of care<br>Routinely used intraocular infusion with balanced salt solution (BSS) during routine pars plana vitrectomy (PPV) in high-risk patients for proliferative vitreoretinopathy (PVR) with primary rhegmatogenous retinal detachment (RRD). | Drug: Placebo<br>* Routinely used intraocular infusion with balanced salt solution (BSS) during routine pars plana vitrectomy (PPV).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proliferative Vitreoretinopathy (PVR) grade CP (posterior - full thickness retinal folds in clock hours) 1 or higher [yes/no] |  | within 12 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| PVR grade CP 1 or higher [yes/no] |  | within 6 weeks | 
| PVR grade CA (anterior - full thickness retinal folds in clock hours) 1 or higher [yes/no] |  | within 6 weeks and 12 weeks | 
| Degree of PVR (PVR grade CA 1-12, PVR grade CP 1-12 (in clock hours)) |  | within 6 weeks and 12 weeks | 
| Best Corrected Visual Acuity (BCVA) measured by ETDRS charts |  | within 6 weeks and 12 weeks | 
| Retinal reattachment after primary intervention [yes/no] |  | within 6 weeks and 12 weeks | 
| Number of retinal re-detachments and if present due to PVR [yes/no] |  | within 6 weeks and 12 weeks | 
| Number and extent of surgical procedures necessary to achieve retinal reattachment |  | within 12 weeks | 
| Occurrence of at least one drug-related adverse event that affects the study eye [yes/no] |  | within 12 weeks |