First in Human Study to Assess the Safety and the Efficacy of an Implantable Nitinol Device in the Treatment of Keratoconus
- Conditions
- Keratoconus
- Interventions
- Device: Intracorneal implantation
- Registration Number
- NCT06451718
- Lead Sponsor
- Fundacio De Recerca Del Instituto De Microcirugia Ocular
- Brief Summary
This Study is a first in human clinical study addressed to evaluate the safety and efficacy of a novel intra-corneal nitinol device (Investigational Device; GROSSO® implant) for the treatment of advanced keratoconus disease of the eye.
- Detailed Description
The medical device under investigation is a sterile thin 8-mm diameter circular scaffold made of a nickel-titanium alloy (nitinol) that is intended as a permanent implant that is surgically inserted into the cornea in order to modify force by inducing a change in corneal shape and consequently improving vision. This Study is aimed at adults with a stage 3-4 keratoconus, a central K reading \> 53.00 D and RMS of coma aberration \> 3.5, which are not eligible for Intrastromal Corneal Ring Segments (ICRS) and are recommended for keratoplasty.
Therefore, this study represents a salvage route to preserve the cornea. Envisaged worst case scenario of failure of the experimental device patients would be redirected to keratoplasty.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 12
- Male and female ≥ 18 years old
- Not suitable for ICRS and are recommended for keratoplasty
- Best distance spectacle corrected visual acuity (BDCSVA) 1.30 - 0.40 logMAR (0.05-0,40 decimal notation)
- Have stable or stabilized disease for 12 months (in case of cross-linking, it must have been done 12 months prior to intervention)
- Have a KC stage 3-4 (Amsler-Krumeich) with a Central K readings > 53.00 D and RMS of coma aberration > 3.5.
- Signed and dated informed consent form
- Inability of patient and/or relatives to understand the clinical investigation procedures and thus inability to give informed consent
- Untreated progressive KC
- Single functioning eye
- Minimum Corneal thickness < 400 μm
- Other ocular diseases (eyelids malposition, uveitis, ocular hypertension, glaucoma, cataract, retinal disorders) or corneal surgeries (refractive corneal surgery, keratoplasty), except corneal crosslinking
- Systemic collagenopathies and/or vasculitis, and other diseases that in the opinion of the principal investigator may be contraindicated
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Study group Intracorneal implantation Participants with study disease
- Primary Outcome Measures
Name Time Method Corrected IOP (bIOP) assessments 6 months follow up Changes in bIOP
Macular central thickness assessments 6 months follow up Changes in macular central thickness
Best Distance Spectacle Corrected Visual Acuity (BDSCVA) 6 month follow up Changes in BDSCVA
Incidence of Treatment-Emergent adverse events , classification and related severity 6 months follow up Assessments, classification and related severity of Serious Adverse Device Effects (SADE), Adverse Events (AE) and Serious Adverse Events (SAE) and
Slit lamp corneal assessment. Observations will be graded as follows:0- Absence 1- Mild 2- Moderate 3- Severe 6 months follow up Corneal inflammation
Corneal infection
Corneal neovascularization
Corneal stromal lysis
Corneal melting
Corneal stromal infiltration
Corneal neo vessels
Persistent corneal epithelial defectsEpithelial corneal thickness assessments 6 months follow up Changes in total and epithelial corneal thickness (central and minimum)
Intraocular pressure (IOP) assessments 6 months follow up Changes in IOP
Subjective numeric scale related to several ocular symptoms, graded from 0 to 10. lower scores reflect better symptomatology outcome 6 month follow up Subjective numeric scale elated to pain, foreign body sensation, tearing, photophobia, glare and halos.
Corneal endothelium assessments 6 months follow up Change in the number of cells/mm\^2 in the corneal endothelium
- Secondary Outcome Measures
Name Time Method Measurement of biomechanical properties and characterization of the cornea by measuring Stress-Strain Index (SSI) 6 month follow up Changes in biomechanical properties. Stress-Strain Index (SSI). Parameter for estimating the material stiffness of corneal tissue, independent of IOP and corneal geometry. The stress/strain curve describes the elastic properties of the cornea. The curves are shifted to the right if the cornea is soft and to the left if it is stiff. The SSI index describes the position of the curve. A value of 1 indicates average elasticity, a value less than 1 indicates softer behaviour and a value greater than 1 indicates stiffer than average behaviour.
Measurement of topographic keratometry values 6 month follow up Changes in topographic keratometry values maximum keratometry(Kmax), minimum Keratometry (Kmin) steep, and average keratometry (Km)
Measurement of topographic astigmatism 6 month follow up Changes in topographic astigmatism
Measurement of refractive astigmatism 6 month follow up Changes in refractive astigmatism
Assessment of the centration of the intracorneal implant 6 month follow up Assessment of the corneal coordinates of the centration of the intracorneal implant
Best Corrected Visual Acuity(BCVA) with rigid gas permeable(RGP) contact lens (RGP-BCVA) 6 month follow up Changes in RGP-BCVA
Measurement of manifest refraction sphere equivalent (MRSE) 6 month follow up Changes in MRSE
Measurement of irregularity index (IR) 6 month follow up Changes in IR from baseline to 6 months follow up. IR can be classified as low when \<0.077 and high when ≥ 0.077
Measurement of Uncorrected Visual Acuity (UCVA) 6 month follow up Changes of UCVA
Measurement of Optical surface index (OSI) related to Optical Quality 6 month follow up Changes in OSI ussing a double pass system. Higher intraocular scatter corre- lates with high OSI. OSI is calculated by the ratio between light in the periphery (circle of a radius between 12 and 20 mins of arc) and in the central peak (circle of a radius of 1 min of arc) of the DP image of the point spread function (PSF)
Measurement of Root Mean Square (RMS) related to Optical Quality 6 month follow up Changes in RMS
Assessment of the corneal applanation 6 month follow up Changes of the corneal curvature or applanation
Measurement of biomechanical properties and characterization of the cornea by measuring Deflection Amplitude Ratio (DAR: Deflection Amplitude Ratio) 6 month follow up Changes in biomechanical properties. DAR: It is the ratio of the central corneal deflection to the average of 2 points 1.0 mm (DAR1) or 2.0 mm (DAR2) either side of the centre. Stiffer corneas would have a lower DA because the corneal centre and the cornea at 1.0 or 2.0 mm deflect at the same time, while a higher DA indicates that the central cornea deflects more than the average corneal deflection at 1.0 or 2.0 mm, whereas a higher DA indicates that the central cornea deflects more than the average corneal deflection at 1.0 or 2.0 mm. central cornea deviates more than the average of the other 2 points, which corresponds to a softer tissue.
Measurement of biomechanical properties and characterization of the cornea by measuring Stiffness Parameter-A1 (SP-A1) and Stress-Strain Index (SSI) 6 month follow up Changes in biomechanical properties. Stiffness Parameter-A1 (SP-A1). It is defined as the pressure resulting at first flattening from the difference between the air puff pressure at the corneal surface and the biomechanically corrected IOP, divided by the deflection amplitude. It is determined using the displacement of the apex from the resting state to the first flattening. This value has been clinically proven to be useful in the assessment of QC with the highest sensitivity and specificity of each of the parameter values. Higher values indicate stiffer corneas. Measured in mmHg/mm.
Measurement of vision Related Quality of Life (VRQoL) 6 month follow up Changes in the score of the questionnaire VRQoL. All items are scored so that a high score represents a better quality of life. Each item is converted to a 0 to 100 possible range, so that the lowest and highest possible scores are set at 0 and 100 repectively. The analyzed items are: Clarity of vision, expectations, Near vision, far vision, diurnal fluctuations, activity limitations, glare, symptoms, dependence on correction, worry, suboptimal correction, appearance, satisfaction with correction
Measurement of biomechanical properties and characterization of the cornea by measuring ,Integrated Radius 6 month follow up Changes in biomechanical properties. Integrated Radius: A dynamic corneal deformation response parameter that represents the reciprocal of the radius during the state of maximum corneal concavity. A larger concave radius is associated with greater resistance to deformation, i.e. a stiffer cornea. The larger the integrated inverse radius and the maximum inverse radius, the lower the resistance to deformation and the lower the corneal stiffness.
Measurement of biomechanical properties and characterization of the cornea by measuring, Ambrósio Relational Thickness horizontal (ARTh) 6 month follow up Changes in biomechanical properties. Ambrósio Relational Thickness horizontal (ARTh). Corneal thickness is measured using the Scheimpflug horizontal image. This allows calculation of the rate of increase in corneal thickness from the apex towards the nasal and temporal sides. The characterisation of the thickness profile allows the calculation of the Ambrósio relational thickness across the horizontal meridian, which is a relative simplification of the tomographic relational thickness calculations also provided by Pentacam.
Trial Locations
- Locations (1)
Instituto de Microcirugía Ocular de Barcelona (IMO)
🇪🇸Barcelona, Bar, Spain