- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04352660
Subconjunctival Versus Direct Mitomycin C in Trabeculectomy
June 14, 2020 updated by: Jiun Do, University of California, San Diego
Subconjunctival Versus Direct Scleral Application of Mitomycin-C in Trabeculectomy
Trabeculectomy is routinely used as a surgical treatment for open angle glaucoma.
Success of trabeculectomy is greatly augmented by the use of antimetabolites to inhibit wound healing, specifically Mitomycin C (MMC).
MMC can be applied to the eye at various sites, concentrations and times.
This study aims to compare the two application routes that are commonly employed: subconjunctival pre-operative injection and intraoperative direct scleral application in terms of IOP lowering effect, bleb appearance and complications.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
Trabeculectomy is widely used as a surgical treatment of uncontrolled open glaucoma.
Success of trabeculectomy at halting or slowing glaucoma progression primarily relies on the extent of conjunctival and sclera wound healing.
The success rates of trabeculectomy increased dramatically with the introduction of anti-metabolites.
For more than two decades mitomycin-c (MMC), a chemotherapeutic agent capable of decreasing fibroblast activity and modulating wound healing at the bleb, has been used with trabeculectomy.
The complications of MMC are well known and several studies have described various methods of application based on exposure time, dose and surface area.
Numerous retrospective and prospective studies have compared the efficacy of MMC applied beneath the conjunctival flap with soaked sponges versus intrascleral application.
In 2008, Lee et al. first described an alternative route of application: subconjunctival injection of MMC directly into the intra-Tenon area.
Seventy-six eyes with primary and secondary open angle glaucoma underwent trabeculectomy with this approach and were followed for one year post-operatively.
Eighty-six percent of eyes achieved an IOP <21 mm Hg and 57% an IOP<14 mm Hg at one year without adjunctive drops.
Transient complications included hyphema, bleb leak and choroidal detachment.
The advantages of injected MMC are primarily in controlling the exact dosage and area of application and reduced surgical time.
Lim et al. retrospectively reviewed the outcomes of trabeculectomy in 57 eyes using sponge application directly to the sclera versus intra-tenon injection.
IOP was significantly lower in the injection group at 1 month, 1, 2, and 3 years.
Trabeculectomy success (IOP<21mm Hg or IOP >20% below baseline without medications or additional surgery) was greater in the injection group at 3 years.
The sponge group experienced more encapsulated blebs but complication rates were similar in both groups.
To date, there have been no prospective studies comparing the IOP-lowering efficacy and safety of intra-tenon injection versus direct scleral application of MMC.
Study Type
Interventional
Enrollment (Actual)
100
Phase
- Phase 4
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- medically uncontrolled glaucoma
- healthy and freely mobile conjunctiva in superior bulbar region
Exclusion Criteria:
- previous incisional glaucoma surgery
- no light perception vision
- pregnant or nursing women
- iris neovascularization or proliferative retinopathy
- iridocorneal endothelial syndrome
- chronic or recurrent uveitis
- steroid-induced glaucoma
- pathologic myopia or refractive error less than -6.00 diopters
- unwillingness or inability to give consent
- inability to return for scheduled protocol visits
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
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 |
---|---|
Active Comparator: Injection group
MMC delivered by preoperative subconjunctival injection
|
MMC delivered by preoperative subconjunctival injection
|
Active Comparator: Sponge group
MMC delivered by intraoperative direct scleral application with impregnated cellulose sponges
|
MMC delivered by intraoperative direct scleral application with impregnated cellulose sponges
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Percentage of Participants Achieving Intraocular Pressure Reduction Thresholds
Time Frame: 6 months
|
Percentage of patients achieving at least a 30% mean intraocular pressure reductions from baseline and with an intraocular pressure <21 mm Hg.
Subjects that met this criteria without the use of intraocular pressure lowering medications were classified as "Complete Success."
Subjects that met this criteria but required the use of intraocular pressure lowering medications were classified as "Qualified Success."
Subjects that failed to meet this criteria were classified as "Failure."
Subjects that failed to meet this criteria and required additional glaucoma surgery were classified as "Complete Failure."
|
6 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Bleb Morphology
Time Frame: 6 months
|
Bleb morphology at 6 months was graded using Indiana Bleb Appearance Grading Scale.
Bleb height was graded on a scale of 0 to 3 (0: flat bleb without visible elevation, 1: low bleb elevation, 2: moderate bleb elevation, 3: high bleb elevation).
Bleb extent was graded on a scale of 0 to 3 (0: no visible bleb extent to less than 1 clock hour, 1: extent equal to or greater than 1 clock hour but less than 2 clock hours, 2: extent equal to or greater than 2 clock hours but less than 4 clock hours, 3: extent equal to or greater than 4 clock hours).
Bleb vascularity was graded on a scale of 0 to 4 (0: avascular/white, 1: avascular/cystic, 2: mild vascularity, 3: moderate vascularity, 4: extensive vascularity).
Scales are descriptive and do not necessarily represent better or worse outcomes.
|
6 months
|
Medications
Time Frame: 6 months
|
Number of intraocular pressure lowering medications used by the patient at follow up visit.
|
6 months
|
Visual Acuity
Time Frame: 6 months
|
Change in visual acuity from baseline
|
6 months
|
Number of Participants With Surgical Complications
Time Frame: 6 months
|
Number of eyes that experienced surgical complications following surgery
|
6 months
|
Number of Participants Requiring Additional Surgery
Time Frame: 6 months
|
Number of eyes requiring additional surgery from each group
|
6 months
|
Postoperative Interventions
Time Frame: 6 months
|
Mean number of postoperative interventions (needling, antifibrotic injections) performed in each group
|
6 months
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: Jiun L Do, MD, PhD, UCSD
- Principal Investigator: Robert N Weinreb, MD, UCSD
- Principal Investigator: Benjamin Xu, MD, PhD, UCSD
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
May 23, 2016
Primary Completion (Actual)
April 14, 2019
Study Completion (Actual)
April 14, 2019
Study Registration Dates
First Submitted
April 15, 2020
First Submitted That Met QC Criteria
April 15, 2020
First Posted (Actual)
April 20, 2020
Study Record Updates
Last Update Posted (Actual)
July 2, 2020
Last Update Submitted That Met QC Criteria
June 14, 2020
Last Verified
June 1, 2020
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 151621
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
No
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Yes
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
No
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.
Clinical Trials on Open Angle Glaucoma
-
AllerganRecruiting18 Month Prospective Efficacy and Safety Study of Bimatoprost Intracameral Implant (DURYSTA) (ARGOS)Ocular Hypertension | Open-angle GlaucomaUnited States
-
Aerie PharmaceuticalsCompletedOcular Hypertension | Open-angle Glaucoma
-
West Virginia UniversityUniversity of Pittsburgh; University of MichiganWithdrawnOpen-angle Glaucoma
-
Glaukos CorporationUnknownOpen-Angle GlaucomaSpain, Germany, Austria, Turkey
-
Alcon ResearchWithdrawnOpen-Angle Glaucoma
-
Asociación para Evitar la Ceguera en MéxicoUnknown
-
Pharmaceutical Research NetworkCompleted
-
National Eye Institute (NEI)CompletedOpen-Angle Glaucoma
Clinical Trials on Mitomycin-C injection
-
Guy's and St Thomas' NHS Foundation TrustUnknownPrimary Open Angle GlaucomaUnited Kingdom
-
Fauze Maluf FilhoTerminatedHead and Neck Neoplasms | Esophageal Neoplasms | Deglutition Disorders | Esophageal StenosisBrazil
-
Hillel Yaffe Medical CenterUnknownUrethral StrictureIsrael
-
Medical Enterprises Ltd.TerminatedUrinary Bladder Cancer | Bladder Cancer | Malignant Tumor of Urinary Bladder | Bladder Neoplasm | Cancer of Bladder | Carcinoma in Situ of Bladder | Bladder Tumors | Cancer of the Bladder | Neoplasms, Bladder | Papillary Carcinoma of Bladder (Diagnosis) | BCG-Unresponsive Bladder CancerUnited States
-
National Cancer Institute (NCI)CompletedSolid NeoplasmUnited States
-
Sidney Kimmel Comprehensive Cancer Center at Johns...Van Andel Research InstituteWithdrawnPancreatic CancerUnited States
-
Indiana UniversityOptonolTerminated
-
Jørgen Bjerggaard JensenActive, not recruiting
-
Croatian Cooperative Group for Clinical Research...Roche Pharma AGUnknownBreast Cancer | MetastasisCroatia
-
Prakash PandalaiRecruiting