Prospective, Multicenter, Non-comparative Clinical Investigation to Support Safety & Effectiveness of I.SPACE® (PROMIR)

Prospective, Multicenter, Non-comparative Clinical Investigation to Support Safety & Effectiveness of I.SPACE® Ophthalmic Viscosurgical Device

I.SPACE® is a hyaluronic acid injectable gel CE (European Conformity) marketed since 2010. It is indicated for use as a surgical aid in ophthalmic anterior segment surgery. The aim is to protect the corneal endothelium and maintains the intraocular space.The product should be instilled in the anterior chamber of the eye and adjusted according to the volume of the aqueous humour.

In this study, 80 patients aged from 18 to 84 years' old at inclusion, who have at least one eye with cataract (mild to moderate severity) based on subjective ophthalmic examination by the investigator, who have given his/her informed consent and meet all the eligibility criteria, will be enrolled.

Subjects will come to a total of 7 visits over a period of 3 months. Protection of corneal endothelium (Mean percent change of CEC density) after baseline injection will be assessed. Surgeon's satisfaction during cataract surgery, mean change in Intraocular Pressure (IOP), percentage of eyes with IOP spikes ≥ 30mm mmHg, corneal thickness, intraocular inflammation, Mean Snellen monocular Uncorrected Distance Visual Acuities (UCDVA), Best Corrected Distance Visual Acuities (BCDVA) and safety will be also assessed.

Study Overview

• Status: Completed
• Conditions: Cataract
• Intervention / Treatment: Device: I.SPACE®

Detailed Description

PROMIR is a prospective, multicenter, non-comparative post-marketing study of a class IIb medical device (medical device regulatory classification IIb).

This uncontrolled open-label study investigates the efficacy and safety of I.SPACE® in corneal endothelium protection and intraocular space maintain.

The study duration is 3 months with a screening visit (V0) up to 14 days before injection, the baseline visit (injection of I.SPACE®), V1) and 5 follow-up visits after 6 hours, 24 hours, 7 days, 30 days and 90 days (V1' to V5). It is envisaged to enroll 80 patients with planned cataract surgery for at least 1 eye in France to obtain at least 68 evaluable patients, which will be monitored over 3 months after baseline injection of I.SPACE® .

The primary endpoint is defined as the mean percent change of CEC density at 3 months (90 days) post-operation (V5) from Baseline (V0). The effectiveness of I.SPACE® will be demonstrated if the CEC density loss is statistically non-superior to a pre-specified threshold of 10% (non-inferiority to -10%).

Surgeon's satisfaction after cataract surgery (questionnaire) will be evaluated at V1.

Protection of corneal endothelium (Mean percent change of CEC density) will be also assessed at V4.

Mean change in Intraocular Pressure (IOP), percentage of eyes with IOP spikes ≥ 30mm mmHg, intraocular inflammation and safety will be assessed at all timepoints.

Corneal thickness will be assessed at V2,V3 and V5. Mean Snellen monocular Uncorrected Distance Visual Acuities (UCDVA), Best Corrected Distance Visual Acuities (BCDVA) and ocular symptoms will be assessed at V2, V3, V4 and V5.

• Study Type: Interventional
• Enrollment (Actual): 81
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Nicolas WEIL; Phone Number: +33 617 918 361; Email: Nicolas.wiel@icta.fr

Study Locations

• France
  • Bordeaux, France, 33100
    • Clinique Ophtalmologique Thiers
  • Bordeaux, France, 33200
    • Centre Rétine Gallien
  • Marseille, France, 13008
    • Vision Sud

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 84 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patient aged from 18 to 84 years' old at inclusion.
• Having at least one eye with cataract (mild or moderate severity) based on subjective ophthalmic examination by the investigator.
• Informed of the clinical investigation and having given freely and expressly his/her informed consent.
• Affiliated to a health social security system.
• Female of childbearing potential should use a medically accepted contraceptive regimen since at least 12 weeks before screening visit.

Exclusion Criteria:

In terms of population

• Pregnant or breastfeeding women or planning a pregnancy during the clinical investigation.
• Participating at the same time in another clinical investigation or is in an exclusion period of one.
• Deprived of their freedom by administrative or legal decision or under guardianship.
• Known hypersensitivity to one of the investigational medical device (IMD) ingredients.
• One-eyed patients.

In terms of associated pathology

• Pre-existing :

  • Glaucoma,
  • severe myopia,
  • diabetic retinopathy,
  • retinal vascular disease,
  • Acute ocular disease or external infection or internal infection or uveitis prior to surgery,
  • Known ocular disease/pathology that may affect visual acuity or that may be expected to require retinal laser treatment or other surgical intervention (other than cataract surgery) during the course of the study.
  • Any causes of compromised aqueous humor outflow.

• History of :

  • Intraocular surgery,
  • ocular trauma,
  • lens pseudoexfoliation capsular syndrome,
  • ocular hypertension > 21 mmHg without treatment
  • chronic or recurrent inflammatory eye disease or a congenital ocular anomaly such as Marfan's Syndrome
• Endothelial cell density at baseline less than 2000 cells/mm2 or poor quality photograph of preoperative endothelial cells (all reasons including corneal abnormalities).
• Any abnormalities that prevented reliable Goldmann applanation tonometry.
• Eyes with Axial Length (AL) >25 mm or < 20 mm or eyes with small pupil diameter, pathologic miosis or pupil abnormalities (non-reactive, fixed pupils, or abnormally shaped pupils);

Relating to previous and ongoing treatments:

• Patient currently treated with Tamsulosine and other alpha 1 antagonist or psychotics

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Treated eye; Eye is treated at Baseline visit (V1)	Device: I.SPACE®; I.SPACE® is a viscoelastic sodium hyaluronate gel use as a surgical aid in ophthalmic anterior segment surgery by maintaining the intraocular space and protecting the corneal endothelium. The baseline injection is performed at V1. The volume of product to use will be at the Investigator discretion, and will be completely removed after surgery.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean percent change of Corneal Endothelium Cells (CEC) density	Mean percent change of CEC density at 3 months (90 days) post-operation from Baseline. The effectiveness of I.SPACE® will be demonstrated if the CEC density loss is statistically non-superior to a pre-specified threshold of 10% (non-inferiority to -10%).	3 months (90 days)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Intraocular space maintenance evaluation	Evaluation of the intraocular space maintenance (questionnaire) using a 4-point scale, assessed by the surgeon, at Baseline. The 4-point scale contains the following categories : "Not at all", "Slightly"; "Very much" and "Extremely".	Baseline (surgery)
Surgeon's satisfaction evaluation	Evaluation of surgeon's satisfaction after cataract surgery (questionnaire) using a 4-point scale assessed by the surgeon, at Baseline. Each cataract surgery stage should be evaluated with a 4-point scale containing the following categories : "Full chamber maintained ", "Work space maintained"; "Shallow" and "flat".	Baseline (surgery)
Mean percent change of CEC density	Mean percent change of CEC density evaluated from baseline to 30 days.	30 days
Mean change in Intraocular Pressure (IOP)	Mean change in IOP, measured by Goldmann applanation tonometry, from baseline to 6 hours, 24 hours, 7 days, 30 days and 90 days.	6 hours, 24 hours, 7 days, 30 days and 90 days.
Percentage of eyes with IOP spikes ≥ 30 millimeter of mercury (mmHg)	Percentage of eyes with IOP spikes ≥ 30mmHg, measured by Goldmann applanation tonometry, at 6 hours, 24 hours, 7 days, 30 days, and 90 days.	6 hours, 24 hours, 7 days, 30 days and 90 days.
Corneal thickness evaluation	Corneal thickness, evaluated at 24 hours, 7 days and 90 days.	24 hours, 7 days and 90 days.
Intraocular inflammation evaluation	Intraocular inflammation, evaluated by slit-lamp examination at 6 hours, 24 hours, 7 days, 30 days and 90 days.	6 hours, 24 hours, 7 days, 30 days and 90 days.
Mean Snellen monocular Uncorrected Distance Visual Acuities (UCDVA), Best Corrected Distance Visual Acuities (BCDVA) and ocular symptoms	UCDVA and BCDVA under photopic lighting conditions and ocular symptoms, at 24 hours, 7 days, 30 days and 90 days. Ocular symptoms will be subjectively assessed by interrogating the patient. If a subject reports a symptoms, the level of severity should be reported.	24 hours, 7 days, 30 days and 90 days.
Report of adverse effects	Evaluation of product safety by adverse event collection throughout the study	90 days

Collaborators and Investigators

• Sponsor: Laboratoires Vivacy
• Collaborators: International Clinical Trials Association; Inferential
• Investigators: Principal Investigator: SANTIAGO Pierre-Yves, Dr, Institut Ophtalmologique de l'Ouest Jules Verne

Study record dates

Study Major Dates

• Study Start (Actual): December 6, 2021
• Primary Completion (Actual): March 1, 2023
• Study Completion (Actual): March 1, 2023

Study Registration Dates

• First Submitted: November 22, 2021
• First Submitted That Met QC Criteria: December 3, 2021
• First Posted (Actual): December 6, 2021

Study Record Updates

• Last Update Posted (Actual): November 29, 2023
• Last Update Submitted That Met QC Criteria: November 23, 2023
• Last Verified: November 1, 2023

More Information

Terms related to this study

• Keywords: surgery; hyaluronic acid; corneal endothelium; anterior segment of the eye
• Additional Relevant MeSH Terms: Eye Diseases; Lens Diseases; Cataract
• Other Study ID Numbers: 2021-A01486-35

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No