Vascular Endothelial Growth Factor (VEGF) Levels in Retinal Vein Occlusion (RVO) During Anti-VEGF Treatment

Study Overview
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Brief Summary
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The purpose of this study is to treat patients with retinal vein occlusion with standard of care anti-vascular endothelial growth factor therapy and to correlate levels of vascular endothelial growth factor in the anterior chamber fluid of the eye. This study will evaluate if measuring the vascular endothelial growth factor will help predict the timing of when anti-vascular endothelial growth factor therapy will be needed.

Detailed Description
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Ten patients, 5 with branch retinal vein occlusion and 5 with central retinal vein occlusion, will receive stand of care anti-vascular endothelial growth factor over the course of 52 weeks while undergoing a paracentesis prior to each treatment. During the paracentesis anterior chamber fluid will be removed to evaluate vascular endothelial growth factor levels along with other cytokines present in the anterior chamber fluid. Ocular coherence tomography will also be collected at each visit to evaluate macular thickness which will be used to help determine treatment windows along with levels of vascular endothelial growth factor. Patients with high levels of vascular endothelial growth factor and the presence of macular edema on ocular coherence tomography will be treated every four weeks. Once vascular endothelial growth factor levels are reduced along with improvements of macula edema treatment windows will be extended to 8 weeks and then to 12 weeks once levels are normal and edema is no longer present.

Official Title
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Correlation of Vascular Endothelial Growth Factor Levels in Anterior Chamber Fluid to Disease State in Patients With Retinal Vein Occlusion Receiving Standard of Care Treatment

Conditions
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Retinal Vein Occlusion

Intervention / Treatment
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* Drug: Aflibercept Ophthalmic


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Willingness and ability to provide written informed consent. Diagnosis of Retinal Vein Occlusion with macular edema and central foveal thickness of greater than or equal to 300 microns confirmed by intravenous fluorescein angiography and Optical Coherence Tomography Visual Acuity between 20/25 and 5/200 Exclusion Criteria: Bilateral Retinal Vein Occlusion Vision worse than 5/200 in study eye History of myocardial infarction, ischemia, or cerebrovascular accident within 6 weeks of screening Concurrent Proliferative Diabetic Retinopathy and/or Maculopathy Concurrent Exudative Age-related Macular Degeneration Concurrent optic neuropathy with the presence of an afferent pupillary defect Previous vitrectomy in the study eye Currently pregnant or planning to become pregnant during the duration of the study. Women currently breastfeeding are also excluded. Previous treatment for retinal vein occlusion in the study eye Any current medical condition which, in the opinion of the investigator is considered to be uncontrolled History of allergy or hypersensitivity to study treatment, fluorescein, or any study procedure and treatment related ingredients (e.g. topical anesthetics, betadine, etc.)

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: Basic Science
Intervention Model: Single Group Assignment
Interventional Model Description: All patients will receive the same standard of care treatment.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Aflibercept<br>All subjects will receive aflibercept every 4 weeks. Once vascular endothelial growth factor levels become normal and macular edema improves treatment windows will be extended up to every 12 weeks. | Drug: Aflibercept Ophthalmic<br>* Anti-vascular endothelial growth factor intraocular injection<br>* Other names: Eylea;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Macular Edema | Measured by central retinal thickness using optical coherence tomography - OCT is an imaging method used to generate a picture of the back of the eye, called the retina. The picture is made by precisely measuring the amount of a dim red light that reflects off the retina | Baseline through week 52 | 
| Change in Macular Volume | Measured by central retinal thickness using optical coherence tomography - OCT is an imaging method used to generate a picture of the back of the eye, called the retina. The picture is made by precisely measuring the amount of a dim red light that reflects off the retina | Baseline through week 52 | 
| Change in Vascular Endothelial Growth Factor (VEGF) level in Anterior Chamber | Evaluated by Enzyme-Linked ImmunoSorbent Assay (ELISA) analysis | Baseline through week 52 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Best Corrected Visual Acuity (BCVA) | Using Snellen Visual Acuity charts - The results are based on what line the patient can read with ease - If a subject's visual acuity is so poor that the subject can't see any letters on the charts, finger counting and/or hand motions will be checked | Baseline through week 52 | 
| Change in Intraocular Pressure (IOP) | Evaluated by tonometry - Tonometry is the procedure eye care professionals perform to determine the intraocular pressure (IOP), the fluid pressure inside the eye - Most tonometers are calibrated to measure pressure in millimeters of mercury (mmHg) | Baseline through week 52 | 
| Number of Intravitreal Injections | Number of injections received during study participation | Baseline through week 52 | 
| Change in Analytes - Chemokine (C-C motif) ligand (CCL)s | Chemokine (C-C motif) ligand 2 (CCL2)/(JE/MCP-1) Monocyte chemoattractant protein 1 and C-C motif chemokine 11(CCL11)/Eotaxin - Analyzed using an ELISA multiplex | Baseline through week 52 | 
| Change in Analytes - chemokine (C-X-C motif) ligand (CXCL)s | CXCL1/GRO alpha/KC/Cytokine-induced neutrophil chemoattractant (CINC-1) and CXCL2/GRO beta/MIP-s/CINC-3 - Analyzed using an ELISA multiplex | Baseline through week 52 | 
| Change in Analytes - Growth factors | Epidermal growth factor (EGF) and basic fibroblast growth factor (FGF basic)/FGF2/bFGF - and Transforming growth factor alpha (TGF-alpha) - and Platelet-derived growth factor (PDGF)-AA and PDGF-AB/BBA analyzed using an ELISA multiplex Analyzed | Baseline through week 52 | 
| Change in Analytes - Interferons | Interferon (IFN)-alpha 2/IFNA2, Interferon (IFN)-beta, and Interferon (IFN)-gamma - Analyzed using an ELISA multiplex | Baseline through week 52 | 
| Change in Analytes - Interleukins | IL-1 alpha/IL-1F1 IL-1 beta/IL-1F2 IL-1ra/IL-1F3 IL-2 IL-3 IL-4 IL-5 IL-6 IL-7 IL-8/CXCL8 IL-10 IL-12 p70 IL-13 IL-15 IL-17/IL-17A IL-17E/IL-25 IL-33 Analyzed using an ELISA multiplex | Baseline through week 52 | 
| Change in Analytes - Proteins | Programmed death-ligand 1(PD-L1)/B7 homolog 1(B7-H1) Analyzed using an ELISA multiplex | Baseline through week 52 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Vision Loss, Eye Injections