Ranibizumab Therapy for Non-arteritic Ischemic Optic Neuropathy
关键词
抽象
描述
Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common acute optic neuropathy in people older than 50 years. It is characterized by sudden partial loss of vision in one eye and has an increased risk of vision loss in the fellow eye. Although cause has not been determined, NAION is thought to occur following an idiopathic ischemic event involving the short posterior ciliary arteries that supply blood to the most anterior part of the optic nerve. A complete loss of vision is rare, but partial loss of visual field or acuity can result from NAION in the affected eye(s).
Patients who have a 'disc at risk' or 'crowded disc' (small cup: disc ratio) are at increased risk for developing NAION. Other risk factors for NAION include age > 50 years and white race (estimated 95% of cases). Hypertension and diabetes also predispose to NAION development. Other factors that have been associated with NAION include high cholesterol, arteriosclerosis, stroke, cardiac and intraocular surgery, tobacco use, nocturnal hypotension, blood loss, glaucoma, elevated homocysteine and sleep apnea. The association between NAION and hypertension, high cholesterol and diabetes is stronger in individuals younger than 50 years than in older persons.
Patients with NAION caused by ischemia leading to swelling of the optic nerve and rapidly progressing visual loss have had limited results with therapy such as corticosteroids, brimonidine, levodopa or surgery, such as optic nerve sheath decompression, in the past. Currently, there is no standard of care for these patients.
Although the role of vascular endothelial growth factor (VEGF) in NAION has not been established, ischemic conditions may lead to VEGF production which could be the cause of edema and swelling. This possibility suggests that VEGF may be a target for therapeutic intervention by ranibizumab. Ranibizumab has demonstrated an effect on edema and vascular permeability. In animal studies it has shown a concentration- dependent effect of blunting the vascular permeability induced by VEGF. Of the more than 5,000 subjects with age-related macular degeneration in current and completed clinical trials, vascular permeability and edema have decreased with the use of ranibizumab.
日期
最后验证: | 07/31/2016 |
首次提交: | 11/18/2007 |
提交的预估入学人数: | 11/18/2007 |
首次发布: | 11/20/2007 |
上次提交的更新: | 08/22/2016 |
最近更新发布: | 09/29/2016 |
首次提交结果的日期: | 03/02/2014 |
首次提交质量检查结果的日期: | 06/12/2016 |
首次发布结果的日期: | 07/24/2016 |
实际学习开始日期: | 10/31/2007 |
预计主要完成日期: | 03/31/2009 |
预计完成日期: | 03/31/2009 |
状况或疾病
干预/治疗
Drug: Ranibizumab
相
手臂组
臂 | 干预/治疗 |
---|---|
Experimental: Ranibizumab To determine the mean change in best corrected visual acuity (BCVA) using the Early Treatment Diabetic Retinopathy Study testing system at 6 months in NAION patients treated as needed (PRN) with ranibizumab. | Drug: Ranibizumab All patients (n=15) will be treated with open label 0.5mg ranibizumab given intravitreally monthly as needed for 6 months. |
资格标准
有资格学习的年龄 | 21 Years 至 21 Years |
有资格学习的性别 | All |
接受健康志愿者 | 是 |
标准 | Inclusion Criteria: - provide written informed consent - 21 years of age or older - new onset, within 14 days, of ischemia and vision loss - Best Corrected Visual Acuity (BCVA) 20/40 or worse Exclusion Criteria: - pregnancy or lactation - proliferative diabetic retinopathy, - diabetic macular edema, - uveitis, - history of ocular trauma, - severe glaucoma, - age-related macular degeneration. - prior or concomitant treatment of oral steroids within 30 days, - participation in any studies of investigational drugs within 30 days, - participation in a ranibizumab clinical trial or, - prior treatment intravitreally or intravenously of Avastin or steroids. |
结果
主要结果指标
1. Change in Visual Acuity [Baseline and 6 months]