Effects of Pneumatic Vitreolysis on Vitreomacular Traction (AG)

Randomized Clinical Trial Assessing the Effects of Pneumatic Vitreolysis on Vitreomacular Traction

Eyes with idiopathic symptomatic vitreomacular traction (VMT) without a macular hole will be randomly assigned to 0.3-mL intraocular gas (C3F8) injection or sham injection to determine if pneumatic vitreolysis (PVL) is effective in releasing VMT.

Study Overview

• Status: Completed
• Conditions: Vitreomacular Traction
• Intervention / Treatment: Device: Pneumatic Vitreolysis (C3F8 injection); Other: Observation

Detailed Description

Investigational Device: 0.3-mL intraocular gas (C3F8) injection

Objectives

Primary

1. To compare the proportion of eyes with central VMT release on OCT after pneumatic vitreolysis with gas injection versus observation (sham injection) in eyes with VMT without an associated macular hole.

   Secondary

2. To evaluate visual function outcomes at 24 weeks after gas injection is performed compared with sham injection.

Study Design: Multi-center, randomized clinical trial

• Study Type: Interventional
• Enrollment (Actual): 46
• Phase: Phase 3

Contacts and Locations

Study Locations

• United States
  • California
    • Campbell, California, United States, 95008
      • Retinal Diagnostic Center
    • Huntington Beach, California, United States, 92647-8693
      • Atlantis Eye Care
    • Mountain View, California, United States, 94040-4123
      • Northern California Retina Vitreous Associates
    • Oakland, California, United States, 94609-3028
      • East Bay Retina Consultants, Inc
    • Palm Desert, California, United States, 92211
      • Southern California Desert Retina Consultants, MC
  • Florida
    • Fort Myers, Florida, United States, 33912
      • National Ophthalmic Research Institute
    • Jacksonville, Florida, United States, 32209
      • University of Florida College of Med., Dept of Ophthalmology, Jacksonville Hlth Sci Ctr
    • Lakeland, Florida, United States, 33805
      • Florida Retina Consultants
    • Orlando, Florida, United States, 32806-1101
      • Florida Retina Institute
    • Pinellas Park, Florida, United States, 33782-4418
      • Southeast Eye Institute, PA dba Eye Associates of Pinellas
    • Sarasota, Florida, United States, 34239
      • Sarasota Retina Institute
  • Georgia
    • Augusta, Georgia, United States, 30909
      • Southeast Retina Center, PC
    • Sandy Springs, Georgia, United States, 30328
      • Thomas Eye Group
  • Illinois
    • Bloomington, Illinois, United States, 61704-2484
      • Gailey Eye Clinic
    • Chicago, Illinois, United States, 60612
      • University of Illinois at Chicago Medical Center
    • Oak Park, Illinois, United States, 60304
      • Illinois Retina Associates, S.C.
  • Indiana
    • Indianapolis, Indiana, United States, 46290
      • Raj K. Maturi, M.D., P.C.
  • Iowa
    • West Des Moines, Iowa, United States, 50266-7705
      • Wolfe Eye Clinic
  • Kansas
    • Overland Park, Kansas, United States, 66211
      • Mid-America Retina Consultants, P.A.
  • Kentucky
    • Paducah, Kentucky, United States, 42001-7502
      • Paducah Retinal Center
  • Louisiana
    • West Monroe, Louisiana, United States, 71291-4452
      • Eye Associates of Northeast Louisiana dba Haik Humble Eye Center
  • Maryland
    • Baltimore, Maryland, United States, 21237
      • Elman Retina Group, PA
  • Massachusetts
    • Ayer, Massachusetts, United States, 01432-1191
      • Valley Eye Physicians and Surgeons
    • Boston, Massachusetts, United States, 02215
      • Joslin Diabetes Center
    • Worcester, Massachusetts, United States, 01605
      • Vitreo-Retinal Associates, PC
  • Michigan
    • Grand Rapids, Michigan, United States, 49546-3725
      • Retina Specialists Of Michigan
  • Minnesota
    • Rochester, Minnesota, United States, 55905
      • Mayo Clinic Department of Opthalmology
  • Missouri
    • Saint Louis, Missouri, United States, 63128-1729
      • The Retina Institute
  • New York
    • New York, New York, United States, 10021
      • MaculaCare
  • North Carolina
    • Asheville, North Carolina, United States, 28803
      • Western Carolina Clinical Research, LLC
    • Charlotte, North Carolina, United States, 28210
      • Charlotte Eye, Ear, Nose, and Throat Assoc., PA
  • Ohio
    • Beachwood, Ohio, United States, 44122
      • Retina Associates of Cleveland, INC
  • Oklahoma
    • Edmond, Oklahoma, United States, 73013-9791
      • Retina Vitreous Center
  • Oregon
    • Eugene, Oregon, United States, 97401-7701
      • Oregon Retina, LLP
    • Portland, Oregon, United States, 97221
      • Retina Northwest, PC
  • Tennessee
    • Chattanooga, Tennessee, United States, 37421
      • Southeastern Retina Associates
    • Knoxville, Tennessee, United States, 37909
      • Southeastern Retina Associates, PC
  • Texas
    • Austin, Texas, United States, 78705
      • Retina Research Center
    • Austin, Texas, United States, 78705-1169
      • Austin Retina Associates
    • San Antonio, Texas, United States, 78240
      • Retinal Consultants of San Antonio
  • Washington
    • Spokane, Washington, United States, 99204
      • Spokane Eye Clinic

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. At least one eye meets the study eye criteria listed below.
2. Able and willing to provide informed consent.
3. Able and willing to avoid high altitude travel, including airline travel, until gas resolution (approximately 6 to 8 weeks).
4. For phakic patients, able and willing to avoid supine position until gas resolution (approximately 6 to 8 weeks).

5. Able and willing to wear wristband that informs any medical personnel that the patient has a gas bubble in the eye

   Exclusion

   A potential participant is not eligible if any of the following exclusion criteria are present:

6. A condition that, in the opinion of the investigator, would preclude participation in the study (e.g., unstable medical status that might preclude completion of follow-up)

7. Participation in an investigational trial within 30 days of randomization that involves treatment with any drug or device that has not received regulatory approval for the indication being studied at the time of study entry

   • Note: study participants should not receive another investigational drug/device while participating in the study

8. Known contraindication to any component of the treatment
9. Known allergy to any drug used in the procedure prep (including povidone iodine)
10. Potential participant is expecting to move out of the area of the clinical center to an area not covered by another clinical center during the next 6 months following randomization

11. Anticipated surgery requiring anesthesia within the next 6 months following randomization

    • Participants cannot receive nitrous oxide until gas resolution

12. For women of child-bearing potential, pregnant at the time of enrollment

    • Women who are potential study participants should be questioned about the potential for pregnancy. Investigator judgement may be used to determine when a pregnancy test is needed.

    Study Eye Criteria

    The participant must have at least one eye meeting all of the inclusion criteria and none of the exclusion criteria listed below.

    A participant can have only one study eye. If both eyes are eligible at the time of randomization, the study eye will be selected by the investigator and participant before randomization.

    The eligibility criteria for a study eye are as follows:

    Inclusion

    1. Vitreomacular adhesion on OCT that is no larger than 3000 microns with visible separation of the vitreous on either side as seen on horizontal and vertical scans, confirmed by central reading center Note: presence of epiretinal membrane is neither a requirement nor exclusion.
    2. Decreased visual function (e.g. metamorphopsia or other visual symptom) that is attributed to VMT.

    Examples of visual symptoms include:

    a) Distortion and/or reduction in visual acuity b) Recognized difficulty with reading, driving, or using a computer c) Patient recognized interference with quality of life because of a and/or b.

    c. Visual acuity letter score of at least 19 (approximate Snellen equivalent 20/400 or better) and at most 78 (20/32 or worse) d. Investigator and participant willing to wait 6 months before surgical intervention, provided visual acuity remains stable

    • An eye that requires prompt treatment for VMT should not be enrolled

    Exclusion e. Other ocular condition that might affect visual acuity during the course of the study or require intraocular treatment (e.g., retinal vein occlusion, substantial age-related macular degeneration, or macular edema induced by a condition other than VMT) • If diabetic retinopathy is present, severity level must be microaneurysms only or better (≤ diabetic retinopathy severity level 20)

    • Presence of drusen is acceptable; however, eyes with geographic atrophy or neovascular age-related macular degeneration involving the macula are excluded f. High level of myopia (spherical equivalent of -8.00 diopters or more myopic if phakic or retinal abnormalities consistent with pathologic myopia if phakic or pseudophakic) g. History of prior gas injection, ocriplasmin injection, or intraocular injection for any reason h. History of prior vitrectomy i. History of uncontrolled glaucoma

    • IOP must be <30 mmHg, with no more than one topical glaucoma medication, and no documented glaucomatous field loss for the eye to be eligible j. History of major ocular surgery (including cataract extraction, scleral buckle, any intraocular surgery, etc.) within prior 4 months or major ocular surgery anticipated within the next 6 months following randomization k. History of YAG capsulotomy performed within 4 months prior to randomization l. Aphakia or anterior chamber intraocular lens m. Exam evidence of severe external ocular infection, including conjunctivitis, chalazion, or substantial blepharitis n. Uveitis o. Presence of any macular hole or lamellar hole (according to reading center grading) p. Retinal history or pathology that might predispose an eye to an increased risk of retinal detachment from the procedure

    • Untreated retinal tears, not retinal holes, are an exclusion. It is up to the investigator to determine whether extent of lattice degeneration or other pathology might increase the risk of retinal detachment.

    q. Any contraindication to paracentesis (e.g., history of narrow angle glaucoma) r. Lenticular or zonular instability

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Pneumatic Vitreolysis; Participants randomized to the Pneumatic Vitreolysis arm will receive 0.3-mL intraocular injection of C3F8 gas.	Device: Pneumatic Vitreolysis (C3F8 injection); Pneumatic Vitreolysis will be performed via an intraocular injection of C3F8 gas. Perfluoropropane (C3F8) is an inert gas under pressure and is administered by injection into the vitreous cavity. It was approved by the FDA in February 1993 (P900066) for the use of placing pressure on detached retina.
Placebo Comparator: Observation; Participants randomized to the observation group will receive a sham injection.	Other: Observation; No intervention; sham injection only

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Proportion of Eyes With Central Vitreomacular Traction Release Without Rescue Vitrectomy	at 24 Weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Eyes With Rescue Treatment Before the 24-week Visit		up to 24 weeks
Number of Eyes With Rescue Vitrectomy Completed Before the 24-week Visit or Planned at the 24 Week Visit	scheduled rescue vitrectomy must be completed within the subsequent 12 weeks.	through 24 Weeks
Number of Eyes With Central Vitreomacular Traction Status		up to 24 weeks
Mean Change in E-ETDRS Visual Acuity Letter Score From Baseline	Best-corrected visual acuity following protocol-defined refraction. Visual Acuity was measured with the Electronic Early Treatment Diabetic Retinopathy Study (E-ETDRS) visual acuity test on a scale from 100 letters (Snellen equivalent of 20/10) to 0 letters (Snellen equivalent <20/800). Higher scores indicate better visual acuity and lower scores indicate worse visual acuity.	Baseline to 24 weeks

Collaborators and Investigators

• Sponsor: Jaeb Center for Health Research
• Collaborators: National Eye Institute (NEI); National Institutes of Health (NIH)
• Investigators: Study Chair: Clement Chan, MD, Southern California Desert Retina Consultants, MC

Study record dates

Study Major Dates

• Study Start (Actual): October 16, 2018
• Primary Completion (Actual): August 6, 2020
• Study Completion (Actual): August 6, 2020

Study Registration Dates

• First Submitted: August 23, 2018
• First Submitted That Met QC Criteria: August 23, 2018
• First Posted (Actual): August 27, 2018

Study Record Updates

• Last Update Posted (Actual): September 21, 2022
• Last Update Submitted That Met QC Criteria: September 6, 2022
• Last Verified: September 1, 2022

More Information

Terms related to this study

• Other Study ID Numbers: DRCR.net Protocol AG; U10EY014231 (U.S. NIH Grant/Contract); U10EY023207 (U.S. NIH Grant/Contract)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes