Proliferative Vitreoretinopathy, Proliferative Vitreo-Retinopathy, Rhegmatogenous Retinal Detachment
Conditions
Brief summary
The goal of this clinical trial is to evaluate the safety and efficacy of intravitreal topotecan for the treatment of patients with rhegmatogenous retinal detachment due to proliferative vitreoretinopathy (PVR) or resulting from an open globe injury, and compare the outcomes to those who do no receive intravitreal topotecan. The main objectives it aims to achieve are: * to study the safety profile of intravitreal topotecan in the treatment of PVR * to evaluate the efficacy of intravitreal topotecan in treating PVR. Post-consent, participants will: * undergo vitrectomy (with or without scleral buckle) as part of standard treatment for retinal detachment. * receive intravitreal topotecan at the time of surgery, post-operative day 7 and post-operative day 28 (if randomized to receive the medication) * come in at post-operative day 1, 7, 28, 56, 84, 126 and 168 to undergo a complete ophthalmic exam along with a fundus photography and optical coherence tomography of the macula, have their intraocular pressure and visual acuity measured and their adverse events monitored, if any. Researchers will compare participants who receive intravitreal topotecan for PVR to those who do not to see if there is a significant variability in recurrence of retinal detachment, rate of retinal reattachment and PVR grade 6 months after surgery.
Detailed description
Rhegmatogenous retinal detachment (RRD) is an acute, sight-threatening condition that occurs after separation of the neurosensory retina from the underlying retinal pigment epithelium (RPE) due to the presence of a retinal break. Proliferative vitreoretinopathy (PVR) represents growth of ectopic fibrocellular growth on the surface of, within and underneath the retina. PVR is hypothesized to occur secondary to the migration of RPE cells to the peri-retina, leading to a mesenchymal transition into contractile myofibroblasts. PVR affects 5-10% of RRDs and is the most common cause of surgical failure in RRD. Given that PVR involves a pro-inflammatory and pro-fibrotic cellular response, adjuvants such as corticosteroids and antimetabolites such as 5-fluorouracil have been attempted in the treatment of this condition. Overall, the efficacy results of these treatments have been mixed, and no standard of care adjuvant therapy has emerged. Topotecan is a chemotherapeutic agent that acts as a topoisomerase inhibitor. It is most commonly administered intravitreally for patients with refractory or recurrent vitreous seeds from retinoblastoma, and shows high efficacy in this setting. At the same time, intravitreal topotecan administered at doses of 5-30µg has been associated with no ocular or systemic complications or adverse electroretinogram changes. To the best of available knowledge, topotecan has not been administered for the treatment of proliferative vitreoretinopathy. Topotecan has anti-inflammatory, anti-proliferative and anti-fibrotic activity that is hypothesized to exhibit high efficacy for the treatment of PVR. In this study, the efficacy and safety of intravitreal topotecan for the treatment of PVR will be investigated.
Interventions
DRUGTopotecan
20 micrograms of intravitreal topotecan given in a 1 cc tuberculin syringe at a concentration of 20 mcg/20mcL.
Sponsors
Massachusetts Eye and Ear Infirmary
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Half of the patients will receive intravitreal topotecan at the time of surgery. Randomization will be done based on a computer-generated list that would randomly allocate each of the 50 participants to being either in the treatment arm or in the control arm, in a particular order. Results will be printed on a card put in sealed envelopes that would be given to each research subject based on the allocation order given by that computer-generated list.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Patients \> 18 years old * Patients presenting with retinal detachment due with PVR (grade C or higher) or retinal detachment associated with open globe trauma * Patients undergoing vitrectomy or vitrectomy with scleral buckle as part of standard care.
Exclusion criteria
* Patient unable to give consent * Patient unable to follow-up * Females of childbearing age who are pregnant at the time of recruitment. A pregnancy test will be done to all women of ages 18-55 prior to surgery to ensure they are not pregnant at the time of recruitment. * Patients with a history of tractional or exudative retinal detachment. * Patients with other planned ocular surgery following PPV * Active or chronic or recurrent uncontrolled ocular or systemic disease * Active or history of chronic or recurrent inflammatory eye disease * Diagnosis of severe nonproliferative or proliferative diabetic retinopathy or vasoproliferative disease in the operative eye * Signs of ocular infection at presentation in either eye * Known or suspected sensitivity or allergy to any of the medications used in the operation or postoperatively * No Light Perception vision in the operative eye * Failure to achieve intraoperative reattachment * Patient with silicone oil instilled in the operative eye at time of presentation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Recurrence of rhegmatogenous retinal detachment secondary to PVR | 6 months after initial surgery, or last follow-up visit available | Investigators will be evaluating whether participant develop a recurrent retinal detachment throughout their follow up after their initial surgery. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Best corrected visual acuity (BCVA) | at the pre-operative assessment, and post-operative day1, 7, 28, 56, 84, 126, 168 | Investigators will be measuring the BCVA of participants throughout their follow up and see if they notice any change from surgery time to final follow up |
| Variation of PVR grade | at the pre-operative assessment, and post-operative day1, 7, 28, 56, 84, 126, 168 | Investigators will be doing a dilated fundus exam and taking fundus photographies for all participants throughout their follow up time to see if the grade of the PVR changes over time. PVR grade goes from grade A to grade C-Anterior to equator/ C-Posterior to equator (grade C being worse than grade A) |
| Retinal reattachment rate at month 6 or last follow up | at post-operative day 168 (or last follow-up visit available if the participant did not show up at post-operative day 168) | Investigators will be doing a dilated fundus exam and taking fundus photographies for all participants throughout their follow up time to see if the retinal reattaches (whether completely or partially) after surgery |
| Recurrence of rhegmatogenous retinal detachment due to any cause | at the pre-operative assessment, and post-operative day1, 7, 28, 56, 84, 126, 168 | Investigators will be measuring the BCVA of participants throughout their follow up and see if they notice any change from surgery time to final follow up |
| Number of participants and type of intraoperative or postoperative complications | at time of surgery, and each follow up visit (post-operative day1, 7, 28, 56, 84, 126, 168) | Any adverse event will be noted during surgery, and at each follow up visit for each participant if applicable. |
Contacts
CONTACTLeo Kim, MD, PhD
PRINCIPAL_INVESTIGATORLeo Kim, MD, PhD
Massachusetts Eye and Ear
Outcome results
None listed