Scleral Buckling for Retinal Detachment Prevention in Genetically Confirmed Stickler Syndrome : a Randomized Controlled Trial
试验速览
- 阶段
- 2 期
- 状态
- 撤回
- 入组人数
- 40
- 试验地点
- 2
- 主要终点
- Best corrected visual acuity and retinal detachment rate
研究概览
简要总结
The purpose of this study is to determine whether a scleral buckling surgical procedure performed on fellow eyes of patients with genetically confirmed Stickler syndrome can prevent the occurrence retinal detachment and/or severe vision loss of the study eye.
详细描述
Stickler syndrome (STL) is a genetic disease affecting several organs. However the major risk is represented by the development of retinal detachment (RD). Up to 80% of patients present a RD and 25% to 80% have sequential bilateral RD. The surgical outcome of RD in this population is worse than that of the general RD population mainly because of the severity at diagnosis and the high frequency and severity of postoperative complications. Prevention has therefore emerged as a therapeutic option for this identifiable high-risk group of patients. Prevention has been proposed especially for the fellow (contralateral) eye of patients having presented a RD in their first eye and often lost vision as a consequence of retinal detachment in the first eye.
The investigators hypothesize that a scleral buckling surgical procedure performed for the fellow eye of STL patients having recently presented a RD of the first eye could prevent the occurrence of bilateral RD and/or vision loss.
Stickler patients are regularly diagnosed and followed-up in referral centers mainly in the context of a recent retinal detachment. They are proposed genetic testing as part of the standard of care. Genetically confirmed Stickler patients having recently presented (<24 months) a retinal detachment and treated as part of the standard care are eligible for this study. During the usual follow-up visits performed for their recent first RD operation they will be informed and offered to participate in the "STL-DR-PREV study" for the prevention of RD of their fellow eye.
Patients in the intervention arm will undergo an encircling scleral buckle surgical procedure, which is a routine surgical procedure used for decades and still in use to treat RD that will be performed in the present study to prevent rather than to treat retinal detachment from a healthy eye of a patient having a genetically confirmed Stickler Syndrome.
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
- None
入排标准
- 年龄范围
- 5 Years 至 35 Years（Child, Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Genetically confirmed Stickler Syndrome
- •Aged 5 to 35
- •Recent retinal detachment in the non-study eye (<24 months)
- •Signed informed consent to participate in the study; For the minors, information and consent of the holders of parental authority
- •Sufficient patient cooperation to perform a complete ophthalmologic examination including a dilated fundus examination
- •Patients affiliated with social security or CMU (profit or being entitled)
排除标准
- •• Any type of previous prevention (laser, cryotherapy, scleral buckle) for the study eye
- •Subclinical retinal rhegmatogenous detachment in the study eye.
- •Any other ocular disease unrelated to Stickler syndrome significantly affecting visual acuity (ETDRS BCVA<20/400).
- •Contraindications to general anesthesia
- •Posterior vitreoretinal traction on optical coherence tomography
- •Pregnant or breastfeeding women
- •Any patient presenting an intraocular pressure during the inclusion visit (M-3) greater than 30 mm Hg
- •Hypersensitivity to povidone iodine, iodine or any of the excipients of the specialty used
- •Hypersensitivity to acetazolamide or any of the excipients of the specialty used
- •Severe hepatic, renal or adrenal insufficiency
- •Sulfonamide intolerance
- •History of renal colic
- •Pre-existing plasma hyperosmolarity
- •Predominantly intracellular dehydration
- •Hypersensitivity to dexamethasone or any of the excipients of the specialty used
- •Hypersensitivity to oxytetracycline or to any of the excipients of Sterdex
- •Treatment with retinoids
- •Hypersensitivity to the active substances or to any of the excipients of Chibrocadron®
- •Personal or family history of glaucoma(Open angle primary glaucoma only)
- •Intraoperative detection of one or more of the above-mentioned non-inclusion criteria
研究组 & 干预措施
Experimental arm
Surgical procedure to prevent retinal detachment in the unaffected eye
干预措施: Encircling scleral buckle surgical procedure (Procedure)
Control arm
Standard procedure of clinical practice without any surgical procedure for the unaffected fellow eye.
结局指标
主要结局
Best corrected visual acuity and retinal detachment rate
时间窗: 5 years
Early Treatment Diabetic Retinopathy Study (ETRDS) best corrected visual acuity (BCVA) and dilated funduscopic examinations at scheduled follow-up (every 6 months)
次要结局
- Rate of retinal breaks(5 years)
- Rate of intravitreal hemorrhage(5 years)
- Outcome in prevention-failed study eyes(5 years)
- Effect of add-on cryotherapy(5 years)
- Safety of the experimental procedure(5 years)