PRevention of Macular EDema After Cataract Surgery
试验速览
- 阶段
- 3 期
- 状态
- 已完成
- 入组人数
- 1,127
- 试验地点
- 16
- 主要终点
- Change in central subfield mean macular thickness as a measurement of efficacy
研究概览
简要总结
Cystoid macular edema (CME) is a common cause of vision loss after cataract surgery. In the last few years, several new treatments have been tried to address the problem of CME after cataract surgery in diabetic and non-diabetic patients. The investigators will perform a large RCT with the aim to provide more definite evidence-based recommendations for clinical guidelines to prevent the occurrence of CME after cataract surgery in patients with and without diabetes mellitus (DM).
详细描述
The objective of this study is to evaluate the effect of different preventive strategies on the occurrence of CME after cataract surgery in non-diabetic and diabetic patients. The design of the study is a multicentre randomised controlled clinical trial. The study population will consist of 926 non-diabetic patients and 209 patients with diabetes mellitus (DM) who require cataract surgery in at least one eye. All patients will receive a phacoemulsification for cataract and placement of a posterior chamber intraocular lens (IOL).
In the non-diabetic population, the patients will receive either bromfenac 0.09% eye drops twice daily starting two days before surgery and continuing 2 weeks postoperative, dexamethasone 0.1% eye drops four times daily starting two days before surgery and continuing four times daily during the first postoperative week and one drop less per day every following week or a combination of both drugs.
In the diabetic population patients will receive either:
- Topical bromfenac 0.09% and dexamethasone 0.1% in the aforementioned dose;
- Topical bromfenac 0.09% and dexamethasone 0.1% in the aforementioned dose and a subconjunctival injection of 40 mg triamcinolone acetonide;
- Topical bromfenac 0.09% and dexamethasone 0.1% in the aforementioned dose and an intravitreal injection of 1.25 mg bevacizumab;
- Topical bromfenac 0.09% and dexamethasone 0.1% in the aforementioned dose, a subconjunctival injection of 40 mg triamcinolone acetonide and an intravitreal injection of 1.25 mg bevacizumab.
The primary endpoint is the change in central subfield mean macular thickness in the 1 mm area (central subfield macular thickness, CSMT) as compared to baseline within the first 6 weeks postoperative.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- Double (Participant, Investigator)
入排标准
- 年龄范围
- 21 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •All patients undergoing routine phacoemulsification (one eye per patient)
- •willing and/or able to comply with the scheduled visits and other study procedures.
- •able to communicate properly and understand instructions.
- •accepting possible off-label use of intravitreal bevacizumab and/or subconjunctival preservative-free TA.
- •Exclusion criteria will be different for non-diabetic and diabetic patients. All ophthalmic exclusion criteria are applicable to the study eye only, unless stated otherwise.
- •General exclusion criteria for participation in this study are:
- •age below 21 years old;
- •participation in another clinical study;
- •post-traumatic cataract;
- •combined surgery;
- •functional monoculus;
- •previous ocular surgery;
- •progressive glaucoma with severe visual field defects, use of anti-glaucomatous medication or steroid-induced IOP elevation that required IOP-lowering treatment;
- •IOP ≥ 25 mmHg;
- •history of any intraocular inflammation or uveitis;
- •history of pseudoexfoliation syndrome, which is expected to cause peroperative complications;
- •history of Fuchs' endothelial dystrophy or cornea guttata 3+;
- •history of retinal vein occlusion;
- •any macular pathology that might influence VA, other than DME;
- •use of intravitreal bevacizumab or ranibizumab in the previous 6 weeks or intravitreal aflibercept in the previous 10 weeks;
- •use of intra- or periocular corticosteroid injection in the previous 4 months;
- •current use of topical NSAIDs or corticosteroids;
- •use of systemic corticosteroids (≥ 20 mg prednisolone or equivalence);
- •history of relevant adverse events, including serious adverse events (SAE), occurring after administration of NSAIDs, acetylsalicylic acid, sodium sulphite, corticosteroids or bevacizumab;
- •contraindications for use of topical NSAIDs, topical or subconjunctival corticosteroids or intravitreal bevacizumab or related drugs;
- •Non-diabetic patients with a history of CME will be excluded from participation in the study.
- •Additionally, diabetic patients will be excluded from participation in case of:
- •macular edema with a CSMT ≥450 µm;
- •very severe NPDR or proliferative DR requiring panretinal photocoagulation or vitrectomy;
- •vitreous haemorrhage present during preoperative visit(s);
- •cerebrovascular accident (CVA), myocardial infarction (MI) or other thromboembolic events in the previous 3 months;
- •a history of recurrent thromboembolic events;
- •a history of severe systemic bleeding in the previous 3 months;
- •major surgery in the previous 3 months;
- •history of glaucoma;
排除标准
- 未提供
研究组 & 干预措施
Non diabetics: bromfenac
bromfenac 0.09% eye drops twice daily starting two days before surgery and continuing 2 weeks postoperatively
干预措施: Bromfenac (Drug)
Non diabetics: dexamethasone
dexamethasone 0.1% eye drops four times daily starting two days before surgery and continuing four times daily during the first postoperative week and one drop less per day every following week
干预措施: Dexamethasone (Drug)
Non diabetics: bromfenac & dexamethasone
bromfenac 0.09% eye drops twice daily starting two days before surgery and continuing 2 weeks postoperative & dexamethasone 0.1% eye drops four times daily starting two days before surgery and continuing four times daily during the first postoperative week and one drop less per day every following week
干预措施: Bromfenac (Drug)
Non diabetics: bromfenac & dexamethasone
bromfenac 0.09% eye drops twice daily starting two days before surgery and continuing 2 weeks postoperative & dexamethasone 0.1% eye drops four times daily starting two days before surgery and continuing four times daily during the first postoperative week and one drop less per day every following week
干预措施: Dexamethasone (Drug)
Diabetics: eye drops
bromfenac 0.09% eye drops twice daily starting two days before surgery and continuing 2 weeks postoperative & dexamethasone 0.1% eye drops four times daily starting two days before surgery and continuing four times daily during the first postoperative week and one drop less per day every following week
干预措施: Bromfenac (Drug)
Diabetics: eye drops
bromfenac 0.09% eye drops twice daily starting two days before surgery and continuing 2 weeks postoperative & dexamethasone 0.1% eye drops four times daily starting two days before surgery and continuing four times daily during the first postoperative week and one drop less per day every following week
干预措施: Dexamethasone (Drug)
Diabetics: eye drops & TA
bromfenac 0.09% eye drops twice daily starting two days before surgery and continuing 2 weeks postoperative & dexamethasone 0.1% eye drops four times daily starting two days before surgery and continuing four times daily during the first postoperative week and one drop less per day every following week
& a peroperative subconjunctival injection of 40 mg triamcinolone acetonide (TA, Triesence/Vistrec)
干预措施: Bromfenac (Drug)
Diabetics: eye drops & TA
bromfenac 0.09% eye drops twice daily starting two days before surgery and continuing 2 weeks postoperative & dexamethasone 0.1% eye drops four times daily starting two days before surgery and continuing four times daily during the first postoperative week and one drop less per day every following week
& a peroperative subconjunctival injection of 40 mg triamcinolone acetonide (TA, Triesence/Vistrec)
干预措施: Dexamethasone (Drug)
Diabetics: eye drops & TA
bromfenac 0.09% eye drops twice daily starting two days before surgery and continuing 2 weeks postoperative & dexamethasone 0.1% eye drops four times daily starting two days before surgery and continuing four times daily during the first postoperative week and one drop less per day every following week
& a peroperative subconjunctival injection of 40 mg triamcinolone acetonide (TA, Triesence/Vistrec)
干预措施: Triamcinolone Acetonide (Drug)
Diabetics: eye drops & bevacizumab
bromfenac 0.09% eye drops twice daily starting two days before surgery and continuing 2 weeks postoperative & dexamethasone 0.1% eye drops four times daily starting two days before surgery and continuing four times daily during the first postoperative week and one drop less per day every following week
& a peroperative intravitreal injection of 1.25 mg bevacizumab (Avastin)
干预措施: Bromfenac (Drug)
Diabetics: eye drops & bevacizumab
bromfenac 0.09% eye drops twice daily starting two days before surgery and continuing 2 weeks postoperative & dexamethasone 0.1% eye drops four times daily starting two days before surgery and continuing four times daily during the first postoperative week and one drop less per day every following week
& a peroperative intravitreal injection of 1.25 mg bevacizumab (Avastin)
干预措施: Dexamethasone (Drug)
Diabetics: eye drops & bevacizumab
bromfenac 0.09% eye drops twice daily starting two days before surgery and continuing 2 weeks postoperative & dexamethasone 0.1% eye drops four times daily starting two days before surgery and continuing four times daily during the first postoperative week and one drop less per day every following week
& a peroperative intravitreal injection of 1.25 mg bevacizumab (Avastin)
干预措施: Bevacizumab (Drug)
Diabetics: eye drops, TA & bevacizumab
bromfenac 0.09% eye drops twice daily starting two days before surgery and continuing 2 weeks postoperative, dexamethasone 0.1% eye drops four times daily starting two days before surgery and continuing four times daily during the first postoperative week and one drop less per day every following week
& a peroperative subconjunctival injection of 40 mg triamcinolone acetonide (TA)
& a peroperative intravitreal injection of 1.25 mg bevacizumab
干预措施: Bromfenac (Drug)
Diabetics: eye drops, TA & bevacizumab
bromfenac 0.09% eye drops twice daily starting two days before surgery and continuing 2 weeks postoperative, dexamethasone 0.1% eye drops four times daily starting two days before surgery and continuing four times daily during the first postoperative week and one drop less per day every following week
& a peroperative subconjunctival injection of 40 mg triamcinolone acetonide (TA)
& a peroperative intravitreal injection of 1.25 mg bevacizumab
干预措施: Dexamethasone (Drug)
Diabetics: eye drops, TA & bevacizumab
bromfenac 0.09% eye drops twice daily starting two days before surgery and continuing 2 weeks postoperative, dexamethasone 0.1% eye drops four times daily starting two days before surgery and continuing four times daily during the first postoperative week and one drop less per day every following week
& a peroperative subconjunctival injection of 40 mg triamcinolone acetonide (TA)
& a peroperative intravitreal injection of 1.25 mg bevacizumab
干预措施: Bevacizumab (Drug)
Diabetics: eye drops, TA & bevacizumab
bromfenac 0.09% eye drops twice daily starting two days before surgery and continuing 2 weeks postoperative, dexamethasone 0.1% eye drops four times daily starting two days before surgery and continuing four times daily during the first postoperative week and one drop less per day every following week
& a peroperative subconjunctival injection of 40 mg triamcinolone acetonide (TA)
& a peroperative intravitreal injection of 1.25 mg bevacizumab
干预措施: Triamcinolone Acetonide (Drug)
结局指标
主要结局
Change in central subfield mean macular thickness as a measurement of efficacy
时间窗: 6 weeks postoperatively
The primary endpoint is the change in central subfield mean macular thickness in the 1 mm area (central subfield macular thickness, CSMT) as compared to baseline within the first 6 weeks postoperatively.
次要结局
- No. of subjects developing clinically significant macular edema as a measurement of efficacy(12 weeks postoperatively)