A clinical trial to evaluate maintenance of vision after switching to treatment with an eye implant containing ranibizumab in participants with neovascular age‑related macular degeneration

Ocular Inclusion Criteria:

• Initial diagnosis of nAMD within 18 months prior to screening
• Difference of <10% in ECD at screening between the 2 eyes as measured by specular microscopy and determined by the independent reading center
• Availability of historical visual acuity (VA) data and spectral-domain optical coherence tomography (SD-OCT) imaging prior to the first anti-vascular endothelial growth factor (VEGF) intravitreal therapy (IVT) treatment for nAMD
• Availability of comprehensive historical anti-VEGF injection data including anti-VEGF agent administered and date of administration from the first anti-VEGF treatment for nAMD
• Demonstrated response to at least two anti-VEGF IVT injections since diagnosis, as evidenced by the following:
• Overall decrease in nAMD disease activity detected on historical or screening OCT as assessed by the investigator and confirmed by the central reading center AND
• Stable or improved BCVA
• Best-corrected visual acuity (BCVA) of 34 letters (approximate 20/200 Snellen equivalent) or better, using Early Treatment of Diabetic Retinopathy Study (ETDRS) chart at a starting distance of 4 meters at screening and enrollment
• All subtypes of nAMD lesions are permissible
• nAMD lesions at the time of diagnosis must involve the macula (6 millimetres (mm) diameter centered at the fovea)
• Sufficiently clear ocular media and adequate pupillary dilation to allow for clinical examination and analysis and grading by the central reading center of SD-OCT images

Prior Ocular Treatment

Study Eye:

• Prior treatment with verteporfin for injection, external-beam radiation therapy, or transpupillary thermotherapy
• Previous treatment with corticosteroid IVT injection
• Previous laser (any type) used for age related macular degeneration (AMD) treatment
• History of vitreous hemorrhage
• History of rhegmatogenous retinal detachment
• History of corneal transplant
• History of conjunctival surgery in the superotemporal quadrant

Either Eye:

• Previous PDS implantation
• Previous intraocular surgery (including cataract surgery) within 6 months of study enrollment
• Prior pars plana vitrectomy surgery
• Previous intraocular device implantation excluding intraocular lenses
• History of glaucoma-filtering surgery, tube shunts, or microinvasive glaucoma surgery
• Intraocular laser therapy including selective laser trabeculoplasty, yttrium-aluminum garnet (YAG), prophylactic peripheral iridotomy within 1 year of screening, or YAG capsulotomy within 3 months of screening
• Contact lens wear in either eye within 2 months of screening
• Any prior ocular trauma (blunt or penetrating)
• History of corneal transplantation, including partial-thickness corneal grafts
• Prior treatment with brolucizumab
• Prior treatment with any anti-VEGF biosimilar agents within 2 months of screening
• Prior treatment with faricimab within 2 months of screening
• Prior treatment with aflibercept 8 mg within 2 months of screening
• Prior treatment with external-beam radiation therapy or brachytherapy

Macular Neovascularization Lesion (MNV) Characteristics

Study Eye:

• Subretinal hemorrhage that involves the center of the fovea, if the hemorrhage is greater than 0.5-disc area (1.27 square millimitres (mm^2)) in size at screening
• Subfoveal fibrosis or subfoveal atrophy

Concurrent Ocular Conditions

Study Eye:

• Retinal pigment epithelial tear
• Retinal tears or peripheral retinal breaks on depressed fundus exam that are untreated, or treated within the 3 months prior to study enrollment
• Previous violation of the posterior capsule is also an exclusion criterion unless it occurred as a result of YAG laser posterior capsulotomy in association with prior, posterior chamber intraocular lens implantation
• Spherical equivalent of the refractive error demonstrating more than 8 diopters of myopia or evidence of pathologic myopia on depressed fundus exam
• Preoperative refractive error that exceeds 8 diopters of myopia, for participants who have undergone prior refractive or cataract surgery
• Spherical equivalent of the refractive error demonstrating more than 5 diopters of hyperopia
• Preoperative refractive error that exceeds 5 diopters of hyperopia, for participants who have undergone prior refractive or cataract surgery
• Uncontrolled ocular hypertension or glaucoma
• Scleral pathology in the superotemporal quadrant (e.g., scleral thinning or calcification)
• Conjunctival pathologies in the superotemporal quadrant
• History or presence of severe posterior blepharitis, recurrent chalazia or hordeolum, severe dry eye syndrome, or severe allergic conjunctivitis
• Ectropion, entropion or other impairment of the upper or lower eyelid impacting lid functionality needed to protect the ocular surface from exposure
• Trichiasis
• Corneal neuropathy
• Lagophthalmos or incomplete blink • Active or history of facial nerve palsy/paresis

Fellow (Non-Study) Eye:

• Concurrent PDS implantation

Either Eye:

• Aphakia or absence of the posterior capsule
• Any concurrent intraocular condition that would either require surgical intervention during the study to prevent or treat visual loss that might result from that condition or affect interpretation of study results
• Corneal ECD ≤1500 cells/mm2 in either eye at screening as determined by the independent reading center
• Fuchs endothelial corneal dystrophy Grade ≥ 2
• Previous corneal endothelial cell damage, including from blunt or surgical trauma
• Any ocular condition that precludes obtaining an analyzable specular microscopy image
• Active or history of corneal edema
• Active or history of corneal dystrophies
• Active or history of iridocorneal endothelial syndrome
• Active or history of pseudoexfoliation syndrome
• Active or history of herpetic keratitis or kerato-uveitis
• Any active or history of uveitis
• Active or history of keratitis, scleritis, or endophthalmitis
• Active ocular or periocular infection
• Active or history of Sjogren's syndrome or keratoconjunctivitis sicca
• Active or history of floppy eyelid syndrome
• Active or history of chronic eye rubbing
• Active thyroid eye disease

Concurrent Systemic Conditions:

• Uncontrolled blood pressure
• Active or history of autoimmune diseases such as rheumatoid arthritis, lupus, granulomatosis with polyangiitis (Wegner's), etc.
• History of stroke within the last 3 months prior to screening
• Uncontrolled atrial fibrillation within 3 months of screening
• History of myocardial infarction within the last 3 months prior to screening
• History of other disease, metabolic dysfunction, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of ranibizumab or placement of the implant and that might affect interpretation of the results of the study or renders the patient at high risk of treatment complications, in the opinion of the investigator
• Current active systemic infection
• Use of any systemic anti-VEGF agents
• Chronic use of oral corticosteroids
• Active cancer within 12 months of enrollment except for appropriately treated carcinoma in situ of the cervix, non-melanoma skin carcinoma, and prostate cancer with a Gleason score of ≤ 6 and a stable prostate-specific antigen for > 12 months
• Previous participation in any non-ocular (systemic) disease studies of investigational drugs within 1 month prior to screening (excluding vitamins and minerals)
• Use of antimitotic or antimetabolite therapy within 30 days or 5 elimination half-lives of the screening visit
• Pregnant or breastfeeding, or intention to become pregnant during the study
• Women of childbearing potential, must have a negative urine pregnancy test result within 28 days prior to initiation of study treatment. If the urine pregnancy test is positive, it must be confirmed by a serum pregnancy test.