Vascular Remodeling and the Effects of Angiogenic Inhibition in Diabetic Retinopathy

National Institutes of Health (NIH)

Status and phase

Completed

Early Phase 1

Conditions

Diabetic Retinopathy

Treatments

Drug: triamcinolone acetonide (Kenalog)

Study type

Interventional

Funder types

NIH

Identifiers

NCT00411333

R01 EY017528-0

Details and patient eligibility

About

The retinal vasculature changes dramatically in patients with diabetic retinopathy especially between non-proliferative and proliferative disease. The retinal vasculature can be imaged and quantified using special dyes. This study will test whether the pattern of the retinal vasculature changes in patients with different levels of diabetic retinopathy can be quantified using computerized image analysis. In addition, the study will evaluate whether new drugs to treat diabetic retinopathy will be able to reverse these vascular changes.

Full description

In this study, we are studying whether vascular density decreases during diabetic retinopathy prior to the pathological neovascularization seen in proliferative disease that results in blindness in more than 50 percent of patients, and whether the adverse, early vascular remodeling and neovascularization can be reversed by anti-angiogenic therapeutics. We have shown that vascular density decreases during early stages of diabetic retinopathy, prior to the pathological neovascularization that defines proliferative retinopathy, and that this change may be reversible with new anti-angiogenic therapeutics. To test this hypothesis we will determine (1) how blood vessels remodel and whether vascular density truly decreases during diabetic retinopathy and (2) how the anti-angiogenic steroid triamcinolone acetonide affects vascular density and pattern during human diabetic retinopathy and in our experimental model, the avian CAM model.

Twenty patients (n = 20) for each of the 4 NPDR stages will be enrolled. In addition, a control group of 20 normal subjects will be recruited from the same clinical practice that do not have diabetes and no evidence of any vascular disease, for a total of 100 patients in the clinical trial.

Enrollment

100 estimated patients

Sex

All

Volunteers

Accepts Healthy Volunteers

Inclusion criteria

Presence of mild, moderate, severe, or very severe non-proliferative diabetic retinopathy (defined as ETDRS level >10) in at least one eye (based on ETDRS criteria)

Exclusion criteria

Any condition that might impair the patient's ability to give informed consent
Any condition or media opacity that might impair the patient's ability to perform vision tests, color fundus photographs or fluorescein angiography
Severe allergy or other contraindication to sodium fluorescein dye
Participating in any other ophthalmic clinical trial