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PEI-GT Trial for Initial Treatment of Primary Open-Angle Glaucoma With Cataract

7 de julio de 2026 actualizado por: Nanfang Hospital, Southern Medical University

Efficacy and Safety of Phacoemulsification Combined With Gonioscopy-Assisted Trabeculotomy as Initial Treatment for Primary Open-Angle Glaucoma With Cataract: A Multicenter Randomized Controlled Trial

The goal of this clinical trial is to learn whether doing phacoemulsification combined with gonioscopy-assisted trabeculotomy as an initial treatment can reduce the burden of glaucoma eye drops in adults with primary open-angle glaucoma and cataract. It will also learn whether this early surgical strategy improves ocular surface health and vision-related quality of life. The main questions it aims to answer are:

Does early combined surgery reduce the need for long-term glaucoma medications? Does early combined surgery improve ocular surface health compared with cataract surgery followed by guideline-based glaucoma eye drops? Does early combined surgery improve vision-related quality of life and anxiety compared with the medication-based treatment strategy? What medical problems or complications do participants have after treatment? Researchers will compare phacoemulsification combined with gonioscopy-assisted trabeculotomy to phacoemulsification followed by guideline-based topical eye pressure-lowering medications.

Participants will:

Undergo cataract surgery with or without gonioscopy-assisted trabeculotomy Attend follow-up visits for 24 months after treatment Have eye pressure, visual acuity, OCT, AS-OCT, visual field, ocular surface, and safety examinations at scheduled visits Complete quality-of-life and anxiety questionnaires at scheduled visits Provide tear samples at selected visits for biomarker testing where applicable

Descripción general del estudio

Estado

Reclutamiento

Condiciones

Intervención / Tratamiento

Descripción detallada

Primary open-angle glaucoma is a chronic progressive optic neuropathy in which sustained intraocular pressure control is important for delaying structural and functional progression. Long-term topical IOP-lowering medication may be limited by ocular surface disease, poor adherence, treatment cost, and cumulative ocular tissue exposure. Gonioscopy-assisted trabeculotomy is an ab interno minimally invasive glaucoma procedure that can be combined with phacoemulsification in patients with coexisting cataract. This trial will compare PEI plus GT with PEI plus conventional medications as an initial treatment strategy in treatment-naive patients with POAG and cataract. Randomization will be stratified by center and implemented through an IWRS or equivalent web-based randomization system. Outcome assessors will be masked whenever feasible. Follow-up visits are scheduled at Day 1, Day 7, Month 1, Month 3, Month 6, Month 9, Month 12, Month 18, and Month 24.

Tipo de estudio

Intervencionista

Inscripción (Estimado)

106

Fase

  • No aplica

Contactos y Ubicaciones

Esta sección proporciona los datos de contacto de quienes realizan el estudio e información sobre dónde se lleva a cabo este estudio.

Estudio Contacto

  • Nombre: Hongyang Zhang, PhD
  • Número de teléfono: +86-20-62787325
  • Correo electrónico: hy3005716@163.com

Copia de seguridad de contactos de estudio

Ubicaciones de estudio

  • Porcelana
      • Guangzhou, Porcelana
        • Reclutamiento
        • Nanfang Hospital, Southern Medical University
        • Contacto:
          • Hongyang Zhang
          • Número de teléfono: +86-20-62787325
          • Correo electrónico: hy3005716@163.com
      • Luzhou, Porcelana
        • Aún no reclutando
        • The Affiliated Hospital of Southwest Medical University
      • Zhengzhou, Porcelana
        • Aún no reclutando
        • The First Affiliated Hospital of Zhengzhou University
        • Contacto:
          • Xin Yang
      • Zhuhai, Porcelana
        • Aún no reclutando
        • Zhuhai Hospital of Guangdong Provincial Hospital of Chinese Medicine
    • Ningxia
      • Ningxia, Ningxia, Porcelana
        • Aún no reclutando
        • People's Hospital of Ningxia Hui Autonomous Region

Criterios de participación

Los investigadores buscan personas que se ajusten a una determinada descripción, denominada criterio de elegibilidad. Algunos ejemplos de estos criterios son el estado de salud general de una persona o tratamientos previos.

Criterio de elegibilidad

Edades elegibles para estudiar

  • Adulto
  • Adulto Mayor

Acepta Voluntarios Saludables

No

Descripción

Inclusion Criteria:

  • Provides written informed consent voluntarily.
  • Age 40 to 85 years.
  • Male or female.
  • Treatment-naive for glaucoma, with no prior IOP-lowering medication, glaucoma laser procedure, or glaucoma surgery.
  • Lens opacity causing decreased visual quality and clinically significant cataract.
  • Diagnosis of POAG combined with cataract by the treating ophthalmologist.
  • Best-corrected visual acuity of 0.1 or better on the Snellen chart, corresponding to LogMAR 1.0 or less.
  • Ability and willingness to complete scheduled follow-up visits and study examinations.

Exclusion Criteria:

  • Secondary glaucoma, including uveitic, pseudoexfoliative, pigmentary, steroid-induced, neovascular, traumatic, or other secondary glaucoma.
  • Angle-closure glaucoma or narrow angle inconsistent with POAG.
  • POAG without visually significant cataract.
  • Previous anti-glaucoma medication use, glaucoma surgery, or glaucoma laser treatment.
  • Advanced visual field loss, defined as visual field mean deviation worse than -12 dB.
  • Severe ocular comorbidity or inability to perform reliable visual acuity testing.
  • Known contraindication to required study medications.
  • Average RNFL thickness or GCIPL thickness less than 54 micrometers.
  • Axial length greater than 26 mm.
  • Monocular status or functional vision in only one eye.
  • Inability to complete reliable visual field or OCT testing.
  • Systemic disease that may affect ocular status or study assessment, including diabetes mellitus, uncontrolled hypertension, malignancy, renal disease, autoimmune disease, neurological disease, liver disease, cardiovascular disease, or systemic inflammatory disease.
  • Visual impairment mainly attributable to disease other than POAG or cataract.
  • Pregnancy, lactation, or planned pregnancy during the study period.

Plan de estudios

Esta sección proporciona detalles del plan de estudio, incluido cómo está diseñado el estudio y qué mide el estudio.

¿Cómo está diseñado el estudio?

Detalles de diseño

  • Propósito principal: Tratamiento
  • Asignación: Aleatorizado
  • Modelo Intervencionista: Asignación paralela
  • Enmascaramiento: Único

Armas e Intervenciones

Grupo de participantes/brazo
Intervención / Tratamiento
Experimental: PEI combined with gonioscopy-assisted trabeculotomy
Participants will undergo phacoemulsification cataract extraction with intraocular lens implantation combined with approximately 120 degrees of ab interno gonioscopy-assisted trabeculotomy during the same surgical session. Postoperative care will follow the protocol, and rescue IOP-lowering medications may be added if clinically indicated.
Producto combinado: PEI combined with gonioscopy-assisted trabeculotomy
Phacoemulsification combined with Ab interno trabeculotomy performed under gonioscopic visualization for approximately 120 degrees to incise/open the trabecular meshwork and expose Schlemm canal. The cutting instrument will be non-device-dependent, such as a Tanito hook, Lanxin knife, Zeng knife, or bent 25-26G needle; KDB is not included as the cutting blade.
Comparador activo: PEI combined with conventional IOP-lowering medications
Participants will undergo phacoemulsification cataract extraction with intraocular lens implantation. Postoperatively, conventional topical IOP-lowering medications will be initiated or adjusted according to guideline-based care and clinical judgment when IOP remains above target.
Producto combinado: PEI combined with conventional topical IOP-lowering medications
Phacoemulsification combined with guideline-based topical IOP-lowering therapy, generally including prostaglandin analogues unless contraindicated, with beta-blockers, carbonic anhydrase inhibitors, alpha-2 agonists, or other agents added or adjusted according to efficacy, tolerance, contraindications, and clinical judgment.

¿Qué mide el estudio?

Medidas de resultado primarias

Medida de resultado
Medida Descripción
Periodo de tiempo
Mean change in intraocular pressure from baseline to Month 24
Periodo de tiempo: Baseline and Month 24
Intraocular pressure will be measured in mmHg, preferably by Goldmann applanation tonometry. Change will be calculated as Month 24 IOP minus baseline IOP and compared between groups.
Baseline and Month 24

Medidas de resultado secundarias

Medida de resultado
Medida Descripción
Periodo de tiempo
Complete success rate
Periodo de tiempo: Month 24
Proportion of participants achieving postoperative IOP >5 mmHg and ≤16 mmHg or at least 20 percent IOP reduction from baseline, without additional IOP-lowering medication, without vision-threatening complication, and without additional glaucoma surgery.
Month 24
Qualified success rate
Periodo de tiempo: Month 24
Proportion of participants achieving postoperative IOP >5 mmHg and ≤16 mmHg or at least 20 percent IOP reduction from baseline, with or without IOP-lowering medication, without vision-threatening complication, and without additional glaucoma surgery.
Month 24
Number of IOP-lowering medications
Periodo de tiempo: Baseline, Day 1, Day 7, Month 1, Month 3, Month 6, Month 9, Month 12, Month 18, and Month 24
Number and class of topical IOP-lowering medications used at each follow-up visit.
Baseline, Day 1, Day 7, Month 1, Month 3, Month 6, Month 9, Month 12, Month 18, and Month 24
Best-corrected visual acuity
Periodo de tiempo: Baseline through Month 24
Best-corrected visual acuity will be recorded and converted to LogMAR for analysis.
Baseline through Month 24
Visual field indices
Periodo de tiempo: Baseline, Month 6, Month 12, Month 18, and Month 24
Humphrey visual field 30-2 SITA Standard indices, including mean deviation and pattern standard deviation, will be recorded with reliability criteria.
Baseline, Month 6, Month 12, Month 18, and Month 24
Retinal nerve fiber layer thickness
Periodo de tiempo: Baseline, Month 6, Month 12, Month 18, and Month 24
Peripapillary retinal nerve fiber layer thickness will be measured by OCT.
Baseline, Month 6, Month 12, Month 18, and Month 24
Ganglion cell-inner plexiform layer thickness
Periodo de tiempo: Baseline, Month 6, Month 12, Month 18, and Month 24
Macular ganglion cell-inner plexiform layer thickness will be measured by OCT.
Baseline, Month 6, Month 12, Month 18, and Month 24
Anterior segment parameters by AS-OCT
Periodo de tiempo: Baseline, Month 1, Month 3, Month 6, Month 9, Month 12, Month 18, and Month 24
AS-OCT parameters may include anterior chamber depth, angle opening distance, trabecular-iris space area, and other protocol-specified anterior segment findings.
Baseline, Month 1, Month 3, Month 6, Month 9, Month 12, Month 18, and Month 24
Ocular surface parameters
Periodo de tiempo: Baseline, Month 1, Month 3, Month 6, Month 9, Month 12, Month 18, and Month 24
Ocular surface assessment includes lipid layer thickness, tear meniscus height, non-invasive tear break-up time, meibomian gland structure, conjunctival hyperemia, and corneal fluorescein staining.
Baseline, Month 1, Month 3, Month 6, Month 9, Month 12, Month 18, and Month 24
NEI VFQ-25 score
Periodo de tiempo: Baseline, Month 6, Month 12, Month 18, and Month 24
Vision-related quality of life will be assessed using the National Eye Institute Visual Function Questionnaire-25 total score.
Baseline, Month 6, Month 12, Month 18, and Month 24
GAD-7 score
Periodo de tiempo: Baseline, Month 6, Month 12, Month 18, and Month 24
Anxiety will be assessed using the Generalized Anxiety Disorder 7-item scale total score.
Baseline, Month 6, Month 12, Month 18, and Month 24
Incidence of adverse events
Periodo de tiempo: Day 1 through Month 24
Ocular and systemic adverse events and serious adverse events will be recorded, including IOP spike, hypotony, hyphema, corneal edema, anterior chamber inflammation, posterior capsule opacification, infection, and need for additional glaucoma surgery.
Day 1 through Month 24
Health economic indicators
Periodo de tiempo: Baseline through Month 24
Direct medical costs, medication costs, follow-up costs, complication management costs, and other prespecified economic cost indicators will be summarized.
Baseline through Month 24

Otras medidas de resultado

Medida de resultado
Medida Descripción
Periodo de tiempo
Tear-fluid biomarker levels
Periodo de tiempo: Baseline and Month 24
Tear-fluid biomarkers include matrix metalloproteinase (MMP), interleukin-13 (IL-13), and tumor necrosis factor-alpha (TNF-alpha).
Baseline and Month 24
Surgery-drug benefit index
Periodo de tiempo: Baseline through Month 24
Composite exploratory index integrating IOP control, medication reduction, structural preservation, ocular surface status, quality of life, safety, and economic outcomes.
Baseline through Month 24

Colaboradores e Investigadores

Aquí es donde encontrará personas y organizaciones involucradas en este estudio.

Patrocinador

Nanfang Hospital, Southern Medical University

Fechas de registro del estudio

Estas fechas rastrean el progreso del registro del estudio y los envíos de resultados resumidos a ClinicalTrials.gov. Los registros del estudio y los resultados informados son revisados ​​por la Biblioteca Nacional de Medicina (NLM) para asegurarse de que cumplan con los estándares de control de calidad específicos antes de publicarlos en el sitio web público.

Fechas importantes del estudio

Inicio del estudio (Estimado)

15 de julio de 2026

Finalización primaria (Estimado)

31 de diciembre de 2029

Finalización del estudio (Estimado)

31 de diciembre de 2030

Fechas de registro del estudio

Enviado por primera vez

7 de julio de 2026

Primero enviado que cumplió con los criterios de control de calidad

7 de julio de 2026

Publicado por primera vez (Actual)

14 de julio de 2026

Actualizaciones de registros de estudio

Última actualización publicada (Actual)

14 de julio de 2026

Última actualización enviada que cumplió con los criterios de control de calidad

7 de julio de 2026

Última verificación

1 de julio de 2026

Más información

Términos relacionados con este estudio

Términos MeSH relevantes adicionales

Otros números de identificación del estudio

  • NFEC-2026-303

Plan de datos de participantes individuales (IPD)

¿Planea compartir datos de participantes individuales (IPD)?

NO

Información sobre medicamentos y dispositivos, documentos del estudio

Estudia un producto farmacéutico regulado por la FDA de EE. UU.

No

Estudia un producto de dispositivo regulado por la FDA de EE. UU.

No

Esta información se obtuvo directamente del sitio web clinicaltrials.gov sin cambios. Si tiene alguna solicitud para cambiar, eliminar o actualizar los detalles de su estudio, comuníquese con register@clinicaltrials.gov. Tan pronto como se implemente un cambio en clinicaltrials.gov, también se actualizará automáticamente en nuestro sitio web. .

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