Scleral Buckling for Retinal Detachment Prevention in Genetically Confirmed Stickler Syndrome (STL-DR-PREV)
Scleral Buckling for Retinal Detachment Prevention in Genetically Confirmed Stickler Syndrome : a Randomized Controlled Trial
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Stickler syndrome (STL) is a genetic disease affecting several organs. However the major risk is represented by the development of retinal detachment (RD). Up to 80% of patients present a RD and 25% to 80% have sequential bilateral RD. The surgical outcome of RD in this population is worse than that of the general RD population mainly because of the severity at diagnosis and the high frequency and severity of postoperative complications. Prevention has therefore emerged as a therapeutic option for this identifiable high-risk group of patients. Prevention has been proposed especially for the fellow (contralateral) eye of patients having presented a RD in their first eye and often lost vision as a consequence of retinal detachment in the first eye.
The investigators hypothesize that a scleral buckling surgical procedure performed for the fellow eye of STL patients having recently presented a RD of the first eye could prevent the occurrence of bilateral RD and/or vision loss.
Stickler patients are regularly diagnosed and followed-up in referral centers mainly in the context of a recent retinal detachment. They are proposed genetic testing as part of the standard of care. Genetically confirmed Stickler patients having recently presented (<24 months) a retinal detachment and treated as part of the standard care are eligible for this study. During the usual follow-up visits performed for their recent first RD operation they will be informed and offered to participate in the "STL-DR-PREV study" for the prevention of RD of their fellow eye.
Patients in the intervention arm will undergo an encircling scleral buckle surgical procedure, which is a routine surgical procedure used for decades and still in use to treat RD that will be performed in the present study to prevent rather than to treat retinal detachment from a healthy eye of a patient having a genetically confirmed Stickler Syndrome.
Study Type
Study Type
Phase
Phase
- Phase 2
Contacts and Locations
Study Contact
Study Contact
- Name: Laetitia PEAUDECERF
- Phone Number: +331 58 41 12 13
- Email: laetitia.peaudecerf@aphp.fr
Study Locations
-
-
-
Paris, France, 75014
- Hopital Cochin
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Genetically confirmed Stickler Syndrome
- Aged 5 to 35
- Recent retinal detachment in the non-study eye (<24 months)
- Signed informed consent to participate in the study; For the minors, information and consent of the holders of parental authority
- Sufficient patient cooperation to perform a complete ophthalmologic examination including a dilated fundus examination
- Patients affiliated with social security or CMU (profit or being entitled)
Exclusion Criteria:
- • Any type of previous prevention (laser, cryotherapy, scleral buckle) for the study eye
- Subclinical retinal rhegmatogenous detachment in the study eye.
- Any other ocular disease unrelated to Stickler syndrome significantly affecting visual acuity (ETDRS BCVA<20/400).
- Contraindications to general anesthesia
- Posterior vitreoretinal traction on optical coherence tomography
- Pregnant or breastfeeding women
- Any patient presenting an intraocular pressure during the inclusion visit (M-3) greater than 30 mm Hg
- Hypersensitivity to povidone iodine, iodine or any of the excipients of the specialty used
- Hypersensitivity to acetazolamide or any of the excipients of the specialty used
- Severe hepatic, renal or adrenal insufficiency
- Sulfonamide intolerance
- History of renal colic
- Pre-existing plasma hyperosmolarity
- Predominantly intracellular dehydration
- Hypersensitivity to dexamethasone or any of the excipients of the specialty used
- Hypersensitivity to oxytetracycline or to any of the excipients of Sterdex
- Treatment with retinoids
- Hypersensitivity to the active substances or to any of the excipients of Chibrocadron®
- Personal or family history of glaucoma(Open angle primary glaucoma only)
- Intraoperative detection of one or more of the above-mentioned non-inclusion criteria
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Experimental arm
Surgical procedure to prevent retinal detachment in the unaffected eye
|
Encircling scleral buckle surgical procedure under general anesthesia
|
|
No Intervention: Control arm
Standard procedure of clinical practice without any surgical procedure for the unaffected fellow eye.
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Best corrected visual acuity and retinal detachment rate
Time Frame: 5 years
|
Early Treatment Diabetic Retinopathy Study (ETRDS) best corrected visual acuity (BCVA) and dilated funduscopic examinations at scheduled follow-up (every 6 months)
|
5 years
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Rate of retinal breaks
Time Frame: 5 years
|
5 years
|
|
|
Rate of intravitreal hemorrhage
Time Frame: 5 years
|
5 years
|
|
|
Outcome in prevention-failed study eyes
Time Frame: 5 years
|
outcome of surgery for RD in the study eye of patients for whom prevention failed and had to be operated on for RD repair of the study eye
|
5 years
|
|
Effect of add-on cryotherapy
Time Frame: 5 years
|
To assess within the experimental arm whether patients having had cryotherapy as part (allowed by the protocol at the surgeon's discretion in addition to the standard procedure) of the scleral buckling procedure present a decrease in the rate of RD as compared to buckled patients without cryotherapy
|
5 years
|
|
Safety of the experimental procedure
Time Frame: 5 years
|
Safety issues related to the experimental surgical procedure will be reported and coded following MEDRA classification
|
5 years
|
Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Study Director: Antoine BREZIN, MD,Phd, Assistance Publique - Hopitaux de Paris
- Principal Investigator: Pierre-Raphael ROTHSHILD, MD, PhD, Assistance Publique - Hopitaux de Paris
Publications and helpful links
General Publications
- Monin C, Van Effenterre G, Andre-Sereys P, Haut J. [Prevention of retinal detachment in Wagner-Stickler disease. Comparative study of different methods. Apropos of 22 cases]. J Fr Ophtalmol. 1994;17(3):167-74. French.
- Abeysiri P, Bunce C, da Cruz L. Outcomes of surgery for retinal detachment in patients with Stickler syndrome: a comparison of two sequential 20-year cohorts. Graefes Arch Clin Exp Ophthalmol. 2007 Nov;245(11):1633-8. doi: 10.1007/s00417-007-0609-2. Epub 2007 Jun 20.
- Carroll C, Papaioannou D, Rees A, Kaltenthaler E. The clinical effectiveness and safety of prophylactic retinal interventions to reduce the risk of retinal detachment and subsequent vision loss in adults and children with Stickler syndrome: a systematic review. Health Technol Assess. 2011 Apr;15(16):iii-xiv, 1-62. doi: 10.3310/hta15160.
- Ang A, Poulson AV, Goodburn SF, Richards AJ, Scott JD, Snead MP. Retinal detachment and prophylaxis in type 1 Stickler syndrome. Ophthalmology. 2008 Jan;115(1):164-8. doi: 10.1016/j.ophtha.2007.03.059. Epub 2007 Aug 2.
- Fincham GS, Pasea L, Carroll C, McNinch AM, Poulson AV, Richards AJ, Scott JD, Snead MP. Prevention of retinal detachment in Stickler syndrome: the Cambridge prophylactic cryotherapy protocol. Ophthalmology. 2014 Aug;121(8):1588-97. doi: 10.1016/j.ophtha.2014.02.022. Epub 2014 May 1.
Study record dates
Study Major Dates
Study Start (Estimated)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- P160948J
- 2018-A01081-54 (Other Identifier: ID-RCB)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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