Safety and Effectiveness of the PXL Platinum 330 System With Riboflavin Solution for Previously Untreated Corneal Ulcers

Phase 2

• Conditions: Keratitis; Corneal Ulcer
• Interventions: Other: Standard of Care Therapy + Sham CXL + Artificial Tears; Combination Product: Standard of Care Therapy + CXL + Riboflavin 0.23% L Solution

• Registration Number: NCT05255107
• Lead Sponsor: Peschke GmbH

Brief Summary

This study is being conducted to evaluate the safety and effectiveness of using the PXL Platinum 330 System with riboflavin solution for performing corneal collagen crosslinking (CXL) for the treatment of previously untreated corneal ulcers. The PXL Platinum 330 System is a combination product consisting of an ultraviolet A (UV-A) 365 nm wavelength light source (PXL Platinum 330 Illumination System) and riboflavin (Riboflavin 0.23% PESCHKE-L Solution) administered in conjunction with the UV-A light as a photosensitizer. The PXL Platinum 330 System is intended to induce corneal collagen CXL to improve the biomechanical properties of the cornea by strengthening the corneal tissue in the anterior stroma. Corneal collagen CXL is performed by pretreating the cornea with riboflavin ophthalmic solution beginning 40 min before UV-A light exposure to saturate the corneal tissue with the riboflavin photosensitizer. The cornea is then irradiated with UV-A light (365 nm) at an irradiance of 18 mW/cm2 (5 seconds on, 5 seconds off) for 10 min. Exposure of the cornea to this UV-A light regimen after topical administration of riboflavin ophthalmic solution has been shown to induce CXL of the corneal collagen fibrils, with a resultant increase in tensile strength and diameter of the collagen fibrils. Clinically, CXL has been shown to stabilize the corneal curvature in eyes with progressive keratoconus, with no significant change in the refractive index of the cornea. Numerous reports and a few clinical trials have also shown benefit in aiding resolution of infective corneal ulcers.

Detailed Description

This is a prospective, 2-arm parallel-group, single-masked, randomized multicenter study to determine the safety and effectiveness of the PXL Platinum 330 System for performing CXL in eyes with previously untreated corneal ulcers. Subjects with documented infectious corneal ulcers that have not been treated (treatment na ve) will be evaluated initially for suitability as candidates for CXL. Subjects who are candidates for CXL will be asked to participate in this study and will undergo the required screening procedures to determine study eligibility. Informed consent will be obtained from each subject before performance of any required study procedures that are not part of the investigator's routine examination. After completing screening procedures, the diagnosis for each eligible eye will be confirmed. Subjects will be randomized to 1 of 2 groups, both including standard of care (SOC) treatment:

1. SOC: Moxifloxacin 0.5% eyedrop therapy every 1 hour (q1h) while awake; to be tapered at treating physician's discretion

2. CXL + SOC: Moxifloxacin 0.5% eyedrop therapy + CXL

Eyes undergoing CXL will have topical anesthetic administered and then have topical riboflavin instilled onto the cornea every 2 min (or longer as needed to assure adequate corneal penetration), after which the cornea will be exposed to UV-A pulsed light 18 mW/cm2 for 10 min. Riboflavin instillation will continue every 2 min during CXL. The CXL procedures will be performed on an outpatient basis using the PXL Platinum 330 System (UV-A light source and riboflavin solution). All use of the PXL Platinum 330 System will be in accordance with this protocol and the general instructions provided by the manufacturer (PESCHKE) in the PXL Platinum 330 Illumination System Operator's Manual. All subjects will be evaluated at Screening/Baseline, Day 0 (Randomization/Treatment), Day 1, Day 3 ( 1 day), Week 1 ( 2 days), Week 2 ( 2 days), and Week 4 ( 3 days) after treatment. Efficacy monitoring throughout the study will include observations at appropriate times for re-epithelialization, size of infection, and corneal culture results. Safety monitoring throughout the study will include observations at appropriate times for pain, IOP, BSCVA, corneal scar size, AEs, clinically significant findings on ophthalmic examination, dilated fundus examination, and slit lamp examination. After treatment, subjects will be followed at the treating physician's discretion.

Study Timeline

• Study First Submitted: 2022-01-26
• Study First Submitted QC: 2022-02-15
• Study First Posted: 2022-02-24
• Study Start: 2022-03-14
• Status Verified: 2022-07
• Last Update Submitted: 2022-10-26
• Last Update Posted: 2022-10-28
• Primary Completion: 2023-11-24
• Study Completion: 2024-02-24

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 468

Inclusion Criteria

• Subjects who have one or both eyes that meet the following criteria will be considered candidates for this study:

  1. 18 years of age or older
  2. Ulcers that have not been treated with ophthalmic antibiotic eyedrops (eg, quinolone, polymyxin/trimethoprim, erythromycin, vancomycin, tobramycin, cefazolin, or other ophthalmic antimicrobials) in the preceding 30 days erythromycin, vancomycin, tobramycin, cefazolin, or other ophthalmic antimicrobials) in the preceding 30 days
  3. Consent to a corneal culture for suspected bacterial keratitis (defined as a corneal epithelial defect of any size with an infiltration of the underlying stroma)
  4. Signed written informed consent
  5. Willingness and ability to comply with schedule for follow-up visits
  6. Minimum corneal thickness >300 μm

Exclusion Criteria

• All subjects meeting any of the following criteria will be excluded from this study:

  1. Presence of a perforated corneal ulcer
  2. Presence of a corneal ulcer that had produced a descemetocele
  3. Presence of a corneal ulcer deeper than 50% depth or 275 μm in the cornea
  4. Any active ocular infection other than the corneal ulcer to be treated
  5. Suspicion of amoebic or viral keratitis requiring treatment with topical anti-amoebic or topical antiviral ophthalmic medications
  6. Previous ocular condition (other than refractive error) in the eye(s) to be treated that may predispose the eye(s) for future complications. This may include history of or active corneal disease (eg, herpes simplex, herpes zoster keratitis, recurrent erosion syndrome, acanthamoeba, etc.)
  7. Uncontrolled systemic disease, especially a collagen-vascular or rheumatologic condition that could be contributing to the corneal condition
  8. Pregnancy (or plan to become pregnant) or lactation during the course of the study
  9. A known sensitivity to study medications
  10. Presence of nystagmus or any other condition that would prevent a steady gaze during the CXL treatment or other diagnostic tests

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Standard of Care Therapy + Sham CXL + Artificial Tears	Standard of Care Therapy + Sham CXL + Artificial Tears	Standard-of-care treatment and Sham CXL and administration of artificial tears.
Standard of Care Therapy + CXL + Riboflavin 0.23% L Solution	Standard of Care Therapy + CXL + Riboflavin 0.23% L Solution	The PXL Platinum 330 Illumination System is a portable electronic medical device. The device's light emitting diode (LED) is used to deliver a metered dose of UV-A light to a targeted treatment area for illuminating the cornea during corneal collagen CXL. PESCHKE-L Solution is a riboflavin 5'-phosphate 0.23% ophthalmic solution that functions as a photosensitizer and is indicated for use with the PXL Platinum 330 Illumination System. Designed to be used when there is epithelial disruption as can occur with a corneal ulcer or wound. It does not contain benzalkonium chloride. It is intended to achieve rapid absorption.

Primary Outcome Measures

Name	Time	Method
To evaluate the safety and effectiveness of corneal collagen CXL for treating previously untreated corneal ulcers	Week 2 (#+/- 2 study days).	Primary Outcome Measure: 1. The composite primary endpoint outcome would be the proportion of patients in the treated group, compared to the control group, who achieve all three of the following components: * complete re-epithelialization at week 2, defined as absence of corneal fluorescein staining noted with the blue light of the slit lamp by the investigator.; * no expansion of infiltrate from baseline to week 2. The size of the infiltrate will be reviewed by the investigator using the slit lamp exam and compared to baseline measures to assess expansion of the infiltrate.; * a negative corneal culture at week 2; 2. Each of the components of this composite endpoints is a binary outcome (yes or no), and are NOT measured as units of measure.

Trial Locations

Locations (12)

The cornea & Laser Eye Institute-NJ; 🇺🇸 Teaneck, New Jersey, United States

San Antonio Eye Center; 🇺🇸 Lackland Air Force Base, Texas, United States

Gorovoy M.D Eye Specialists; 🇺🇸 Fort Myers, Florida, United States

Price Vision Group; 🇺🇸 Indianapolis, Indiana, United States

Prisma Health Opthalmology; 🇺🇸 Columbia, South Carolina, United States

Woolfson Eye; 🇺🇸 Chattanooga, Tennessee, United States

Houston Eye Associates; 🇺🇸 Houston, Texas, United States

Valley Eye; 🇺🇸 Oshkosh, Wisconsin, United States

Colorado Eye Consultants; 🇺🇸 Littleton, Colorado, United States

Milwaukee Eye Surgeons; 🇺🇸 Milwaukee, Wisconsin, United States

Bay Area Eye Institute; 🇺🇸 Tampa, Florida, United States

SightMD; 🇺🇸 Babylon, New York, United States