Overview

This study will evaluate the long-term safety and tolerability of the Port Delivery System with ranibizumab (PDS) (100 mg/mL) in patients with neovascular age-related macular degeneration (nAMD) who have either completed Phase II Study GX28228 (Ladder), Phase III Study GR40548 (Archway), Phase IIIb Study WR42221 (Velodrome), or completed Week 24 visit in Study WR42221 but were not eligible to be randomized in WR42221.

Eligibility

Inclusion Criteria:

• Previous enrollment in and completion of Study GX28228 (Ladder) or Study GR40548 (Archway), without early treatment or study discontinuation in either study OR Previous enrollment in Study WR42221 (Velodrome) and either not eligible to be randomized in Study WR42221 at Week 24 or completed the study (from the Q24W or Q36W arm)
• Ability and willingness to undertake all scheduled visits and assessments
• For women of childbearing potential: agreement to remain abstinent or use contraceptive measures

Exclusion Criteria:

• Pregnant or breastfeeding, or intending to become pregnant during the treatment period and for at least 28 days after the last intravitreal injection of ranibizumab or 1 year after the last Implant refill-exchange of ranibizumab
• History of other ocular diseases that give reasonable suspicion of a disease or condition that contraindicates the use of ranibizumab, that might affect interpretation of the results of the study or that renders the participant at high risk for treatment complications
• History of other diseases, 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 that renders the participant at high risk of treatment complications
• Requirement for continuous use of any medications or treatments indicated in the "Prohibited Therapy"

Substudy

Inclusion Criteria

• For women of childbearing potential: agreement to remain abstinent (refrain from heterosexual intercourse) or use contraceptive measures,

Patients must meet the following ocular criteria for the study eye for substudy entry:

• Diagnosis of exudative nAMD within 2 years prior to the enrollment visit
• Previous treatment with at least two anti-VEGF ITV injections (e.g., ranibizumab, bevacizumab, or aflibercept) for nAMD per standard of care within 6 months prior to the enrollment visit
• Demonstrated response to prior anti-VEGF ITV treatment since diagnosis, as evidenced at enrollment by the following:

        Overall decrease in nAMD disease activity detected on SD-OCT AND Stable or improved
        best-corrected visual acuity (BCVA)
          -  All subtypes of nAMD lesions are permissible (i.e., type I, type II, type III, or
             mixed forms per optical coherence tomography (OCT) classification) nAMD lesions at the
             time of diagnosis must involve the macula (6 mm diameter centered at the fovea).
          -  Sufficiently clear ocular media and adequate pupillary dilation to allow for analysis
             and grading by the central reading center of FP and SD-OCT images.
        Exclusion Criteria
        Prior Ocular Treatments Study Eye
          -  History of vitrectomy surgery, submacular surgery, or other surgical intervention for
             AMD
          -  Prior treatment with Visudyne, external-beam radiation therapy, or transpupillary
             thermotherapy
          -  Previous treatment with corticosteroid ITV injection
          -  Previous intraocular device implantation
          -  Previous laser (any type) used for AMD treatment
        Either Eye
          -  Treatment with anti-VEGF agents other than ranibizumab within 1 month prior to the
             enrollment visit
          -  Prior participation in a clinical trial involving anti-VEGF drugs within 6 months
             prior to the enrollment visit, other than ranibizumab
        CNV Lesion Charateristics Study Eye
          -  Subretinal hemorrhage that involves the center of the fovea, if the hemorrhage is
             greater than 0.5 disc area (1.27 mm2 ) in size at screening
          -  Subfoveal fibrosis or subfoveal atrophy
        Either Eye
        - CNV due to other causes, such as ocular histoplasmosis, trauma, or pathologic myopia
        Concurrent Ocular Conditions Study Eye
          -  Retinal pigment epithelial tear
          -  Any concurrent intraocular condition (e.g., cataract, glaucoma, diabetic retinopathy,
             or epiretinal membrane) 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
          -  Active intraocular inflammation (grade trace or above)
          -  History of vitreous hemorrhage
          -  History of rhegmatogenous retinal detachment
          -  History of rhegmatogenous retinal tears or peripheral retinal breaks within 3 months
             prior to the enrollment visit
          -  Aphakia or absence of the posterior capsule
          -  Previous violation of the posterior capsule is also an exclusion criterion unless it
             occurred as a result of yttrium-aluminum garnet (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
          -  Preoperative refractive error that exceeds 8 diopters of myopia, for patients who have
             undergone prior refractive or cataract surgery in the study eye
          -  Intraocular surgery (including cataract surgery) within 3 months preceding the
             enrollment visit
          -  Uncontrolled ocular hypertension or glaucoma and any such condition the investigator
             determines may require a glaucoma-filtering surgery during a patient's participation
             in the study
          -  History of glaucoma-filtering surgery, tube shunts, or microinvasive glaucoma surgery
          -  History of corneal transplant
          -  History of prior vitrectomy surgery and absence of posterior capsule
        Either Eye
          -  History of idiopathic or autoimmune-associated uveitis
          -  Active infectious conjunctivitis, keratitis, scleritis, or endophthalmitis
        Concurrent Systemic Conditions
          -  Inability to comply with study schedule or procedures as described in the study
             protocol
          -  Uncontrolled blood pressure
          -  History of stroke within the last 3 months prior to informed consent
          -  Uncontrolled atrial fibrillation within 3 months of informed consent
          -  History of myocardial infarction within the last 3 months prior to informed consent
          -  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 systemic treatment for a confirmed active systemic infection
          -  Use of any systemic anti-VEGF agents
          -  Chronic use of oral corticosteroids
          -  Active cancer within 12 months of enrollment
          -  Previous participation in any non-ocular (systemic) disease studies of investigational
             drugs within 1 month preceding the informed consent (excluding vitamins and minerals)
          -  Use of antimitotic or antimetabolite therapy within 30 days or 5 elimination
             half-lives of the enrollment visit
          -  History of albinism
          -  Pregnant or breastfeeding, or intending to become pregnant during the treatment period
             and for at least 28 days after the last ITV injection of ranibizumab or 1 year after
             the last implant refill-exchange of ranibizumab