Relationship Between Intraocular Pressure Fluctuation and Retinal Ganglion Cell Function in Eyes Receiving Latanoprost 0.005% Versus Placebo
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 82
- 试验地点
- 1
- 主要终点
- Evidence of impact of intraocular (IOP) reduction on retinal ganglion cell (RGC) function
研究概览
简要总结
The purpose of this investigation is to evaluate the relationship between IOP fluctuation, RGC dysfunction, and optic nerve and retinal nerve fiber layer (RNFL) thickness changes in patients with glaucoma and ocular hypertension receiving latanoprost 0.005% versus placebo.
详细描述
It has been hypothesized that intraocular (IOP) variability is an independent risk factor for the progression of glaucoma. IOP variability includes 24 hour IOP fluctuation during the waking period (diurnal fluctuation) and sleep period (nocturnal fluctuation) as well as longitudinal IOP variability measured in the diurnal period over the course of multiple office visits.
Latanoprost has been clinically used to lower eye pressure in glaucoma and ocular hypertension for almost 10 years. Latanoprost 0.005% has been demonstrated to provide superior ocular hypotensive efficacy compared with timolol 0.5% in pivotal phase 3 clinical trials (Alm et al. 1995; Camras 1996).
The Pattern Electroretinogram (PERG) is a non-invasive technology that objectively measures the retinal ganglion cell (RGC) function (Porciatti and Ventura 2004). A recent study has demonstrated that the RGC function can be improved following IOP reduction in glaucomatous eyes with early visual field defects (Ventura and Porciatti 2005).
The purpose of this investigation is to evaluate the relationship between IOP fluctuation, RGC dysfunction, and optic nerve and retinal nerve fiber layer (RNFL) thickness changes in patients with glaucoma and ocular hypertension receiving latanoprost 0.005% versus placebo.
研究设计
- 研究类型
- Observational
- 观察模型
- Case Crossover
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 85 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Inclusion Criteria - OHT:
- •Ocular hypertension defined as an IOP ≥ 24 mm Hg and ≤ 32 mm Hg in one eye and IOP ≥ 22 mm Hg and ≤ 32 mm Hg in the fellow eye
- •Normal optic disc
- •Normal visual field defined as follows:
- •Mean Deviation (MD) or Pattern Standard Deviation (PSD) of p>5%
- •Normal Glaucoma Hemifield Test (GHT)
- •Reliable visual field exam (less than 33% false positives or false negatives, and less than 20% fixation losses)
- •Inclusion Criteria - POAG:
- •Glaucomatous visual field loss defined as a CPSD (p < 0.05), or GHT (p < 1%) outside normal limits with consistent with ONH or NFL defect
- •Early visual field loss defined as MD ≤ -6.0 dB
- •Untreated IOP ≤ 32 mmHg
- •ONH or NFL defect defined as either inter-eye CDR asymmetry > 0.2, rim thinning or notching, or NFL bundle defect visible on slitlamp biomicroscopy and stereo color fundus photography
排除标准
- •Exclusion Criteria - OHT:
- •Best-corrected visual acuity less than 20/40 either eye
- •Abnormal or unreliable VF
- •Untreated IOP > 32 mmHg
- •Age < 18 or >85 years
- •Refractive error of > +3.00 D or < -7.00 D
- •Previous intraocular surgery except for uncomplicated cataract extraction with posterior chamber intraocular lens implantation
- •Need for chronic ocular or systemic corticosteroid use
- •Narrow/closed angle (gonioscopy must show 75% or more of the angle to be Grade 2 or more by Shaffer's grading system)
- •Diabetic retinopathy
- •Other diseases that may cause VF loss or optic disc abnormalities
- •Life-threatening or debilitating illness making it unlikely patient could successfully complete the study
- •Inability to clinically view or photograph the optic discs due to media opacity or poorly dilating pupil
- •Refusal of informed consent or of commitment to the full length of the study
- •Contraindication to latanoprost or placebo vehicle
- •Exclusion criteria - POAG:
- •Best-corrected visual acuity less than 20/40
- •Untreated IOP > 32 mmHg
- •Age < 18 or >85 years
- •Refractive error of > +3.00 D or < -7.00 D
- •Previous intraocular surgery except for uncomplicated cataract extraction with posterior chamber intraocular lens implantation
- •Diabetic retinopathy
- •Other diseases that may cause VF loss or optic disc abnormalities
- •Inability to clinically view or photograph the optic discs due to media opacity or poorly dilating pupil
- •Inability to perform reliably on automated VF testing
- •Life-threatening or debilitating illness making it unlikely patient could successfully complete the study.
- •Refusal of informed consent or of commitment to the full length of the study
- •Contraindication to latanoprost or placebo vehicle
研究组 & 干预措施
primary open angle glaucoma
Patients with glaucomatous optic neuropathy defined as narrowing of the neuroretinal rim, notching, excavation, or RNFL defect; and repeatable standard automated perimetry abnormality defined as a glaucoma hemifield test (GHT) "outside normal limits" or pattern standard deviation (PSD) outside 95% normal limits were included.
干预措施: latanoprost 0.005% (Drug)
primary open angle glaucoma
Patients with glaucomatous optic neuropathy defined as narrowing of the neuroretinal rim, notching, excavation, or RNFL defect; and repeatable standard automated perimetry abnormality defined as a glaucoma hemifield test (GHT) "outside normal limits" or pattern standard deviation (PSD) outside 95% normal limits were included.
干预措施: Placebo (Drug)
Ocular Hypertensive group
Ocular hypertension defined as an intraocular pressure ≥ 24 mm Hg and ≤ 32 mm Hg in one eye and IOP ≥ 22 mm Hg and ≤ 32 mm Hg in the fellow eye, with normal optic disc, normal visual field defined as follows mean Deviation (MD) or Pattern Standard Deviation (PSD) of p>5%, normal Glaucoma Hemifield Test (GHT) and reliable visual field exam
干预措施: latanoprost 0.005% (Drug)
Ocular Hypertensive group
Ocular hypertension defined as an intraocular pressure ≥ 24 mm Hg and ≤ 32 mm Hg in one eye and IOP ≥ 22 mm Hg and ≤ 32 mm Hg in the fellow eye, with normal optic disc, normal visual field defined as follows mean Deviation (MD) or Pattern Standard Deviation (PSD) of p>5%, normal Glaucoma Hemifield Test (GHT) and reliable visual field exam
干预措施: Placebo (Drug)
结局指标
主要结局
Evidence of impact of intraocular (IOP) reduction on retinal ganglion cell (RGC) function
时间窗: 8 weeks
RGC function is evaluated by pattern electroretinogram optimized for glaucoma (PERGLA)
次要结局
未报告次要终点
研究者
David S. Greenfield
Professor of Ophthalmology
University of Miami