Triple Therapy for Diffuse Diabetic Macular Edema (TTDDME)
18. oktober 2010 opdateret af: Military Institute of Medicine, Poland
Combined Phako-Vitrectomy With ILM Peeling, Retinal Endophotocoagulation, and Intraoperative Use of Bevacizumab for Diffuse Diabetic Macular Edema
The purpose of this study is to evaluate the safety end efficacy of combined phakoemulsification and vitrectomy with retinal endophotocoagulation and intraoperative use of bevacizumab in patients with diffuse diabetic macular edema (DDME), to determine the possible preoperative and intraoperative factors that might influence surgical outcomes.
Studieoversigt
Status
Ukendt
Betingelser
Intervention / Behandling
Detaljeret beskrivelse
The pathogenesis of the diabetic macular edema is multiple. Therefore treatment of this disease should be combined too. VEGF is involved in pathogenesis of diabetic macular edema and recently anti-VEGF agents such as bevacizumab have been shown to be beneficial in the treatment of this retinal disorder. However, endogenous VEGF is required for visual function. Growing body evidence indicates that VEGF acts also on nonvascular cells, it plays survival role on Muller cells and photoreceptors. Therefore anti-VEGF therapies should be administered with caution and not persistent. Photocoagulation in nonperfused areas eliminate increased production of VEGF, proliferation of RPE and increased production of PEDF in surrounded impact laser area. Vitrectomy with ILM peeling reliefs traction on the macula, improve oxygenation of the macula leading to decreased vascular permeability with subsequent resolution or decrease in DME. Removed ILM contains a part of the Müller cell endfeet and the horizontal gliosis. It is likely that the proliferation of GFAP-stained gliofibrils, observed in microdamaged Müller cells, preserves the blood-retinal barrier, reinforces architectural cohesion, and opposes the installation of the edema. Therefore, we made hypothesis that combined triple therapy was effective for decreasing macular thickness and improvement of vision for eyes with diffuse diabetic macular edema.
It is important for the surgeon to determine the factors that might influence surgical outcome so that patients are chosen for the procedure that they can get benefit from. Therefore, we evaluated the possible preoperative and intraoperative factors that might influence surgical outcomes
Undersøgelsestype
Interventionel
Tilmelding (Forventet)
30
Fase
- Ikke anvendelig
Kontakter og lokationer
Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.
Studiesteder
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Szaserów 44
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Warsaw, Szaserów 44, Polen, 04-141
- Rekruttering
- Military Institute of Medicine
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Ledende efterforsker:
- Robaszkiewicz Jacek, dr med.
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Underforsker:
- Chmielewska I. Katarzyna, lek. med.
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Kontakt:
- Kowal Ewelina
- Telefonnummer: (+48) 22 665 707 584
- E-mail: ekowal@wim.mil.pl
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Deltagelseskriterier
Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.
Berettigelseskriterier
Aldre berettiget til at studere
18 år til 80 år (Voksen, Ældre voksen)
Tager imod sunde frivillige
Ingen
Køn, der er berettiget til at studere
Alle
Beskrivelse
Inclusion Criteria:
- diagnosis of DDME on clinical exam, definite retinal thickening involving the center of the macula, confirmed by fluorescein angiography, with or without PVD,
- BCVA of 0,3 or worse in log MAR units (<=70 ETDRS letter) and 1,5 or better in log MAR units (>=10 ETRDS letter),
- mean central macular thickness greater than 250 μm on optic coherence tomography (OCT),
- presence of vitreomacular traction or a thickened and taut posterior hyaloid or presence of an epimacular membrane.
Exclusion Criteria:
- significant macular ischemia defined as enlarged perifoveal capillary loss (>1000 µm) by fluorescein angiography,
- the focal macular edema due to focal leakage from microaneurysm,
- ophthalmic disorders associated with macular edema, such as uveitis, branch or central retinal vein occlusion and pseudophakic cystoid macular edema,
- vitreous hemorrhage or tractional retinal detachment secondary to diabetic retinopathy,
- an ocular condition is present such that, visual acuity would not improve from resolution of macular edema (e.g., foveal atrophy, pigmentary abnormalities, dense subfoveal hard exudates),
- history of retinal macular photocoagulation, intravitreal corticosteroids, or other treatment for DME within 3 months prior to enrollment,
- history of any intraocular surgery within prior 6 months.
Studieplan
Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: N/A
- Interventionel model: Enkelt gruppeopgave
- Maskning: Ingen (Åben etiket)
Våben og indgreb
Deltagergruppe / Arm |
Intervention / Behandling |
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Eksperimentel: edematous tractional epimacular membrane
Diabatic maculopathy comes to the edematous or tractional form.
It is believed that epiretinal membranes are comprised from glial components.
The processes of these cells may invade through the internal limiting membrane of the retina to the vitreous causing the vitreoretinal adhesion and anomalous posterior detachment of vitreous (APVD).
In the macula, APVD causes vitreo-macular traction syndrome, which results in diffuse diabetic macular edema.
If vitreoschisis is present, a place of dissection is crucial.
If break occurs in front of the hyalocytes remaining on the retinal surface, the vitreous layer is thick and easily shrinks concentrically, which results in the formation of epimacular membrane.
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Three port pars plana vitrectomy is performed by one surgeon (JR).
Induction of PVD is initiated by active suction with the vitrectomy probe over the ONH and continued peripherally.
Peeling of the epimacular tissue and ILM is performed by grasping the flap of the ILM with an eckhardts forceps.
Trypan Blue is used to stain the ILM.
Peripheral laser endophotocoagulation is performed in cases of avascular areas based on FA, active neovascularization, peripheral retinoschisis or retinal breaks.
All eyes have a 1,25 mg/0,05 ml bevacizumab injection into vitreous cavity and SF6 gas tamponade at the end of the procedure.
Even of absence of cataract formation, a combined procedure is performed because of exactly peripheral vitreous shaving and prevention of cataract formation.
Andre navne:
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Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
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Best-corrected visual acuity (BCVA) and central macular thickness (CMT)
Tidsramme: up to 1 week before surgery
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The best corrected visual acuity (BCVA) for ETDRS chart and central macular thickness (CMT) are assessed preoperatively and during the follow-up period.
OCT is performed 1 mm and 6 mm diameter topography centered at the patient fixation point.
We evaluate mean central retinal thickness and central retinal volume 1 mm and 6 mm in diameter.
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up to 1 week before surgery
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Best-corrected visual acuity (BCVA) and central macular thickness (CMT)
Tidsramme: 16 up to 17 weeks after surgery
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The best corrected visual acuity (BCVA) for ETDRS chart, results are converted to log MAR for statistical analysis.
The central macular thickness (CMT) are assessed 1 mm diameter topography centered at the patient fixation point for OCT-SLO.
We evaluate mean central retinal thickness and central retinal volume 1 mm and 6 mm in diameter.
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16 up to 17 weeks after surgery
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Best-corrected visual acuity (BCVA) and central macular thickness (CMT)
Tidsramme: 32 up to 33 weeks after surgery
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A follow-up examination include: The best corrected visual acuity (BCVA) for ETDRS chart, results are converted to log MAR for statistical analysis.
The central macular thickness (CMT) are assessed 1 mm diameter topography centered at the patient fixation point for OCT-SLO.
We evaluate mean central retinal thickness and central retinal volume 1 mm and 6 mm in diameter.
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32 up to 33 weeks after surgery
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Best-corrected visual acuity (BCVA) and central macular thickness (CMT)
Tidsramme: 48 up to 49 weeks after surgery
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A follow-up examination include: The best corrected visual acuity (BCVA) for ETDRS chart, results are converted to log MAR for statistical analysis.
The central macular thickness (CMT) are assessed 1 mm diameter topography centered at the patient fixation point for OCT-SLO.
We evaluate mean central retinal thickness and central retinal volume 1 mm and 6 mm in diameter.
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48 up to 49 weeks after surgery
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Best-corrected visual acuity (BCVA) and central macular thickness (CMT)
Tidsramme: 64 up to 65 weeks after surgery
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A follow-up examination include: The best corrected visual acuity (BCVA) for ETDRS chart, results are converted to log MAR for statistical analysis.
The central macular thickness (CMT) are assessed 1 mm diameter topography centered at the patient fixation point for OCT-SLO.
We evaluate mean central retinal thickness and central retinal volume 1 mm and 6 mm in diameter.
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64 up to 65 weeks after surgery
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Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
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Presence of vitreomacular traction or epimacular membrane, grade of DR, patients age, HbA1c level, BMI, systemic hypertension
Tidsramme: up to 2 weeks before surgery
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The demographic characteristics of the patients including: age, grender, metabolic condition: HbA1c level, body mass index, presence of systemic hypertension, ocular condition: diabetic retinopathy stage, previous laser, presence of viteomacular traction or epiretinal membrane are recorded to eveluate the possible association with chance in postoperative BCVA.
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up to 2 weeks before surgery
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Samarbejdspartnere og efterforskere
Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.
Efterforskere
- Ledende efterforsker: Robaszkiewicz Jacek, dr med., Department of Ophthalmology Military Institute of Medicine
Publikationer og nyttige links
Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.
Datoer for undersøgelser
Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.
Studer store datoer
Studiestart
1. december 2008
Primær færdiggørelse (Forventet)
1. december 2010
Studieafslutning (Forventet)
1. december 2011
Datoer for studieregistrering
Først indsendt
6. oktober 2010
Først indsendt, der opfyldte QC-kriterier
8. oktober 2010
Først opslået (Skøn)
11. oktober 2010
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Skøn)
19. oktober 2010
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
18. oktober 2010
Sidst verificeret
1. september 2010
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
- 46/WIM/2008
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