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Ocular Micro-vascular Research Base on Functional Slip Lamp Biomicroscopy

Primary Purpose

Dry Eye Syndromes, Inflammation, Microvessels

Status
Unknown status
Phase
Phase 4
Locations
China
Study Type
Interventional
Intervention
Fluorometholone
Functional Slit-Lamp Biomicroscopy
Sponsored by
Zhongshan Ophthalmic Center, Sun Yat-sen University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional health services research trial for Dry Eye Syndromes

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • age ≧ 18 years
  • Ocular Surface Disease Index (OSDI) ≧ 12.
  • A 5-min Schirmer I test (ST) result showing less than 5 mm of moisture on the strip.
  • A noninvasive average tear-film break-up time (NI-avBUT) less than 5 s.

Exclusion Criteria:

  • Patients were excluded if they had an eye infection, injury, non-DE ocular inflammation, ocular surgery within the last 6 months, or any concurrent treatment that might interfere with the interpretation of the study results (systemic corticosteroids, immunosuppressive therapy, or hormonal replacement therapy). Patients were also excluded if they had an uncontrolled disease, had a significant illness or were pregnant or lactating.

Sites / Locations

  • Wan ChenRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Dry eye group

Control group

Arm Description

The recruitment of subjects met the criteria of DEWS. Each subject received treatment based on increasing severity according to the expert consensus for the treatment of DE inflammation. For moderate levels of severity, topical anti-inflammatory agents (0.1% Fluorometholone) were administered twice daily and then gradually less frequently until inflammation was controlled. For severe DE, the approach was similar to that of the moderate level but with an increased concentration and treatment frequency of the anti-inflammatory agents (0.1% Fluorometholone, 4 times daily). Topical 0.05% tacrolimus twice daily when DE was extremely severe. Functional Slit-Lamp Biomicroscopy were administrated to collected data from this group.

Normal health subject without drug intervention, Functional Slit-Lamp Biomicroscopy were administrated to collected data from this group.

Outcomes

Primary Outcome Measures

Conjunctival microvascular blood flow velocity
Acheived by a traditional slit lamp (HAAG-STREIT SWISS MADE 900.7.2.34925) with a digital camera (Canon 60D. Canon Inc, Melville, NY) and a custom software.
Conjunctival microvascular blood flow velocity
Acheived by a traditional slit lamp (HAAG-STREIT SWISS MADE 900.7.2.34925) with a digital camera (Canon 60D. Canon Inc, Melville, NY) and a custom software.
Conjunctival microvascular blood flow velocity
Acheived by a traditional slit lamp (HAAG-STREIT SWISS MADE 900.7.2.34925) with a digital camera (Canon 60D. Canon Inc, Melville, NY) and a custom software.
Conjunctival microvascular diameter
Acheived by a traditional slit lamp (HAAG-STREIT SWISS MADE 900.7.2.34925) with a digital camera (Canon 60D. Canon Inc, Melville, NY) and a custom software.
Conjunctival microvascular diameter
Acheived by a traditional slit lamp (HAAG-STREIT SWISS MADE 900.7.2.34925) with a digital camera (Canon 60D. Canon Inc, Melville, NY) and a custom software.
Conjunctival microvascular diameter
Acheived by a traditional slit lamp (HAAG-STREIT SWISS MADE 900.7.2.34925) with a digital camera (Canon 60D. Canon Inc, Melville, NY) and a custom software.
Conjunctival microvascular blood flow rate
Acheived by a traditional slit lamp (HAAG-STREIT SWISS MADE 900.7.2.34925) with a digital camera (Canon 60D. Canon Inc, Melville, NY) and a custom software.
Conjunctival microvascular blood flow rate
Acheived by a traditional slit lamp (HAAG-STREIT SWISS MADE 900.7.2.34925) with a digital camera (Canon 60D. Canon Inc, Melville, NY) and a custom software.
Conjunctival microvascular blood flow rate
Acheived by a traditional slit lamp (HAAG-STREIT SWISS MADE 900.7.2.34925) with a digital camera (Canon 60D. Canon Inc, Melville, NY) and a custom software.
The hyperemia index
The hyperemia index (HI) was measured by determining the percentage of conjunctival microvascular area in the conjunctiva automatically.26 The subjects were required to keep their eyes open and focus on the illuminated ring in front. Three consecutive readings were recorded, and the median was used. All data were recorded and analyzed with TF-scan software in the system.
The hyperemia index
The hyperemia index (HI) was measured by determining the percentage of conjunctival microvascular area in the conjunctiva automatically.26 The subjects were required to keep their eyes open and focus on the illuminated ring in front. Three consecutive readings were recorded, and the median was used. All data were recorded and analyzed with TF-scan software in the system.
The hyperemia index
The hyperemia index (HI) was measured by determining the percentage of conjunctival microvascular area in the conjunctiva automatically.26 The subjects were required to keep their eyes open and focus on the illuminated ring in front. Three consecutive readings were recorded, and the median was used. All data were recorded and analyzed with TF-scan software in the system.

Secondary Outcome Measures

Non-invasived tear-film break-up time
The system measures the tear-film break-up time (NI-BUT) by monitoring the Placido projection on the cornea and includes the noninvasive first tear-film break-up time (NI-fBUT) and NI-avBUT. NI-fBUT and NI-avBUT were the measured times of the first and half-area breaks in the tear film between the full opening of the eyelids after 2 complete blinks.
Non-invasived tear-film break-up time
The system measures the tear-film break-up time (NI-BUT) by monitoring the Placido projection on the cornea and includes the noninvasive first tear-film break-up time (NI-fBUT) and NI-avBUT. NI-fBUT and NI-avBUT were the measured times of the first and half-area breaks in the tear film between the full opening of the eyelids after 2 complete blinks.
Non-invasived tear-film break-up time
The system measures the tear-film break-up time (NI-BUT) by monitoring the Placido projection on the cornea and includes the noninvasive first tear-film break-up time (NI-fBUT) and NI-avBUT. NI-fBUT and NI-avBUT were the measured times of the first and half-area breaks in the tear film between the full opening of the eyelids after 2 complete blinks.
Corneal Fluorescein Staining
Fluorescein was administered into the conjunctival sac under a cobalt blue light from the slit lamp. Corneal epithelial cell disruption was measured via corneal staining (National Eye Institute (NEI) scale, 5 areas of the cornea assessed (central, temporal, nasal, superior, and inferior), and the scores were assigned per a 0-8 scale for each area (total 40). Tear production was measured with Schirmer strips without anesthesia.
Corneal Fluorescein Staining
Fluorescein was administered into the conjunctival sac under a cobalt blue light from the slit lamp. Corneal epithelial cell disruption was measured via corneal staining (National Eye Institute (NEI) scale, 5 areas of the cornea assessed (central, temporal, nasal, superior, and inferior), and the scores were assigned per a 0-8 scale for each area (total 40). Tear production was measured with Schirmer strips without anesthesia.
Corneal Fluorescein Staining
Fluorescein was administered into the conjunctival sac under a cobalt blue light from the slit lamp. Corneal epithelial cell disruption was measured via corneal staining (National Eye Institute (NEI) scale, 5 areas of the cornea assessed (central, temporal, nasal, superior, and inferior), and the scores were assigned per a 0-8 scale for each area (total 40). Tear production was measured with Schirmer strips without anesthesia.
Schirmer I test
A meansurement of tear production with Schirmer strips and anaesthesia.
Schirmer I test
A meansurement of tear production with Schirmer strips and anaesthesia.
Schirmer I test
A meansurement of tear production with Schirmer strips and anaesthesia.

Full Information

First Posted
November 30, 2017
Last Updated
November 19, 2018
Sponsor
Zhongshan Ophthalmic Center, Sun Yat-sen University
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1. Study Identification

Unique Protocol Identification Number
NCT03747614
Brief Title
Ocular Micro-vascular Research Base on Functional Slip Lamp Biomicroscopy
Official Title
Ocular Micro-vascular Research Base on Functional Slip Lamp Biomicroscopy
Study Type
Interventional

2. Study Status

Record Verification Date
November 2018
Overall Recruitment Status
Unknown status
Study Start Date
June 30, 2017 (Actual)
Primary Completion Date
June 30, 2020 (Anticipated)
Study Completion Date
June 30, 2020 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Zhongshan Ophthalmic Center, Sun Yat-sen University

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Dry eye disease (DED), as one of the most common ocular surface diseases that affecting visual acuity, is highly associated with ocular surface inflammation. Until now, there is no accurate quantization index system to evaluate real-time ocular surface inflammation. Besides, an individualized therapy for ocular surface inflammation is also badly needed. As we all know, conjunctival congestion is one of the important clinical appearance of ocular surface inflammation. Hence, we suggest that several specific microvascular indexes could measure the change of ocular surface inflammation. Our program is aiming to investigate the correlation between inflammatory factors and blood flow velocity as well as microvascular distribution detecting from bulbar conjunctiva through our own devices and software.Futhermore, we tend to compare ocular surface microvascular indexes and microvascular distribution in normal people and dry eye patients in order to establish a database for Chinese people. By confirming the relationship between ocular surface microvascular indexes and ocular inflammation, we hope to set up new diagnostic criteria for ocular inflammation and an individualized therapeutic regimen based on ocular surface microvascular indexes. Finally, we want to establish a precision diagnostic and therapeutic pattern for dry eye disease.
Detailed Description
Dry eye (DE) is a growing public health concern that affects not only the visual function but also the quality of life of patients. In 2017, the International DE Study Workshop (DEWSII) adjusted the definition of DE by particularly emphasizing the inflammation in the ocular surface, and this adjustment represented a major shift in the understanding of dry eye disease (DED) pathogenesis and the facilitation of DED treatment.1,2 The recurrence of chronic and low-grade inflammation plays an important role in long-term disease progression and gradually deteriorates the ocular surface.3 Previous studies have concluded that the inflammatory response is involved in the pathological process of DE.4-7 The concentrations of IL-1α and mature IL-1ß in the tear fluid are increased.4,5 The activity of MMP-9, a suggested biomarker associated with ocular surface diseases including DE, is significantly elevated in Meibomian gland dysfunction (MGD), Sjögren's syndrome (SS) and aqueous tear deficiency (ATD).6 Other studies have indicated that inflammatory mediators such as IL-6, IL-8 and TNFα are expressed proportionally to the severity of DE symptoms, indicating the involvement of inflammation.7 The identification of inflammation as a major factor in DE informs the treatment strategy, including anti-inflammatory medication, which results in improvements to the ocular surface condition and to ocular comfort in DED patients.8,9 A series of studies have demonstrated improvements in the subjective and objective signs and symptoms of DE after anti-inflammatory and immunomodulatory therapies.8-11 To monitor the status of ocular surface inflammation and the ocular surface condition, traditional assessments, namely, evaluation of conjunctival hyperemia12 and corneal fluorescein staining using a slit lamp biomicroscope, are used. However, these methods are subjective and volatile and may not be sensitive indicators of the disease stage and treatment efficacy.13 A number of new tests have been used to distinguish inflammation.13-15 These new technologies include corneal confocal microscopy,15 conjunctival impression cytology16 and inflammatory tear-film cytokine tests in research and in the clinic.17 These newly implemented techniques have several limitations. Corneal confocal microscopy is a structure-based instrument with a narrow view of 400 × 400 µm2 that is limited to localization and cell counting. Conjunctival impression cytology16 and inflammatory tear-film cytokine tests19 are not routinely used, possibly due to the invasiveness, high cost and discomfort of these techniques.5,18 Therefore, the development of new methodologies to noninvasively and subjectively evaluate the inflammation status of the ocular surface is crucial. The microvascular system of the bulbar conjunctiva can be easily accessed. The release of inflammatory cytokines on the ocular surface can cause vasodilation, which may result in alterations to the conjunctival microcirculation.19 Cheung et al. used a computer-assisted intravital microscope to evaluate vasculopathies of the conjunctival vessels and identified microvascular abnormalities in patients with diabetes20 and in patients who wore contact lens.21 Schulze et al. have also performed 'evaluations of the redness of the bulbar conjunctiva using fractal analysis and photometry.22 However, these studies did not directly measure the microcirculation. The microcirculation is an important aspect of the vascular system, may directly represent the hemodynamic response to ocular surface inflammation and may exhibit more sensitivity for monitoring vascular responses to anti-inflammatory treatment. Recently, Jiang et al. developed a functional slit-lamp biomicroscope that could be used to measure the conjunctival blood flow velocity (BFV) and vessel diameter.23 The goal of the present study was to characterize the microvasculature and microcirculation in the bulbar conjunctiva of DE patients in response to anti-inflammatory treatment.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Dry Eye Syndromes, Inflammation, Microvessels

7. Study Design

Primary Purpose
Health Services Research
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Model Description
subjects from zhongshan ophthalmic center
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
20 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Dry eye group
Arm Type
Experimental
Arm Description
The recruitment of subjects met the criteria of DEWS. Each subject received treatment based on increasing severity according to the expert consensus for the treatment of DE inflammation. For moderate levels of severity, topical anti-inflammatory agents (0.1% Fluorometholone) were administered twice daily and then gradually less frequently until inflammation was controlled. For severe DE, the approach was similar to that of the moderate level but with an increased concentration and treatment frequency of the anti-inflammatory agents (0.1% Fluorometholone, 4 times daily). Topical 0.05% tacrolimus twice daily when DE was extremely severe. Functional Slit-Lamp Biomicroscopy were administrated to collected data from this group.
Arm Title
Control group
Arm Type
Experimental
Arm Description
Normal health subject without drug intervention, Functional Slit-Lamp Biomicroscopy were administrated to collected data from this group.
Intervention Type
Drug
Intervention Name(s)
Fluorometholone
Other Intervention Name(s)
Tacrolimus
Intervention Description
Fluorometh010neEyeDrops: Brand names: Allergan Pharmaceuticals Ireland, Serial number: J20130061, NDC 60758-880-05. Tacrolimus Brand names: Senju Pharmaceutical Co., Ltd. Fukusaki Plant Serial number: H20130452
Intervention Type
Device
Intervention Name(s)
Functional Slit-Lamp Biomicroscopy
Intervention Description
A traditional slit lamp (HAAG-STREIT SWISS MADE 900.7.2.34925) was used, and a digital camera (Canon 60D. Canon Inc, Melville, NY) was attached via an inherent camera port. Custom software was used to measure the conjunctival microvascular BFV and vessel diameter using a protocol that has been previously described in detail. At baseline, video clips were recorded on six fields of the bulbar conjunctiva, which was approximately 1 mm from the limbus. During the follow-up visits, attention was given to relocating the vessel segments for these 6 fields.
Primary Outcome Measure Information:
Title
Conjunctival microvascular blood flow velocity
Description
Acheived by a traditional slit lamp (HAAG-STREIT SWISS MADE 900.7.2.34925) with a digital camera (Canon 60D. Canon Inc, Melville, NY) and a custom software.
Time Frame
Baseline
Title
Conjunctival microvascular blood flow velocity
Description
Acheived by a traditional slit lamp (HAAG-STREIT SWISS MADE 900.7.2.34925) with a digital camera (Canon 60D. Canon Inc, Melville, NY) and a custom software.
Time Frame
30 days after commencement of treatment
Title
Conjunctival microvascular blood flow velocity
Description
Acheived by a traditional slit lamp (HAAG-STREIT SWISS MADE 900.7.2.34925) with a digital camera (Canon 60D. Canon Inc, Melville, NY) and a custom software.
Time Frame
60 days after commencement of treatment
Title
Conjunctival microvascular diameter
Description
Acheived by a traditional slit lamp (HAAG-STREIT SWISS MADE 900.7.2.34925) with a digital camera (Canon 60D. Canon Inc, Melville, NY) and a custom software.
Time Frame
Baseline
Title
Conjunctival microvascular diameter
Description
Acheived by a traditional slit lamp (HAAG-STREIT SWISS MADE 900.7.2.34925) with a digital camera (Canon 60D. Canon Inc, Melville, NY) and a custom software.
Time Frame
30 days after commencement of treatment
Title
Conjunctival microvascular diameter
Description
Acheived by a traditional slit lamp (HAAG-STREIT SWISS MADE 900.7.2.34925) with a digital camera (Canon 60D. Canon Inc, Melville, NY) and a custom software.
Time Frame
60 days after commencement of treatment
Title
Conjunctival microvascular blood flow rate
Description
Acheived by a traditional slit lamp (HAAG-STREIT SWISS MADE 900.7.2.34925) with a digital camera (Canon 60D. Canon Inc, Melville, NY) and a custom software.
Time Frame
Baseline
Title
Conjunctival microvascular blood flow rate
Description
Acheived by a traditional slit lamp (HAAG-STREIT SWISS MADE 900.7.2.34925) with a digital camera (Canon 60D. Canon Inc, Melville, NY) and a custom software.
Time Frame
30 days after commencement of treatment
Title
Conjunctival microvascular blood flow rate
Description
Acheived by a traditional slit lamp (HAAG-STREIT SWISS MADE 900.7.2.34925) with a digital camera (Canon 60D. Canon Inc, Melville, NY) and a custom software.
Time Frame
60 days after commencement of treatment
Title
The hyperemia index
Description
The hyperemia index (HI) was measured by determining the percentage of conjunctival microvascular area in the conjunctiva automatically.26 The subjects were required to keep their eyes open and focus on the illuminated ring in front. Three consecutive readings were recorded, and the median was used. All data were recorded and analyzed with TF-scan software in the system.
Time Frame
Baseline
Title
The hyperemia index
Description
The hyperemia index (HI) was measured by determining the percentage of conjunctival microvascular area in the conjunctiva automatically.26 The subjects were required to keep their eyes open and focus on the illuminated ring in front. Three consecutive readings were recorded, and the median was used. All data were recorded and analyzed with TF-scan software in the system.
Time Frame
30 days after commencement of treatment
Title
The hyperemia index
Description
The hyperemia index (HI) was measured by determining the percentage of conjunctival microvascular area in the conjunctiva automatically.26 The subjects were required to keep their eyes open and focus on the illuminated ring in front. Three consecutive readings were recorded, and the median was used. All data were recorded and analyzed with TF-scan software in the system.
Time Frame
60 days after commencement of treatment
Secondary Outcome Measure Information:
Title
Non-invasived tear-film break-up time
Description
The system measures the tear-film break-up time (NI-BUT) by monitoring the Placido projection on the cornea and includes the noninvasive first tear-film break-up time (NI-fBUT) and NI-avBUT. NI-fBUT and NI-avBUT were the measured times of the first and half-area breaks in the tear film between the full opening of the eyelids after 2 complete blinks.
Time Frame
Baseline
Title
Non-invasived tear-film break-up time
Description
The system measures the tear-film break-up time (NI-BUT) by monitoring the Placido projection on the cornea and includes the noninvasive first tear-film break-up time (NI-fBUT) and NI-avBUT. NI-fBUT and NI-avBUT were the measured times of the first and half-area breaks in the tear film between the full opening of the eyelids after 2 complete blinks.
Time Frame
30 days after commencement of treatment
Title
Non-invasived tear-film break-up time
Description
The system measures the tear-film break-up time (NI-BUT) by monitoring the Placido projection on the cornea and includes the noninvasive first tear-film break-up time (NI-fBUT) and NI-avBUT. NI-fBUT and NI-avBUT were the measured times of the first and half-area breaks in the tear film between the full opening of the eyelids after 2 complete blinks.
Time Frame
60 days after commencement of treatment
Title
Corneal Fluorescein Staining
Description
Fluorescein was administered into the conjunctival sac under a cobalt blue light from the slit lamp. Corneal epithelial cell disruption was measured via corneal staining (National Eye Institute (NEI) scale, 5 areas of the cornea assessed (central, temporal, nasal, superior, and inferior), and the scores were assigned per a 0-8 scale for each area (total 40). Tear production was measured with Schirmer strips without anesthesia.
Time Frame
Baseline
Title
Corneal Fluorescein Staining
Description
Fluorescein was administered into the conjunctival sac under a cobalt blue light from the slit lamp. Corneal epithelial cell disruption was measured via corneal staining (National Eye Institute (NEI) scale, 5 areas of the cornea assessed (central, temporal, nasal, superior, and inferior), and the scores were assigned per a 0-8 scale for each area (total 40). Tear production was measured with Schirmer strips without anesthesia.
Time Frame
30 days after commencement of treatment
Title
Corneal Fluorescein Staining
Description
Fluorescein was administered into the conjunctival sac under a cobalt blue light from the slit lamp. Corneal epithelial cell disruption was measured via corneal staining (National Eye Institute (NEI) scale, 5 areas of the cornea assessed (central, temporal, nasal, superior, and inferior), and the scores were assigned per a 0-8 scale for each area (total 40). Tear production was measured with Schirmer strips without anesthesia.
Time Frame
60 days after commencement of treatment
Title
Schirmer I test
Description
A meansurement of tear production with Schirmer strips and anaesthesia.
Time Frame
Baseline
Title
Schirmer I test
Description
A meansurement of tear production with Schirmer strips and anaesthesia.
Time Frame
30 days after commencement of treatment
Title
Schirmer I test
Description
A meansurement of tear production with Schirmer strips and anaesthesia.
Time Frame
60 days after commencement of treatment

10. Eligibility

Sex
All
Gender Based
Yes
Gender Eligibility Description
The participant eligibility is based on self-representation of gender identity.
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: age ≧ 18 years Ocular Surface Disease Index (OSDI) ≧ 12. A 5-min Schirmer I test (ST) result showing less than 5 mm of moisture on the strip. A noninvasive average tear-film break-up time (NI-avBUT) less than 5 s. Exclusion Criteria: Patients were excluded if they had an eye infection, injury, non-DE ocular inflammation, ocular surgery within the last 6 months, or any concurrent treatment that might interfere with the interpretation of the study results (systemic corticosteroids, immunosuppressive therapy, or hormonal replacement therapy). Patients were also excluded if they had an uncontrolled disease, had a significant illness or were pregnant or lactating.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Jin Yuan, PHD
Phone
13825141659
Email
yuanjincornea@126.com
First Name & Middle Initial & Last Name or Official Title & Degree
YUQING DENG
Phone
18120557291
Email
15927646647@163.com
Facility Information:
Facility Name
Wan Chen
City
Guangzhou
State/Province
Guangdong
ZIP/Postal Code
510060
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Wan Chen
Phone
13751770265
Email
yeah-cw@126.com
First Name & Middle Initial & Last Name & Degree
Lulu Peng
Phone
15622263892
Email
15622263892@163.com

12. IPD Sharing Statement

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Ocular Micro-vascular Research Base on Functional Slip Lamp Biomicroscopy

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