Intravitreal Dexamethasone Implant (Ozurdex) Versus Bevacizumab in Patients With Diabetic Macular Edema Undergoing Cataract Surgery

Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center

Status

Withdrawn

Conditions

Cataract

Diabetic Macular Edema

Treatments

Drug: Bevacizumab Injection

Study type

Interventional

Funder types

Other

Industry

Identifiers

NCT04067856

22361-01

Details and patient eligibility

About

The purpose of this research is to compare the effectiveness of bevacizumab (Avastin) with another a dexamethasone implant (Ozurdex), with respect to anatomic and visual outcomes as well as injection frequency in subjects undergoing cataract surgery with a concurrent diagnosis of diabetic macular edema (DME).

Full description

Subjects over the age of 18 with both: 1) visually significant cataracts requiring cataract surgery and 2) diabetic macular edema (DME) will be enrolled in the study. Subjects with high risk proliferative diabetic retinopathy and any other retinal vascular disease or retinal pathology that may limit vision will be excluded. Baseline photography will be done to quantify the amount of DME and to exclude the presence of proliferative diabetic retinopathy or other retinal vascular or general retinal pathology. Subjects will be randomized to receive either an intravitreal injection of Ozurdex or Avastin at the time of cataract surgery. Subjects will be monitored the day after surgery, one to two weeks after cataract surgery and again monthly thereafter for a total of six visits from the time of cataract surgery with standardized visual acuity measurement, ophthalmologic examination and retinal photography performed at each visit. For the first two months after cataract surgery, subjects receiving Ozurdex will receive an injection of Avastin if the degree of swelling worsens by more than 10% on photography or the vision decreases. For the first two months after cataract surgery, subjects receiving Avastin will receive repeat injections of Avastin on a monthly basis. For each monthly visit thereafter, both groups will receive an intravitreal injection of Avastin if clinically significant DME is present or if vision declines.

Sex

All

Ages

18 to 89 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Age greater than 18 years old with type one or type two diabetes mellitus
Center-involving diabetic macular edema with central subfield thickness ≥ 320um on Heidelberg Spectralis optical coherence tomography (OCT) testing
Best-corrected electron-early treatment diabetic retinopathy study (E-ETDRS Visual Acuity) visual acuity letter score between 78 to 24
Any Lens Opacities Classification System (LOCS) III cataract grade greater than or equal to two

Exclusion criteria

Presence of macular edema attributable to other causes including but not limited to retinal venous occlusive disease and non-infectious uveitis
History of glaucoma
History of steroid-induced intraocular pressure (IOP) elevation that required IOP-lowering treatment
Optic nerve cup to disc ratio greater than 0.6
Active proliferative diabetic retinopathy
Presence of other retinal diseases including but not limited to age-related macular degeneration, retinal venous occlusive disease and posterior segment uveitis
Any prior intraocular surgery
Treatment with any anti-VEGF medication within the past 3 months or intravitreal steroid within the past 6 months
Panretinal photocoagulation within the prior 6 months or anticipated need for panretinal photocoagulation within the next 6 months
IOP greater than or equal to 25
Systolic blood pressure > 180 mmHg or diastolic > 110 mmHg
Myocardial infarction, other cardiac event requiring hospitalization, cerebrovascular accident, transient ischemic attack or treatment for acute congestive heart failure within the past 6 months