- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05231928
A Novel Argon Laser Iridoplasty for Pigment Dispersion Syndrome
Efficacy of a Novel Argon Laser Iridoplasty for Management of Pigment Dispersion Syndrome Assessed by Anterior Segment Optical Coherence Tomography
Pigment dispersion syndrome is a rare condition where anomalous iris configuration leads to posterior iris bowing with subsequent friction with the lenticulozonular unit resulting in dispersion of pigment from the back surface of the iris into the anterior segment as well as thinning with resultant transillumination defects in the mid iris segment. The released pigment is deposited in various parts of the anterior segment resulting in a constellation of clinical signs:
Krukenberg Spindle: Back surface of the cornea Zentmayer ring: Back surface of the lens. Egger line: Anterior vitreous face. More importantly, pigment accumulated in the trabecular meshwork leading to visible hyperpigmentation of the trabeculum seen by gonioscopy. This leads to reduction of aqueous outflow which leads to ocular hypertension or even glaucoma which is known as pigment dispersion glaucoma which is considered one of refractory glaucomas.
Current practice in the management of pigment dispersion syndrome revolves around the management of glaucoma when it develops by IOP lowering medication, Laser trabeculoplasty or peripheral iridoplastyor glaucoma surgery as a last resort. The only prophylactic measure in practice that is aimed at preventing the progression from mere pigment dispersion to pigment dispersion glaucoma is the long term use of miotic eyedrops e.g. Pilocarpine which comes with both risks and side effects i.e. the risk of retinal breaks and detachment which is even higher in a cohort which is predominantly myope, the constriction of visual field and ocular surface complications.
In this interventional case series, the investigators assess the efficacy of a novel Argon Laser iridoplasty in the management of pigment dispersion through correcting the posterior iris bowing and hence halting the dispersion process so that glaucoma wouldn't develop in the first place instead of managing glaucoma after it sets in which proved refractory.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
*Study design: Interventional, longitudinal, prospective, uncontrolled case series study
**Methods:
- Population: cases of pigment dispersion syndrome/glaucoma.
- Sample size:
Not determined since it is a case series with still active recruitment.
- A series of pigment dispersion syndrome and/or pigment dispersion glaucoma cases encountered in the ophthalmology outpatient clinic of Fayoum University Hospitals will be assessed clinically for confirmation of signs of pigment dispersion by slitlamp examination and gonioscopy. Intraocular pressure will be measured and monitored. Fundus examination with special attention to the optic disc will be done. Cases will be assessed prior to iridoplasty by anterior segment optical coherence tomography to document the anomalous iris configuration with subsequent serial anterior segment OCT at one week, one month and three months after iridoplasty as well as IOP measurement.
The iridoplasty procedure will be performed as follows:
- Pilocarpine 2% topically is used to induce miosis.
- Topical ocular anesthetic is instilled.
- The Nidek Argon laser device together with a YAG capsolutomy or Abraham Iridotomy lens as auxilliary lenses are used.
- The site and parameters of argon laser applications on the anterior iris surface are tailored for each patient according to iris configuration and pupil diameter in mesopic conditions determined by anterior segment OCT.
- Topical Brimonidine 0.2% bid is used for one week after the procedure to guard against IOP spikes.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Ahmed Ameen Ismail, MBBCh
- Phone Number: 00201067964547
- Email: am178@fayoum.edu.eg
Study Contact Backup
- Name: Sherin Sadek, PhD
- Phone Number: 00201006232012
- Email: sh.sadek@gmail.com
Study Locations
-
-
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Fayoum, Egypt
- Recruiting
- Fayoum University Hospitals
-
Contact:
- Somaya Al Gohary, PhD
- Phone Number: +200846300587
- Email: smg02@fayoum.edu.eg
-
Contact:
- Nader Shaaban, PhD
- Phone Number: +200846300587
- Email: nsz00@fayoum.edu.eg
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Pigment dispersion syndrome/glaucoma confirmed by either clinical signs or imaging with documented posterior iris bowing.
Exclusion Criteria:
- Active or history of Uveitis.
- Pupil size > 7mm in mesopic conditions.
- Previous Iris-based laser procedures e.g. Iridotomy, Iridoplasty
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Argon Laser Iridoplasty
Argon Laser is applied to the anterior iris surface after pharmacological miosis and instillation of ocular surface anesthetic using YAG capsulotomy lens or Abraham Iridotomy lens as auxiliary lenses.
Laser is applied at sites and with parameters that are tailored for each case according to exact iris configuration, iris colour and pupil diameter.
|
Argon Laser is applied to the anterior iris surface at sites and with parameters tailored according to iris configuration, pupil size, iris colour. The device used is Nidek Argon Laser device with YAG capsulotomy or Abraham Iridotomy lens as auxilliary lenses. -Topical Pilocarpine 2% and ocular surface anesthetic are applied prior to the procedure and Brimonidine 0.2% bid is used fo a week after the procedure together with topical dexamethasone ophthalmic solution. |
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
correction of posterior iris bowing
Time Frame: Baseline documentation of posterior bowing by anterior segment OCT followed by one week, one month, three months follow up by anterior segment OCT for changes in iris configuration.
|
The posterior iris bowing is at the basis of pigment dispersion pathology and so the correction of this posterior bowing halts the disease process at its very roots. Correction means either flattening or anterior bowing of iris (a change from negative bowing values to zero bowing or positive bowing values) |
Baseline documentation of posterior bowing by anterior segment OCT followed by one week, one month, three months follow up by anterior segment OCT for changes in iris configuration.
|
Collaborators and Investigators
Sponsor
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
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
Other Study ID Numbers
- R 211
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
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 Pigment Dispersion Syndrome
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University Hospital, MontpellierCompleted
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University of ParmaCompletedPigment Dispersion Syndrome: Natural History and Possible Protective Effect of a YAG Laser IridotomyPigment Dispersion SyndromeItaly
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National Eye Institute (NEI)Completed
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National Eye Institute (NEI)CompletedOcular Hypertension | Glaucoma | Glaucoma, Open-AngleUnited States
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University of Colorado, DenverCompletedOcular Hypertension | Open Angle Glaucoma | Pseudoexfoliation Glaucoma | Pigment Dispersion SyndromeUnited States
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Temple UniversityCompletedOcular Hypertension | Glaucoma | Open Angle Glaucoma | Pigment Dispersion Syndrome | Glaucoma, Open Angle, Pseudo-exfoliativeUnited States
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Alcon ResearchCompletedOcular Hypertension | Open-Angle Glaucoma | Pigment Dispersion Glaucoma
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Alcon ResearchCompletedOcular Hypertension | Primary Open-angle Glaucoma | Pigment Dispersion GlaucomaGermany
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Glaucoma Research & Education GroupPharmaLogic Development, Inc.UnknownPrimary Open Angle Glaucoma | Ocular Hypertension | Pigment Dispersion Glaucoma | Pseudo-Exfoliative GlaucomaUnited States
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Santen Pharma Malaysia Sdn BhdUnknownOcular Hypertension | Primary Open-angle Glaucoma | Pseudoexfoliation Glaucoma | Pigment Dispersion Glaucoma | Primary Angle-Closure Glaucoma
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National University Hospital, SingaporeCompleted
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National University Hospital, SingaporeUnknown