Steroids for Early Treatment of Radiation Retinopathy

NCT ID: NCT03238157

Last Updated: 2021-08-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

WITHDRAWN

Clinical Phase

PHASE2/PHASE3

Study Classification

INTERVENTIONAL

Study Start Date

2022-02-01

Study Completion Date

2022-09-01

Brief Summary

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Radiation retinopathy is a known complication of ocular radiation therapy. To date there is no known effective treatment. In addition to their anti-vascular endothelial growth factor (VEGF) properties, corticosteroids decrease the retinal capillary permeability by increasing the activity/density of tight junctions and acute inflammatory effects of radiation in various tissues.

Detailed Description

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The purpose of the project is threefold:

1. To study the natural history of radiation retinopathy using advanced imaging techniques. A combination of macular OCT to evaluate for edema, OCT angiography to evaluate for macular and peri-papillary ischemia and wide-field angiography for peripheral ischemia and leakage. Potential role of OCT angiography in radiation retinopathy will be evaluated by comparison to other eye (control) and FA.
2. Currently there is no consensus on effective management strategy for radiation retinopathy. Patients in the interventional will be prospectively followed to study efficacy of steroids for early treatment of radiation retinopathy while comparing the multimodal therapeutic approach in a randomized trial.
3. Patients in the observational arm will be prospectively followed while comparing the multimodal therapeutic approach in a randomized trial.

Conditions

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Radiation Retinopathy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Randomized to either observation (2:1) (standard of care) or intravitreal Fluocinolone Acetonide (FA) implant
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Observation

The study will only include those patients that are ascertained be at more than 50% risk for vision loss (20/200 or worse at 3 years) because of total radiation dose of \>40 Gy to the center of the macula. These "at risk" patients included in the study will receive intravitreal triamcinolone (4 mg in 0.1 ml) injected at the time of plaque removal. If lack of IOP rise (30 mm Hg or more) at 3 months, then randomized to either observation (2:1) (standard of care).

Group Type NO_INTERVENTION

No interventions assigned to this group

Intervention

The study will only include those patients that are ascertained be at more than 50% risk for vision loss (20/200 or worse at 3 years) because of total radiation dose of \>40 Gy to the center of the macula.1 These "at risk" patients included in the study will receive intravitreal triamcinolone (4 mg in 0.1 ml) injected at the time of plaque removal. If lack of IOP rise (30 mm Hg or more) at 3 months, then randomized to intravitreal Fluocinolone Acetonide (FA) implant.

Group Type ACTIVE_COMPARATOR

Fluocinolone Acetonide (FA) implant

Intervention Type DRUG

Fluocinolone Acetonide (FA) implant is designed to release FA at an initial rate of approximately 0.6 g/d, decreasing over the first month to a steady rate of 0.3 to 0.4 g/d with a duration of approximately 30 months.

Interventions

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Fluocinolone Acetonide (FA) implant

Fluocinolone Acetonide (FA) implant is designed to release FA at an initial rate of approximately 0.6 g/d, decreasing over the first month to a steady rate of 0.3 to 0.4 g/d with a duration of approximately 30 months.

Intervention Type DRUG

Other Intervention Names

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Steroid

Eligibility Criteria

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Inclusion Criteria

* Primary uveal melanoma
* Primary treatment with plaque brachytherapy
* Baseline visual acuity 20/200 or better
* Posterior tumor margin \>1.50 mm from the center of the macula
* Posterior tumor margin \> 1.50 mm from the closest disc margin
* Calculated total dose to center of the macula \>40 Gy

Exclusion Criteria

* Iris melanoma
* Opaque media
* less than 21 years of age
* Inability to give consent
* Positive pregnancy test
Minimum Eligible Age

18 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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The Cleveland Clinic

OTHER

Sponsor Role lead

Responsible Party

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Arun SINGH

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Cole Eye Instiute

Cleveland, Ohio, United States

Site Status

Countries

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United States

Other Identifiers

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NDA 201923

Identifier Type: -

Identifier Source: org_study_id

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