Risk Factors and Progression of Keratoconus
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 200
- 试验地点
- 2
- 主要终点
- ABCD grading of keratoconus
研究概览
简要总结
Primary objective :
Description of keratoconus at baseline and during progression in 200 participants followed by the ophthalmology departments of CHU Montpellier, CHU Bordeaux and CHU Toulouse during a 2-year period. Clinical outcome, histology of the cornea and tears proteomics will be assessed in 4 groups at different points in time:
- At 6 months in participants with no intervention (risk reduction instructions: not to rub their eyes)
- At 6 months in participants with no intervention that didn't comply with the risk reduction instructions
- At 1 month in participants assigned to cross-linking surgery
- At 1 month in participants assigned to intra corneal ring surgery If both eyes are affected, both will be evaluated with their own visit agenda. Visits for no surgery participants will be set at 6 months, 12 months and 24 months in the absence of intervention (apart from the behavioral risk reduction).
Visits for surgery participants will be set at D7, 1 month, 6 months, 12 months and 24 months after the procedure: cross-linking or placement of the intra corneal ring.
Secondary objective :
Description of the association between clinical outcomes, histological progression of the cornea and tears proteomics in time, 2 years period.
Comparison of tears proteomics in 36 participants with keratoconus followed at CHU of Montpellier and healthy participants at baseline .
详细描述
This trial is a prospective cohort study of 200 participants with keratoconus followed by the ophthalmology departments of CHU Montpellier, CHU Bordeaux and CHU Toulouse during a 2-year period. If both eyes are affected, each will be evaluated considering their own visit agenda. Histological and proteomic evaluations will be performed in 36 participants's eyes whose initial management is abstention of surgery (12 participants), cross-linking (12 participants) or intra corneal ring (12 participants).
The target population consist of participants with clinical keratoconus (topographic Rabinowitz criteria with slit lamp abnormalities and visual impairment), preclinical or crude keratoconus (abnormal or suspicious topography with normal slit lamp examination and normal visual acuity). They will be aged between 10 and 40 years included.
The follow-up will be taken care off by the ophthalmology departments of the Montpellier University Hospital, Bordeaux University Hospital or Toulouse University Hospital Collection of written informed consent, after a period of reflection, will be necessary for adult participants. For minors: informed consent will have to be signed by at least one of the 2 parents or legal guardians, and approval from the child will be asked after a period of reflection. All participants will have to be affiliated to the French social security system or beneficiary of such a system.
Description of the study course:
No therapeutic intervention outside of routine care will be performed. Depending on the therapeutic orientation, the follow-up is carried out as follows:
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 10 Years 至 40 Years（Child, Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Participants with clinical keratoconus (Rabinowitz criteria with topographic slit lamp abnormalities and visual impairment), preclinical or crude keratoconus (abnormal or suspicious topography with normal slit lamp examination and normal visual acuity, visual acuity)
- •Followed by the ophthalmology services of the CHU Montpellier, CHU Bordeaux or CHU Toulouse
- •For adult Participants: collection of written informed consent, after a period of reflection period
- •For minors: informed consent signed by at least one of the 2 parents or legal representatives legal representatives, and assent of the child after a period of reflection
- •Affiliation to the French social security system or beneficiary of such a system
排除标准
- •Person under legal supervision, guardianship or curator
- •History of corneal implant on both eyes
- •Planned relocation before the end of the first stage of treatment (abstention, cross-linking, intra-corneal ring depending on the participant)
结局指标
主要结局
ABCD grading of keratoconus
时间窗: Baseline vs Visit at 1 month/6 months/12 months/24 months
Grading of the keratoconus, according to the ABCD classification : * A: keratometry of the anterior surface of the cornea (Anterior radius of curvature (ARC)), in the area of 3 mm centered by the thinnest point. * B: keratometry of the posterior surface of the cornea (Back or posterior radius of curvature PRC), in the 3mm area centered by the thinnest point. * C: thinnest point of the Cornea, i.e. minimum pachymetry. * D: Distance best corrected vision: visual acuity with the best correction, measured in 10° or in the Parinaud scale.
Keratoconus histological progression - Confocal microscopy (tissue thickness)
时间窗: Baseline vs Visit at 1 month/6 months/12 months/24 months
Histological degradation of the cornea taken at baseline for reference. The confocal microscope allows longitudinal analysis making it possible to carry out comparative qualitative and quantitative analyzes of the corneal tissue during time. In keratoconus, this technique is possible to highlight a reduction in basal plexus nerve density and poorer anterior stromal cell density compared to healthy subjects. Tissue thickness in microns (µm)
Keratoconus clinical progression (Keratometry map)
时间窗: Baseline vs Visit at 1 month/6 months/12 months/24 months
Modelisation of refraction measurements in diopters, by corneal elevation topography (Orbscan and Pentacam), giving an additional indicator of the corneal deformity. High values of diopter correspond to positive bulges of the cornea. A topographic axial map will be acquired to monitor minimal and maximal keratometry. These measurements will be taken at baseline and compared for reference of progression at each visit for each eye. Keratoconus definition according to Rabinowitz (Rabinowitz YS, 1989) criteria: * Corneal asymmetry greater than 1.5 diopters (D), between the upper and lower part of the cornea, on the median vertical axis. * Central corneal power (Kmax) \> 47.2 D, measured at the top of the cone. * Asymmetry of central keratometry \> 1D between the two eyes
Keratoconus clinical progression (Pachymetric map)
时间窗: Baseline vs Visit at 1 month/6 months/12 months/24 months
Thickness of the cornea will be assessed in microns (µm) at several locations and will be presented as a map by corneal elevation topography (Orbscan and Pentacam). The pachymetric map will be acquired at baseline and compared for reference of progression at each visit for each eye. The higher and lower thickness points will be notified for the anterior and posterior parts of the eye.
Keratoconus clinical progression (Visual acuity test)
时间窗: Baseline vs Visit at 1 month/6 months/12 months/24 months
Visual acuity test with and without correction: decimal and Parinaud scales secondarily translated in LogMar.
Keratoconus clinical progression (Biomicroscopic examination of the cornea)
时间窗: Baseline vs Visit at 1 month/6 months/12 months/24 months
A biomicroscopic examination of the cornea in search of signs that may modify the therapeutic indications i.e : Fleischer rings (iron deposits in the lower part of the bulge, due to the stagnation of tears), visible corneal nerves, corneal opacities (due to scar tissue)
Keratoconus histological progression - Confocal microscopy (Cellular organization)
时间窗: Baseline vs Visit at 1 month/6 months/12 months/24 months
Histological degradation of the cornea taken at baseline for reference. The confocal microscope allows longitudinal analysis making it possible to carry out comparative qualitative and quantitative analyzes of the corneal tissue during time. In keratoconus, this technique is possible to highlight a reduction in basal plexus nerve density and poorer anterior stromal cell density compared to healthy subjects. Cell organization and morphology. Image acquisition. * Colonization by inflammatory cells (yes/no), increased nucleo/cytoplasmic ratio (yes/no), hyperreflectivity of the nuclei (yes/no). * Nerve density of the basal plexuses of normal appearance (yes/no), straight with branches (yes/no), normal hyperreflectivity (yes/no)
Keratoconus histological progression - Confocal microscopy (Cellular density)
时间窗: Baseline vs Visit at 1 month/6 months/12 months/24 months
Histological degradation of the cornea taken at baseline for reference. The confocal microscope allows longitudinal analysis making it possible to carry out comparative qualitative and quantitative analyzes of the corneal tissue during time. In keratoconus, this technique is possible to highlight a reduction in basal plexus nerve density and poorer anterior stromal cell density compared to healthy subjects. Cellular density (number). Image acquisition. \- Cell count in the different layers, corneal nerve count from the basal plexus to the corneal apex
Keratoconus histological progression - Confocal microscopy (Light scattering)
时间窗: Baseline vs Visit at 1 month/6 months/12 months/24 months
Histological degradation of the cornea taken at baseline for reference. The confocal microscope allows longitudinal analysis making it possible to carry out comparative qualitative and quantitative analyzes of the corneal tissue during time. In keratoconus, this technique is possible to highlight a reduction in basal plexus nerve density and poorer anterior stromal cell density compared to healthy subjects. Light scattering in vivo, measurement of corneal deformity. Diopter.
Risk factors - Questionnaire
时间窗: Baseline vs 24 months
* Presence of atopy/allergy * Eye rubbing * Family medical history * Ethnicity * Smoking habits * Dry eye syndrome
Tears proteomics
时间窗: Baseline vs Visit at 1 month/6 months
For 36 participants from Montpellier. Composition and evolution of tears determined by proteomic analysis
Keratoconus clinical progression (Keratometry map)
时间窗: Baseline vs Visit at 1 month/6 months/12 months/24 months
Modelisation of refraction measurements in diopters, by corneal elevation topography (Orbscan and Pentacam), giving an additional indicator of the corneal deformity. High values of diopter correspond to positive bulges of the cornea. A topographic axial map will be acquired to monitor minimal and maximal keratometry. These measurements will be taken at baseline and compared for reference of progression at each visit for each eye. Keratoconus definition according to Rabinowitz (Rabinowitz YS, 1989) criteria: * Corneal asymmetry greater than 1.5 diopters (D), between the upper and lower part of the cornea, on the median vertical axis. * Central corneal power (Kmax) \> 47.2 D, measured at the top of the cone. * Asymmetry of central keratometry \> 1D between the two eyes
Keratoconus clinical progression (Visual acuity test)
时间窗: Baseline vs Visit at 1 month/6 months/12 months/24 months
Visual acuity test with and without correction: decimal and Parinaud scales secondarily translated in LogMar.
Keratoconus clinical progression (Biomicroscopic examination of the cornea)
时间窗: Baseline vs Visit at 1 month/6 months/12 months/24 months
A biomicroscopic examination of the cornea in search of signs that may modify the therapeutic indications i.e : Fleischer rings (iron deposits in the lower part of the bulge, due to the stagnation of tears), visible corneal nerves, corneal opacities (due to scar tissue)
Keratoconus clinical progression (Pachymetric map)
时间窗: Baseline vs Visit at 1 month/6 months/12 months/24 months
Thickness of the cornea will be assessed in microns (µm) at several locations and will be presented as a map by corneal elevation topography (Orbscan and Pentacam). The pachymetric map will be acquired at baseline and compared for reference of progression at each visit for each eye. The higher and lower thickness points will be notified for the anterior and posterior parts of the eye.
ABCD grading of keratoconus
时间窗: Baseline vs Visit at 1 month/6 months/12 months/24 months
Grading of the keratoconus, according to the ABCD classification : * A: keratometry of the anterior surface of the cornea (Anterior radius of curvature (ARC)), in the area of 3 mm centered by the thinnest point. * B: keratometry of the posterior surface of the cornea (Back or posterior radius of curvature PRC), in the 3mm area centered by the thinnest point. * C: thinnest point of the Cornea, i.e. minimum pachymetry. * D: Distance best corrected vision: visual acuity with the best correction, measured in 10° or in the Parinaud scale.
Keratoconus histological progression - Confocal microscopy (tissue thickness)
时间窗: Baseline vs Visit at 1 month/6 months/12 months/24 months
Histological degradation of the cornea taken at baseline for reference. The confocal microscope allows longitudinal analysis making it possible to carry out comparative qualitative and quantitative analyzes of the corneal tissue during time. In keratoconus, this technique is possible to highlight a reduction in basal plexus nerve density and poorer anterior stromal cell density compared to healthy subjects. Tissue thickness in microns (µm)
Keratoconus histological progression - Confocal microscopy (Cellular organization)
时间窗: Baseline vs Visit at 1 month/6 months/12 months/24 months
Histological degradation of the cornea taken at baseline for reference. The confocal microscope allows longitudinal analysis making it possible to carry out comparative qualitative and quantitative analyzes of the corneal tissue during time. In keratoconus, this technique is possible to highlight a reduction in basal plexus nerve density and poorer anterior stromal cell density compared to healthy subjects. Cell organization and morphology. Image acquisition. * Colonization by inflammatory cells (yes/no), increased nucleo/cytoplasmic ratio (yes/no), hyperreflectivity of the nuclei (yes/no). * Nerve density of the basal plexuses of normal appearance (yes/no), straight with branches (yes/no), normal hyperreflectivity (yes/no)
Keratoconus histological progression - Confocal microscopy (Cellular density)
时间窗: Baseline vs Visit at 1 month/6 months/12 months/24 months
Histological degradation of the cornea taken at baseline for reference. The confocal microscope allows longitudinal analysis making it possible to carry out comparative qualitative and quantitative analyzes of the corneal tissue during time. In keratoconus, this technique is possible to highlight a reduction in basal plexus nerve density and poorer anterior stromal cell density compared to healthy subjects. Cellular density (number). Image acquisition. \- Cell count in the different layers, corneal nerve count from the basal plexus to the corneal apex
Keratoconus histological progression - Confocal microscopy (Light scattering)
时间窗: Baseline vs Visit at 1 month/6 months/12 months/24 months
Histological degradation of the cornea taken at baseline for reference. The confocal microscope allows longitudinal analysis making it possible to carry out comparative qualitative and quantitative analyzes of the corneal tissue during time. In keratoconus, this technique is possible to highlight a reduction in basal plexus nerve density and poorer anterior stromal cell density compared to healthy subjects. Light scattering in vivo, measurement of corneal deformity. Diopter.
Risk factors - Questionnaire
时间窗: Baseline vs 24 months
* Presence of atopy/allergy * Eye rubbing * Family medical history * Ethnicity * Smoking habits * Dry eye syndrome
Tears proteomics
时间窗: Baseline vs Visit at 1 month/6 months
For 36 participants from Montpellier. Composition and evolution of tears determined by proteomic analysis
次要结局
- Keratoconus histological evolution(Baseline vs Visit at 1 month/6 months)
- ABCD class worsening between consultations(Baseline vs Visit at 1 month/6 months - Baseline vs 12 months - Baseline vs 24 months)
- Proteomic profile evolution(Baseline vs Visit at 1 month/6 months)