Dråbeløs Pars Plana Vitrektomi undersøgelse (DVS)
To demonstrate that intraoperative use of subtenon triamcinolone acetonide at the time of surgery without postoperative eye drops is non-inferior to the regimen of postoperative eye drops following primary pars plana vitrectomy for retinal detachment.
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Detaljeret beskrivelse
This is a non-inferiority, single-center, randomized, controlled, open-label clinical trial. Investigators will recruit patients that present to their clinic or emergency department with newly diagnosed mac-on or mac-off rhegmatogenous retinal detachment. Patients will be randomized to one of the following groups:
- Group 1: A total of 84 study subjects (84 eyes) will receive topical antibiotic qid for one week after surgery, topical prednisolone 1% qid tapered by one drop weekly for four weeks (4/3/2/1 taper), and topical atropine 1% daily for one week.
- Group 2: A total of 84 study subjects (84 eyes) will receive sub-tenon injection of triamcinolone acetonide (40 mg/mL) at the time of surgery, with no post-operative eye drops.
Both groups will receive subconjunctival injection of antibiotic (cefazolin 50 mg/0.5 ml, moxifloxacin 0.5 mg/0.1 ml, or vancomycin 1 mg/0.1 ml) and subconjunctival injection of dexamethasone (4 mg/ml) at the time of surgery, as well as atropine 1% and antibiotic-steroid ointment (neomycin-polymyxin B-dexamethasone) at the time of surgery.
Undersøgelsestype
Undersøgelsestype
Tilmelding (Faktiske)
Tilmelding
Fase
Fase
- Fase 4
Kontakter og lokationer
Studiesteder
-
-
Massachusetts
-
Boston, Massachusetts, Forenede Stater, 02114
- Massachusetts Eye and Ear
-
-
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
- Primary rhegmatogenous retinal detachment (mac-on or mac-off) requiring pars plana vitrectomy (23, 25 and 27-gauge)
Exclusion Criteria:
- Need for concomitant lensectomy or cataract surgery
- Pars plana vitrectomy taking place more than seven days after the initial diagnosis
- History of any prior vitreoretinal surgery (excluding laser surgery) in surgical eye
- History of previous retinal detachment in surgical eye
- History of ocular incisional surgery within six months of surgery (excluding laser surgery) in surgical eye
- History of ocular laser surgery within 1 month in surgical eye
- History of intravitreal injection within 1 month in surgical eye
- Diagnosis of glaucoma or intraocular pressure more than 21 mmHg in either eye
- Active or chronic or recurrent uncontrolled ocular or systemic disease
- Active or history of chronic or recurrent inflammatory eye disease
- Previous history of steroid response
- Current treatment with oral, topical, or intravitreal corticosteroids
- Presence of proliferative vitreoretinopathy at the time of diagnosis
- Presence of giant retinal tear at the time of diagnosis
- Diagnosis of proliferative diabetic retinopathy
- Anterior chamber inflammation on presentation in either eye
- Signs of ocular infection at presentation in either eye
- Acute external ocular infections
- Known or suspected sensitivity or allergy to any of the medications used in the operation or postoperatively
- Inability to use or apply topical eye drops
- Requirement for silicone oil as a tamponade agent
- Individuals with impaired decision-making capacity
- Non-English-speaking subjects
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Ingen (Åben etiket)
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
|
Aktiv komparator: Group 1
|
Standard of care surgery Antibiotic eye drop 4 times per day for 1 week after surgery
Andre navne:
Steroid eye drop 4 times per day tapered by one drop weekly for 4 weeks (4/3/2/1 taper) after surgery
Andre navne:
Eye drop daily for 1 week after surgery
Andre navne:
|
|
Aktiv komparator: Group 2
|
Standard of care surgery Sub-tenon injection of triamcinolone acetonide (40mg/mL) at the time of surgery
Andre navne:
|
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Mean anterior chamber cell
Tidsramme: Day 7 after surgical procedure
|
Mean anterior chamber cell based on SUN (Standardization of Uveitis Nomenclature) criteria as measured by Slit Lamp Biomicroscopy |
Day 7 after surgical procedure
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Mean anterior chamber cell
Tidsramme: Day 1, 30 and 90 after surgical procedure
|
Mean anterior chamber cell based on Standardization of Uveitis Nomenclature (SUN) criteria as measured by Slit Lamp Biomicroscopy |
Day 1, 30 and 90 after surgical procedure
|
|
Need for rescue medication (corticosteroid)
Tidsramme: Day 1, 7, 30 and 90 after surgical procedure
|
Need for additional medication (corticosteroid) to control post-operative inflammation |
Day 1, 7, 30 and 90 after surgical procedure
|
|
Intraocular pressure less than 5 or more 30 mmHg
Tidsramme: Day 1, 7, 30 and 90 after surgical procedure
|
Intraocular pressure measured by applanation tonometer or tono-pen |
Day 1, 7, 30 and 90 after surgical procedure
|
|
Need for medications to reduce intraocular pressure
Tidsramme: Day 1, 7, 30 and 90 after surgical procedure
|
Need for additional medication to reduce intraocular pressure |
Day 1, 7, 30 and 90 after surgical procedure
|
|
Visual acuity
Tidsramme: Day 1, 7, 30 and 90 after surgical procedure
|
Best-corrected visual acuity measured using Snellen chart |
Day 1, 7, 30 and 90 after surgical procedure
|
|
Degree of pain
Tidsramme: Day 1, 7, 30 and 90 after surgical procedure
|
Degree of pain on a pain scale of 1-10 (0: pain free, 10: unspeakable pain) |
Day 1, 7, 30 and 90 after surgical procedure
|
|
Self-reported adherence to positioning
Tidsramme: Day 1 and 7 after surgical procedure
|
Assessment of self-reported adherence to positioning: "Over the past day or week, what percentage of time or number of hours per day do you think you adhered with the recommended positioning?" |
Day 1 and 7 after surgical procedure
|
|
Self-reported adherence to eye drops
Tidsramme: Day 1, 7 and 30 after surgical procedure
|
Assessment of self-reported adherence to eye drops in the control group: "Over the past week or month, what percentage of your drops do you think you took correctly?" |
Day 1, 7 and 30 after surgical procedure
|
|
Progression of cataract
Tidsramme: Day 30 and 90 after surgical procedure
|
Evaluation of progression of cataract by Slit Lamp Biomicroscopy |
Day 30 and 90 after surgical procedure
|
|
Adverse events
Tidsramme: Day 1, 7, 30 and 90 after surgical procedure
|
Adverse Events including: Endophthalmitis, Re-detachment requiring surgery, Intraocular pressure requiring medication, Need for additional procedures, Any other adverse events |
Day 1, 7, 30 and 90 after surgical procedure
|
Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Efterforskere
Efterforskere
- Ledende efterforsker: Nimesh A. Patel, MD, Massachusetts Eye and Ear
Publikationer og nyttige links
Generelle publikationer
- Paccola L, Jorge R, Barbosa JC, Costa RA, Scott IU. Anti-inflammatory efficacy of a single posterior subtenon injection of triamcinolone acetonide versus prednisolone acetate 1% eyedrops after pars plana vitrectomy. Acta Ophthalmol Scand. 2007 Sep;85(6):603-8. doi: 10.1111/j.1600-0420.2007.00923.x. Epub 2007 Apr 24.
- Brown GT, Karth PA, Hunter AA. Novel Postoperative Dropless Protocol for Micro-Incision Vitrectomy Surgery. Ophthalmic Surg Lasers Imaging Retina. 2021 Nov;52(11):587-591. doi: 10.3928/23258160-20211014-01. Epub 2021 Nov 1.
- Bonfiglio V, Reibaldi M, Macchi I, Fallico M, Pizzo C, Patane C, Russo A, Longo A, Pizzo A, Cillino G, Cillino S, Vadala M, Rinaldi M, Rejdak R, Nowomiejska K, Toro MD, Avitabile T, Ortisi E. Preoperative, Intraoperative and Postoperative Corticosteroid Use as an Adjunctive Treatment for Rhegmatogenous Retinal Detachment. J Clin Med. 2020 May 21;9(5):1556. doi: 10.3390/jcm9051556.
- Assil KK, Greenwood MD, Gibson A, Vantipalli S, Metzinger JL, Goldstein MH. Dropless cataract surgery: modernizing perioperative medical therapy to improve outcomes and patient satisfaction. Curr Opin Ophthalmol. 2021 Jan;32 Suppl 1:S1-S12. doi: 10.1097/ICU.0000000000000708.
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Faktiske)
Primær færdiggørelse
Studieafslutning (Faktiske)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Yderligere relevante MeSH-vilkår
- Patologiske processer
- Patologiske tilstande, tegn og symptomer
- Betændelse
- Peptider
- Aminosyrer, peptider og proteiner
- Proteiner
- Organiske kemikalier
- Heterocykliske forbindelser
- Heterocykliske forbindelser, 2-ring
- Heterocykliske forbindelser, smeltet ring
- Lipider
- Alkaloider
- Polycykliske forbindelser
- Gravidier
- Graviditet
- Steroider
- SMUSED-RING-forbindelser
- Steroider, fluoreret
- Membranproteiner
- AZA -forbindelser
- Makrocykliske forbindelser
- Fluoroquinoloner
- 4-quinolones
- Quinolones
- Quinoliner
- Peptider, cyklisk
- Lipopeptider
- Heterocykliske forbindelser, bro-ring
- Atropinderivater
- Tropanes
- Azabicyclo -forbindelser
- Belladonna alkaloider
- Solanaceous alkaloider
- Bridged Bicyclo -forbindelser, heterocykliske
- Antimikrobielle Kationiske Peptider
- Antimikrobielle Peptider
- Poredannende cytotoksiske proteiner
- Moxifloxacin
- Atropin
- Triamcinolon
- Triamcinolonacetonid
- Polymyxiner
- Prednisolonacetat
- 1(beta)-D-arabinofuranosylcytosine-5'-diphosphate prednisolone
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- 2022P000046
Plan for individuelle deltagerdata (IPD)
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