A Phase 2 interventional study of Intravitreal infliximab and Pars plana vitrectomy in Rhegmatogenous Retinal Detachment, Proliferative Vitreoretinopathy and Retinal Detachment, sponsored by Cairo University. Completed at 1 site in Egypt. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2024-01-19.
Sponsored by Cairo University · Phase 2, Interventional, and Treatment
Proliferative vitreoretinopathy (PVR) is the most common cause for failure of rhegmatogenous retinal detachment repair and is characterized by the growth and contraction of cellular membranes within the vitreous cavity on both sides of the retinal surface as well as intraretinal fibrosis.
Multiple therapeutic agents have been tried as an adjunctive to retinal detachment surgery for PVR with no consistent efficacy. Tumor necrosis factor-α (TNF-α), which is a prominent inflammatory cytokine, is secreted in response to trauma, infection, and inflammation. It is a key mediator of ocular inflammation and its interactions with the retinal pigment epithelium (RPE) cell contribute to the initiation of PVR. This may occur through the action of TNF-α on the RPE cells inducing changes in cellular morphologies that lead to the formation of fibroblastic cells.
Infliximab (Remicade; Janssen Biotech, Horsham, PA, USA) is a mouse-human chimeric antibody that neutralizes the biological activity of TNF-α by high-affinity binding to the soluble and transmembrane forms of TNF-α, therefore preventing the effective binding of TNF-α with its receptors. Infliximab is used in the treatment of various ocular and systemic inflammatory conditions. Furthermore, intravitreal infliximab has been used for the treatment of various ocular diseases and has proven to be generally safe for the short term in inflammatory ocular conditions. A recent study showed that intravitreal infliximab can inhibit the development of PVR and reduce levels of cytokines in an experimental dispase-induced PVR model.
The purpose of this randomized controlled trial is to evaluate the efficacy of intravitreal infliximab injection as an adjunct to pars plana vitrectomy in the treatment of PVR associated with primary rhegmatogenous retinal detachment.
Proliferative vitreoretinopathy (PVR) is the most common cause for failure of rhegmatogenous retinal detachment repair and is characterized by the growth and contraction of cellular membranes within the vitreous cavity on both sides of the retinal surface as well as intraretinal fibrosis.
The incidence of PVR in all cases of retinal detachment is estimated to be 5- 10%. The incidence of PVR has largely remained unchanged in prospective studies despite the evolution of vitreoretinal techniques over the past 25 years, including valved trocars and smaller gauge instrumentation.
Numerous risk factors for the development of PVR have been identified. Almost all risk factors for PVR are associated with intravitreal dispersion of retinal pigment epithelial cells or breakdown of the blood-ocular barrier. Following a retinal break, the retinal pigment epithelial (RPE) cells are exposed to the vitreous cavity to react to growth factors and cytokines in the vitreous, resulting in a forward feedback to secret more growth factors and cytokines to further stimulate cellular responses.
Multiple therapeutic agents have been tried as an adjunctive to retinal detachment surgery for PVR with no consistent efficacy. Tumor necrosis factor-α (TNF-α), which is a prominent inflammatory cytokine, is secreted in response to trauma, infection, and inflammation. It is a key mediator of ocular inflammation and its interactions with RPE cells contribute to the initiation of PVR. This is because TNF-α was found to act on the RPE cells consequently inducing changes in cellular morphologies leading to the formation of fibroblastic cells. Additionally, if TNF-α is combined with other growth factors, a strong synergistic effect can be induced to form epithelial-mesenchymal transition (EMT)-associated fibrotic focus.
Infliximab (Remicade; Janssen Biotech, Horsham, PA, USA) is a mouse-human chimeric antibody that neutralizes the biological activity of TNF-α by high-affinity binding to the soluble and transmembrane forms of TNF-α, therefore preventing the effective binding of TNF-α with its receptors. Infliximab is used in the treatment of various ocular and systemic inflammatory conditions. Furthermore, intravitreal infliximab has been used for the treatment of various ocular diseases and has proven to be generally safe for the short term in inflammatory ocular conditions. A recent study showed that intravitreal infliximab can inhibit the development of PVR and reduce levels of cytokines in an experimental dispase-induced PVR model.
The purpose of this randomized controlled trial is to evaluate the efficacy of intravitreal infliximab injection as an adjunct to pars plana vitrectomy in the treatment of PVR associated with primary rhegmatogenous retinal detachment.
43 studies on the registry are indexed under Vitreoretinopathy, Proliferative; 11 are open to participants now.
This study's enrollment of 66 is close to the median of 64 across 30 interventional studies indexed under Vitreoretinopathy, Proliferative.
Browse Vitreoretinopathy, Proliferative studies →Cairo University is the lead sponsor of 4,941 studies on the registry; 1,458 are open to participants now.
Of its 37 completed or terminated interventional studies of FDA-regulated products, 5 (14%) have results posted.
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Exclusion Criteria:
This group will receive 1 mg/0.05 mL of intravitreal infliximab at the end of standard pars plana vitrectomy.
Drug: Intravitreal infliximab · Procedure: Pars plana vitrectomy
This group will undergo standard pars plana vitrectomy.
Procedure: Pars plana vitrectomy
1 mg/0.05 mL of infliximab will be injected intravitreally at the end of pars plana vitrectomy.
Also known as: Remicade
Standard pars plana vitrectomy
Anatomical success
Anatomical Success will be defined as stable complete retinal reattachment following pars plana vitrectomy and silicone oil removal.
Time frame: 9 months
Visual acuity
Best corrected visual acuity will be measured at follow up visits using standard Snellen charts.
Time frame: 1, 3, 6, and 9 months
Macular structure
Optical coherence tomography will be done at each follow up visit to assess the structure of the macula.
Time frame: 1, 3, 6, and 9 months
Macular vascularity
Optical coherence tomography angiography will be done at each follow up visit to assess macular vascular density.
Time frame: 7 months
Macular function
Macular function will be assessed during follow up visits using multifocal electroretinography
Time frame: 7 months
Single operation success rate
The rate of successful retinal reattachment following a single operation will be calculated.
Time frame: 9 months
Recurrence rate
Cumulative rate of recurrence of retinal detachment and reoperation following the primary surgery will be calculated during the study period.
Time frame: 9 months
Epiretinal proliferative
The formation of significant epiretinal proliferation will be assessed clinically at each follow up visit.
Time frame: 1, 3, 6, and 9 months
Plan to share: No
This study is completed, as verified in Jan 2024. You cannot join it, but the record below documents what was studied.
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Studies of the drug tested here: Infliximab
Vitreoretinopathy, Proliferative →