- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01738243
Hyaluronic Acid Gels for Upper Lid Retraction in Active Stage Thyroid Eye Disease (HALR)
Phase IV Study of Hyaluronic Acid Gels for Upper Lid Retraction in Active Stage Thyroid Eye Disease
Thyroid eye disease (TED) is an autoimmune disease that affects the eye area. The disease presents with a variety of physical findings, including bulging of the eyes (proptosis), upper and lower eyelid retraction, and swelling/inflammation of the eye itself.
The disease passes through two phases: active and inactive. The active phase lasts between 18 and 24 months. During this phase, TED signs and symptoms generally worsen and then often improve. The inactive phase follows, during which the signs and symptoms of TED cease to improve and usually stabilize.
Lid retraction is a cardinal sign of TED. In addition to potentially causing cornea damage due to improper lid closure, lid retraction is also very troublesome for patients due to its cosmetic appearance. The precise pathophysiology of lid retraction is poorly understood, but a leading hypothesis is that it occurs due to scarring and fibrosis in the muscles that lift the eyelid.
Currently, the definitive treatment for lid retraction is surgery, which can be used to lengthen the lid itself or remove inflamed tissue from behind the eye, thus causing the eye to bulge less. In cases when patients first present to their physician with corneal ulceration or compression of the optic nerve, surgery may be performed immediately. However, in most instances, surgical procedures are delayed until the active stage of the disease has passed. Thus, most patients must endure the cosmetic and irritant symptoms of TED for up to two years.
Hyaluronic Acid Gels (HAG) have been FDA approved for the treatment of facial rhytids (wrinkles). They are injected under the skin and work by increasing volume. Recently, some smaller retrospective research studies have shown that HAG is also effective in correcting upper and lower eyelid retraction in TED. Hence, HAG may be for patients with active stage TED. It is also thought that if employed early in active phase disease, HAG may also help to decrease the severity of associated symptoms and reduce the need for surgery.
The purpose of the current investigation is to define the clinical utility of HAG correction of upper eyelid in active TED in terms of anatomic (lid position), quantitative (corneal dry eye signs) and qualitative effects (symptom severity and thyroid related quality of life).
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Locations
-
-
California
-
Los Angeles, California, United States, 90095
- Jules Stein Eye Institute
-
Los Angeles, California, United States, 90095
- The Jules Stein Eye Institute at UCLA
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Active stage TO as determined by symptom onset of under 9 months.
- Upper eyelid retraction of 1mm or greater in one or both eyes.
- Complaints of either significant ocular symptoms (despite appropriate use of ocular lubricants), or cosmetic deformity associated with the eyelid retraction.
Exclusion Criteria:
- Age less than 21 years: due to lack of data on safety for HAG fillers in pediatric population
- Age over 65 years of age: as HAG filler effect may be different in this population
- Are pregnant or nursing: as there is little safety data on potential teratogenicity of HAG fillers
- Have a demonstrated allergy to HAG fillers or lidocaine
- Have a current infection, skin sore, pimple, rash, hive or cyst over the injection site: to avoid worsening the infection or transmitting it
- Have a bleeding disorder or currently taking blood thinning medications such as Coumadin, heparin or acetylsalicylic acid on a daily basis.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Unilateral Upper Eyelid Retraction
This arm will consist of participants with unilateral upper eye lid retraction secondary to thyroid eye disease (TED). Patients enrolled will be randomized 1:1 to Hyaluronic Acid Gel Injection or Saline injection |
The conjunctiva is anesthetized with Proparacaine Hydrochloride Ophthalmic Solution, 0.5%.
The upper eyelid is everted and the conjunctiva just superior to the upper tarsal edge is exposed.
Using a 30-gauge needle, a single bolus of Hyaluronic Acid Gel is placed centrally in the subconjunctival levator-Muller plane.
Small volumes (0.1 to 0.2 ml) of Hyaluronic Acid Gel are injected with the end point being adequate lowering with improved symmetry.
Other Names:
The conjunctiva is anesthetized with Proparacaine Hydrochloride Ophthalmic Solution, 0.5%.
The upper eyelid is everted and the conjunctiva just superior to the upper tarsal edge is exposed.
Using a 30-gauge needle, a single bolus of saline is placed centrally in the subconjunctival levator-Muller plane.
Small volumes (0.1 to 0.2 ml) of saline are injected with the end point being adequate lowering with improved symmetry.
Other Names:
|
Experimental: Bilateral Upper Eyelid Retraction
This arm will consist of participants with bilateral upper eye lid retraction secondary to thyroid eye disease (TED). Patients enrolled will be randomized 1:1 to Hyaluronic Acid Gel injection or Saline injection |
The conjunctiva is anesthetized with Proparacaine Hydrochloride Ophthalmic Solution, 0.5%.
The upper eyelid is everted and the conjunctiva just superior to the upper tarsal edge is exposed.
Using a 30-gauge needle, a single bolus of Hyaluronic Acid Gel is placed centrally in the subconjunctival levator-Muller plane.
Small volumes (0.1 to 0.2 ml) of Hyaluronic Acid Gel are injected with the end point being adequate lowering with improved symmetry.
Other Names:
The conjunctiva is anesthetized with Proparacaine Hydrochloride Ophthalmic Solution, 0.5%.
The upper eyelid is everted and the conjunctiva just superior to the upper tarsal edge is exposed.
Using a 30-gauge needle, a single bolus of saline is placed centrally in the subconjunctival levator-Muller plane.
Small volumes (0.1 to 0.2 ml) of saline are injected with the end point being adequate lowering with improved symmetry.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Upper eyelid scleral show and marginal reflex distance 1 in mm
Time Frame: 6 weeks after injection
|
Physicians will measure the amount of lid retraction (upper eyelid scleral show, marginal reflex distance 1) present in study participants 6 weeks following injection of hyaluronic acid gel vs. saline.
|
6 weeks after injection
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Dry Eye
Time Frame: 6 weeks post injection.
|
We will measure severity of dry eye signs using the Oxford staining scale and the Ocular surface disease index
|
6 weeks post injection.
|
Quality of life
Time Frame: 6 weeks
|
The Graves Orbitopathy Quality of Life (GO-QOL) survey will be given to subjects at entry and at 6 weeks.
|
6 weeks
|
Complications
Time Frame: 6 weeks
|
Complications including null effect, ecchymosis, retrobulbar hemorrhage, cranial nerve injury and extraocular muscle dysfunction will be monitored and reported
|
6 weeks
|
Collaborators and Investigators
Investigators
- Principal Investigator: Daniel Rootman, University of California, Los Angeles
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Immune System Diseases
- Autoimmune Diseases
- Endocrine System Diseases
- Genetic Diseases, Inborn
- Eye Diseases, Hereditary
- Graves Disease
- Exophthalmos
- Orbital Diseases
- Goiter
- Hyperthyroidism
- Eye Diseases
- Graves Ophthalmopathy
- Thyroid Diseases
- Physiological Effects of Drugs
- Immunologic Factors
- Protective Agents
- Adjuvants, Immunologic
- Viscosupplements
- Hyaluronic Acid
Other Study ID Numbers
- PRE#12-003174
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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