Fluocinolone Implant to Treat Macular Degeneration

Patients must be able to understand and sign the protocol informed consent.

Patients must have a diagnosis of AMD defined by the presence of drusen larger than 63 micrometer in size in one eye and age greater than or equal to 50 years.

Patients must have vision of 5 letters or better in the fellow compared with the study eye.

Patients visual acuity must be 20/200 to 20/400 in the study eye for the initial 6 patients. Following DSMC approval, visual acuity of 20/60 to 20/400 in the study eye for the remaining 10 patients.

Patients must be ineligibility for a clinically proven laser photocoagulation protocol.

Patients must have the presence of choroidal neovascularization under the fovea as defined as any one of the following stereoscopic fuorescein angiogram (SFA) features (determined by the Reading Center): a) Early stippled hyperfluorescence of flat retinal pigment epithelium with ill-defined boundary and little or mild leakage in the late frames of the fluorescein; b) Irregular elevation of the retinal pigment epithelium that does not exhibit discrete or bright hyperfluorescence in the early transit phase of the angiogram. Stippled hyperfluorescence may be present. Late frames may show persistent fluorescein staining or leakage within a sensory retinal detachment overlying this area; c) Early well-defined lacy hyperfluorescence with late frames that show persistent fluorescein staining or leakage; d) The area of late leakage or staining must involve at least 1 standard disc area (1.77 mm(2)) and should not exceed 16 standard disc areas on the fovea; e) The area of hyperfluorescence determined by the reading center as well-defined CNVM must be less than 50 percent of the total area of early and late hyperfluorescence identified by the reading center as total area of CVNM.

Patients must have the ability to obtain retinal photographs and angiography of sufficient quality such that the macular area can be assessed according to standard clinical practice.

Patients must be greater than or equal to 50 years of age.

No prior retinal detachment surgery or history of retinal detachment in either eye.

No choroidal neovascularization, in the study eye, associated with other ocular disease such as pathologic myopia, ocular histoplasmosis or posterior uveitis, etc.

No presence of geographic atrophy or serous pigment epithelial detachment under the fovea in the study eye.

No decreased vision, in the study eye, due to retinal disease not attributable to CNVM, such as serous retinal pigment epithelial detachment, nonexudative form of ARM, geographic atrophy, inherited retinal dystrophy, uveitis, or epiretinal membrane.

No decreased vision, in the study eye, due to significant media opacity such as corneal disease or cataract, or opacity precluding photography of the retina

No other antiangiogenic treatment with thalidomide or alpha interferon.

No intraocular pressure greater than or equal to 26 or history suggesting glaucoma (e.g. history of the diagnosis of glaucoma, past or present use of medications to control intraocular pressure, or disc/nerve fiber layer defects suggestive of glaucoma) and glaucomatous visual field defects as documented by Goldmann or Humphrey perimetry taken within 6 months to qualification.

No contraindications to performing the necessary diagnostic studies, especially the use of fluorescein angiography.

No known history of untoward complications from corticosteroid therapy, including elevated intraocular pressure in response to topical or periocular corticosteroids.

No medical problems that make consistent follow-up over the treatment period unlikely (e.g. stroke, severe MI, terminal carcinoma).

No current use of or likely need for systemic or ocular medications known to be toxic to the lens, retina, or optic nerve, such as: a) Deferoxamine; b) Chloroquine/Hydroxychloroquine (Plaquenil); c) Tamoxifen; d) Phenothiazine; e) Phenothiazines; f) Ethambutol; g) Ocular or systemic steroids or use of steroid-containing inhalers or nasal sprays utilized more than 6 days a month on average. Any regular use of pills containing steroids.

Determination by the Reading Center in the study eye any one of the following: a) Well-defined choroidal neovascularization (as defined by the MPS) whose area, as seen on the early frames of the SFA, is greater than 50 percent of the total area of late leakage or staining; b) Presence of subretinal dull white fibrous tissue constituting disciform scarring whose area is greater than 25 percent of the area of choroidal neovascularization and which is present outside the area of choroidal neovascularization; c) Poor quality fluorescein angiogram, media opacity or technical difficulties precluding adequate interpretation and classification of the angiographic findings; d) The total area of the lesion occupied by the CNVM will not be less that the area occupied by all lesion components that might obscure the boundaries of the CNVM such as elevated blocked fluorescence and/or serous detachment of the RPE; e) Presence of subfoveal hemorrhage.

No medical condition deemed prohibitive for surgery by the NIH anesthesiologist.