search
Back to results

Accelerated Corneal Collagen Crosslinking Protocols

Primary Purpose

Keratoconus

Status
Recruiting
Phase
Not Applicable
Locations
Egypt
Study Type
Interventional
Intervention
Accelerated crosslinking (ACXL)
Sponsored by
Assiut University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Keratoconus

Eligibility Criteria

18 Years - 40 Years (Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria: Patients with mild to moderate progressive keratoconus with maximum keratometry value Kmax < 56.0 D, Corneal thinnest pachymetry ≥ 400 µm and Corrected distance visual acuity (CDVA) equal to or better than 20/200 Snellen's acuity. Established keratoconus progression: Increase of 1.0D or more in the manifest cylinder Increase of 0.5D or more in the manifest refraction spherical equivalent Increase of 1.0D or more in Kmax Increase of 0.75D or more in Kmean decrease of 2% or more in central thickness Age: 18-40 y Clear cornea Exclusion Criteria: Corneal scarring Previous corneal surgery Severe keratoconus wit non measurable refraction or Kmax ≥ 56 D or Corneal thinnest pachymetry < 400 µm

Sites / Locations

  • Tiba eye centerRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

group 1

group 2

Arm Description

Patients in this group will undergo pulsed light accelerated crosslinking (pl-ACXL)

Patients in this group will undergo continuous-light accelerated crosslinking (cl-ACXL)

Outcomes

Primary Outcome Measures

1. Visual outcome measures
Uncorrected and corrected distance visual acuity (UDVA & CDVA) using Snellen acuity chart
2. Refractive outcome measures
Manifest refraction spherical equivalent (MRSE) using Topcon autorefractometer
3. Topographic outcome measures
Scheimflug imaging device (Pentacam) for Diagnosis and follow up of Keratoconus after ACXL
Demarcation line depth
Demarcation line depth is an outcome used to assess the success of CXL procedure using anterior segment ocular coherence tomography (AS-OCT)

Secondary Outcome Measures

Full Information

First Posted
January 12, 2023
Last Updated
February 16, 2023
Sponsor
Assiut University
search

1. Study Identification

Unique Protocol Identification Number
NCT05693740
Brief Title
Accelerated Corneal Collagen Crosslinking Protocols
Official Title
Pulsed Light Versus Continuous Light Accelerated Epithelium-Off Cross-linking for Treatment of Progressive Keratoconus; a Prospective Comparative Study
Study Type
Interventional

2. Study Status

Record Verification Date
February 2023
Overall Recruitment Status
Recruiting
Study Start Date
August 1, 2022 (Actual)
Primary Completion Date
March 1, 2024 (Anticipated)
Study Completion Date
March 1, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Assiut University

4. Oversight

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

5. Study Description

Brief Summary
To evaluate and compare the effect of pulsed light (pl-ACXL) accelerated and continuous light accelerated (cl-ACXL) epithelium-off cross-linking in halting the progression of keratoconus.
Detailed Description
Keratoconus (KC), which was first described in detail in 1854, is the most common corneal primary ectasia and is characterized by progressive bilateral and asymmetric corneal thinning and bulging outward into a cone-like shape that can severely impact patients' vision. Keratoconus usually develops in the second and third decades of life and progresses until the fourth decade. It was thought to be a rare corneal disease. Despite a great deal of research, no one theory explains it all and it may be caused by a combination of things. However, Meek proposed that the loss of structural integrity in the KC cornea was caused by the presence of abnormal keratocytes and matrix proteins and upregulated proteolysis triggered an unravelling of lamellae along their length and from their anchors at the limbus, with an opening of the lamellar bifurcations. This theory is supported by observations following riboflavin/UVA collagen cross-linking, where the proposed cross-linkage of the tissue increases both the resistance of the stroma to enzymatic digestion and the cohesiveness between collagen fibrils and the non-collagenous matrix. Conventional CXL (CXL) with a continuous irradiation of 3 mW/cm2 for 30 min is considered safe and effective in the prevention of keratoconus progression according to different clinical trials. nevertheless, the procedure is time-consuming, lasting around 1 h, which may lead to patient discomfort and reduced physician working efficiency. With evolving technical advances, commercially available UV light sources have been developed, making CXL more efficient with shorter UV exposure times, higher UV intensities, and pulsed light compared with continuous light settings. Various accelerated CXL protocols have been described and its effect on biomechanical properties on corneas stated as equal to the standard protocol. Ex-vivo studies also suggest a distinction between various accelerated CXL protocols by providing evidence for a drop in efficiency with increased UV illumination intensity while maintaining equal surface energy. In this study we evaluate the two types of "accelerated crosslinking".

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Keratoconus

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
Single blinded Prospective, Interventional, randomized, comparative study
Masking
Outcomes Assessor
Allocation
Randomized
Enrollment
40 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
group 1
Arm Type
Active Comparator
Arm Description
Patients in this group will undergo pulsed light accelerated crosslinking (pl-ACXL)
Arm Title
group 2
Arm Type
Active Comparator
Arm Description
Patients in this group will undergo continuous-light accelerated crosslinking (cl-ACXL)
Intervention Type
Procedure
Intervention Name(s)
Accelerated crosslinking (ACXL)
Intervention Description
Epithelium-off accelerated corneal crosslinking is a procedure in which the cornea is soaked with riboflavin followed by exposure to ultraviolet irradiation in either pulsed-light or continuous-light modes to strengthen the corneal stroma and halt keratoconus progression.
Primary Outcome Measure Information:
Title
1. Visual outcome measures
Description
Uncorrected and corrected distance visual acuity (UDVA & CDVA) using Snellen acuity chart
Time Frame
one year following surgery
Title
2. Refractive outcome measures
Description
Manifest refraction spherical equivalent (MRSE) using Topcon autorefractometer
Time Frame
one year following surgery
Title
3. Topographic outcome measures
Description
Scheimflug imaging device (Pentacam) for Diagnosis and follow up of Keratoconus after ACXL
Time Frame
one year following surgery
Title
Demarcation line depth
Description
Demarcation line depth is an outcome used to assess the success of CXL procedure using anterior segment ocular coherence tomography (AS-OCT)
Time Frame
3 months following surgery

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
40 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Patients with mild to moderate progressive keratoconus with maximum keratometry value Kmax < 56.0 D, Corneal thinnest pachymetry ≥ 400 µm and Corrected distance visual acuity (CDVA) equal to or better than 20/200 Snellen's acuity. Established keratoconus progression: Increase of 1.0D or more in the manifest cylinder Increase of 0.5D or more in the manifest refraction spherical equivalent Increase of 1.0D or more in Kmax Increase of 0.75D or more in Kmean decrease of 2% or more in central thickness Age: 18-40 y Clear cornea Exclusion Criteria: Corneal scarring Previous corneal surgery Severe keratoconus wit non measurable refraction or Kmax ≥ 56 D or Corneal thinnest pachymetry < 400 µm
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
rana mostafa, bachelor
Phone
01095759179
Email
ratycat222@yahoo.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mahmoud Abdel-Radi, MD
Organizational Affiliation
Assiut University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Tiba eye center
City
Assiut
ZIP/Postal Code
71516
Country
Egypt
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Mahmoud Abdel-Radi
Phone
01007252060

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
29703291
Citation
Zhu Y, Reinach PS, Zhu H, Li L, Yang F, Qu J, Chen W. Continuous-light versus pulsed-light accelerated corneal crosslinking with ultraviolet-A and riboflavin. J Cataract Refract Surg. 2018 Mar;44(3):382-389. doi: 10.1016/j.jcrs.2017.12.028.
Results Reference
background

Learn more about this trial

Accelerated Corneal Collagen Crosslinking Protocols

We'll reach out to this number within 24 hrs