Early Laser Treatment for Diabetic Eye Disease in China : A Pilot Randomized Trial
2022年5月6日 更新者：Congdon Nathan、Sun Yat-sen University
Early Laser Treatment for Diabetic Eye Disease in China: The PEARL Pilot Randomized Trial
To compare immediate laser pan-retinal photocoagulation (PRP) treatment of severe or very severe non proliferative diabetic retinopathy (NPDR) stage versus deferral of treatment until the appearance of any proliferative diabetic retinopathy (PDR) in rural and urban patients in China.
Interview data from some patients and survey data from ophthalmologists in the study hospitals will help determine acceptability of early treatment, and how to overcome barriers to increased use of this option.
研究概览
详细说明
China now has the world's largest number of diabetic persons.
Population studies show that only 10% of Chinese rural-dwellers with DR receive therapy.
The current standard approach to treatment of DR often requires patients to return for multiple examinations over years, before they reach trial-proven criteria for treatment.
This long process is ill-suited to support good compliance with care in low-resource settings.
Our recent published review suggests that earlier PRP treatment, which could reduce the burden of compliance, may be clinically effective and cost effective, but the current evidence base is insufficient to make a firm recommendation.
研究类型
介入性
注册 (预期的)
200
阶段
- 不适用
联系人和位置
本节提供了进行研究的人员的详细联系信息，以及有关进行该研究的地点的信息。
学习联系方式
- 姓名：Wenhui Zhu, MD
- 电话号码：8400 86-20-87755766
- 邮箱：dctzwh@139.com
学习地点
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Guangdong
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Guangzhou、Guangdong、中国、510000
- 招聘中
- Zhongshan Ophthalmic Center
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接触：
- Nathan Congdon, MD
- 电话号码：86-020-87682342
- 邮箱：ncongdon1@gmail.com
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首席研究员：
- Nathan Congdon, MD
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参与标准
研究人员寻找符合特定描述的人，称为资格标准。这些标准的一些例子是一个人的一般健康状况或先前的治疗。
资格标准
适合学习的年龄
18年 至 80年 (成人、年长者)
接受健康志愿者
不
有资格学习的性别
全部
描述
Inclusion Criteria:
- Adults aged >= 18 years with untreated DR at severe or very severe NPDR stage in either one or both eyes, according to the clinical opinion of the investigator.
- Sufficiently clear ocular media to allow visualization of the retina and retinal photography in either eye.
- Capable of giving informed consent.
Exclusion Criteria:
- DR at later stage of retinopathy than severe or very severe (eg, two or more of the 4-2-1 criteria are met) NPDR in either eye, but a patient may be enrolled if one eye has severe or very severe NPDR and the fellow eye has PRP-treated PDR and has been stable after treatment.
- Clinically significant macular edema in either eye.
- Dense cataracts or other media opacity preventing visualization of the retina in the eye.
- History of previous surgical or laser treatment for DR or other retinal conditions in a study eye, including history of anti-VEGF or corticosteroid injection or focal laser for DME within 6 months, or any history of scleral buckle, vitrectomy or other retinal detachment repair.
- History of other retinal vascular disorders including CRVO, CRAO, BRVO, BRAO in the study eye.
- Previous cataract or glaucoma surgery is specifically allowed if performed ≥ 6 weeks prior to enrollment.
- Pregnancy.
- Severe renal insufficiency treated with hemodialysis treatment, kidney transplant, pancreatic transplant, and intensive insulin therapy initiated within 4 months.
- Nystagmus, unable to cooperate with laser treatment.
学习计划
本节提供研究计划的详细信息，包括研究的设计方式和研究的衡量标准。
研究是如何设计的？
设计细节
- 主要用途：治疗
- 分配：随机化
- 介入模型：并行分配
- 屏蔽：单身的
武器和干预
参与者组/臂 |
干预/治疗 |
|---|---|
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实验性的：Early Intervention
pan-retinal photocoagulation laser treatment applied to the study eye within 2-4 weeks.
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PRP initially consists of 1200 - 1600 burns given over 2-3 sessions and separated by2-3weeks by 532-argon laser machine.
其他名称：
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有源比较器：Standard Care
pan-retinal photocoagulation laser treatment deferred until the onset of any PDR.
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PRP initially consists of 1200 - 1600 burns given over 2-3 sessions and separated by2-3weeks by 532-argon laser machine.
其他名称：
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研究衡量的是什么？
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
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Proportion of eyes progressing to any degree of PDR
大体时间：1 year
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The diagnosis of PDR will be made by detecting either active new vessels in the optic nerve head or elsewhere in the retina as determined by fundus photography read by a masked investigator or preretinal/vitreous haemorrhage at any time during the 12 month follow-up period.
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1 year
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
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Proportion of early versus standard treated eyes with: Loss of >= 10 and of 15 ETDRS letters
大体时间：1 year
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1 year
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Mean change in best corrected visual acuity from baseline to week 52.
大体时间：1 year
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1 year
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Proportion of early versus standard treated eyes with: retinal detachment
大体时间：1 year
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1 year
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Proportion of early versus standard treated eyes with: increase of diabetic macular edema per Optical Coherence Tomography
大体时间：1 year
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1 year
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Sensitivity & specificity of the diagnosis of any degree of PDR among study ophthalmologists
大体时间：1 year
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Study ophthalmologists will also ascertain the primary outcome measure (diagnosis of any degree of PDR) on the basis of slit-lamp biomicropscopy fundus examination with a contact lens and indirect ophthalmoscopy.
We will compare the sensitivity & specificity of the diagnosis of any degree of PDR among study ophthalmologists with the gold stander (diagnosis provided by graders according to the fundus photos.)
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1 year
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其他结果措施
结果测量 |
大体时间 |
|---|---|
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Comparing the Early versus Standard groups: Proportion of participants show on recommended revisits on time and accept recommended treatments (laser treatment .etc)
大体时间：1 year
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1 year
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Patient vision-related quality of life (VRQOL); composite and individual domain scores of the NEI VFQ25 questionnaire.
大体时间：1 year
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1 year
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合作者和调查者
在这里您可以找到参与这项研究的人员和组织。
调查人员
- 首席研究员：Nathan Congdon, PhD、Zhongshan Ophthalmic Center, Sun Yat-sen University
出版物和有用的链接
负责输入研究信息的人员自愿提供这些出版物。这些可能与研究有关。
一般刊物
- Xu Y, Wang L, He J, Bi Y, Li M, Wang T, Wang L, Jiang Y, Dai M, Lu J, Xu M, Li Y, Hu N, Li J, Mi S, Chen CS, Li G, Mu Y, Zhao J, Kong L, Chen J, Lai S, Wang W, Zhao W, Ning G; 2010 China Noncommunicable Disease Surveillance Group. Prevalence and control of diabetes in Chinese adults. JAMA. 2013 Sep 4;310(9):948-59. doi: 10.1001/jama.2013.168118.
- Wang FH, Liang YB, Zhang F, Wang JJ, Wei WB, Tao QS, Sun LP, Friedman DS, Wang NL, Wong TY. Prevalence of diabetic retinopathy in rural China: the Handan Eye Study. Ophthalmology. 2009 Mar;116(3):461-7. doi: 10.1016/j.ophtha.2008.10.003. Epub 2009 Jan 24.
- Fundus photographic risk factors for progression of diabetic retinopathy. ETDRS report number 12. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology. 1991 May;98(5 Suppl):823-33.
- Royle P, Mistry H, Auguste P, Shyangdan D, Freeman K, Lois N, Waugh N. Pan-retinal photocoagulation and other forms of laser treatment and drug therapies for non-proliferative diabetic retinopathy: systematic review and economic evaluation. Health Technol Assess. 2015 Jul;19(51):v-xxviii, 1-247. doi: 10.3310/hta19510.
- Shimura M, Yasuda K, Nakazawa T, Kano T, Ohta S, Tamai M. Quantifying alterations of macular thickness before and after panretinal photocoagulation in patients with severe diabetic retinopathy and good vision. Ophthalmology. 2003 Dec;110(12):2386-94. doi: 10.1016/j.ophtha.2003.05.008.
- Japanese Society of Ophthalmic Diabetology, Subcommittee on the Study of Diabetic Retinopathy Treatment; Sato Y, Kojimahara N, Kitano S, Kato S, Ando N, Yamaguchi N, Hori S. Multicenter randomized clinical trial of retinal photocoagulation for preproliferative diabetic retinopathy. Jpn J Ophthalmol. 2012 Jan;56(1):52-9. doi: 10.1007/s10384-011-0095-2. Epub 2011 Oct 19.
研究记录日期
这些日期跟踪向 ClinicalTrials.gov 提交研究记录和摘要结果的进度。研究记录和报告的结果由国家医学图书馆 (NLM) 审查，以确保它们在发布到公共网站之前符合特定的质量控制标准。
研究主要日期
学习开始 (实际的)
2016年10月1日
初级完成 (预期的)
2023年10月1日
研究完成 (预期的)
2023年10月1日
研究注册日期
首次提交
2016年10月12日
首先提交符合 QC 标准的
2016年11月3日
首次发布 (估计)
2016年11月6日
研究记录更新
最后更新发布 (实际的)
2022年5月9日
上次提交的符合 QC 标准的更新
2022年5月6日
最后验证
2022年3月1日
更多信息
此信息直接从 clinicaltrials.gov 网站检索，没有任何更改。如果您有任何更改、删除或更新研究详细信息的请求，请联系 register@clinicaltrials.gov. clinicaltrials.gov 上实施更改，我们的网站上也会自动更新.