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Efficacy and Safety of the Use of Ophthalmic Viscosurgical Devices (OVD) FIDIAL PLUS vs IAL®-F During Cataract Surgery

Primary Purpose

Cataract

Status
Completed
Phase
Not Applicable
Locations
Italy
Study Type
Interventional
Intervention
FIDIAL PLUS
IAL®-F
Sponsored by
Fidia Farmaceutici s.p.a.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Cataract focused on measuring Ophthalmic Viscosurgical Devices, Corneal endothelium cells, Cataract Surgery, Hyaluronic acid

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Subject able to comprehend the full nature and the purpose of the study; Subjects able to cooperate with the Investigator and to comply with the requirements of the entire study; Subject provided written informed consent to participate in the study obtained according to Good Clinical Practice (GCP); Females of childbearing potential (i.e., not permanently sterilised - post hysterectomy or tubal ligation status - or not postmenopausal) must have a negative urine pregnancy test result at Screening and surgery days and must use an appropriate method of contraception for at least 30 days before inclusion in the study and during the whole study period, according to the definition in ICH M3 Guideline. The following criteria apply to both eyes: Nuclear cataract with visual acuity between 20/200 (logmar 1.0) and 20/32 (logmar 0.2); Intraocular pressure (IOP) between 14 and 21 mmHg (Goldmann tonometer); Previous refraction between -5 and +3 diopters in spherical equivalent; Corneas perfectly transparent without leukoma or other corneal pathology. Exclusion Criteria: Any acute, chronic or uncontrolled disease as severe heart failure, recent cardiovascular event, respiratory failure, severe hepatic or renal disease, poorly controlled diabetes mellitus, active severe autoimmune disease, active malignancy etc. that in the opinion of the Investigator, would increase the risk of operation or affect the outcome of the study; Epilepsy and any other condition that would prevent cooperation during surgery, including head tremor, deafness, neck or back problems, restless legs syndrome, claustrophobia etc.; Have a history of allergic/hypersensitivity reaction to sodium hyaluronate (NaHA); Participation in another clinical trial within the past 30 days; The following criteria apply both eyes: Corneal endothelium cell density less than 1800 cells/mm square; Pseudoexfoliation syndrome (PEX) or suspected zonular compromise of any origin; Corneal angle narrow or/and glaucoma; Anterior segment pathology likely to increase the risk of an adverse outcome for phacoemulsification cataract surgery (e.g., pseudoexfoliation syndrome, synechiae, iris atrophy, inadequate dilation, shallow anterior chamber, traumatic cataract, lens subluxation etc.); Any corneal irregularity or leukoma (as assessed by slit lamp and specular microscope pachymetry); Complicated cataracts; Subjects requiring implantation of toric lenses; Proliferative retinopathy, macular degeneration or oedema of any origin. Other ocular pathology that may compromise vision despite successful cataract surgery; Signs of ocular or systemic infection and/or inflammation; Previous intraocular surgery, refractive surgery or severe ocular trauma.

Sites / Locations

  • Azienda Ospedaliera Universitaria Integrata di Verona

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

FIDIAL PLUS

IAL®-F

Arm Description

Solution of NaHA 20 mg/1.1 ml pre-filled syringe for intraocular use. 1.8% solution of sodium hyaluronate that is derived from a bacterial fermentation (not of animal origin).

Solution of NaHA 20 mg/1.1 ml pre-filled syringe for intraocular use. Animal derived 1.8% sodium hyaluronate OVD.

Outcomes

Primary Outcome Measures

Change of corneal endothelium cell density after phacoemulsification cataract surgery with use of two different OVD (Ophthalmic Viscosurgical Devices)
This outcome will be calculated as percentage of corneal endothelial cells loss at day 28 (T3/T6) when compared with baseline (T0). This will be assessed as a paired t-test comparing the mean percentage change of FIDIAL PLUS against the mean percentage change from baseline of IAL®-F at Day 28. Corneal endothelial cell density will be measured by non-contact specular microscopy.

Secondary Outcome Measures

Incidence of a significant (≥30 mmHg) rise in IOP (Intraocular pressure) during study duration
This will be assessed using McNemar's test to assess the difference in proportion of eyes with a significant rise in IOP during the investigation to the proportion of eyes without a significant rise in IOP during the investigation. IOP will be measured with Goldmann tonometer and expressed in millimeters of mercury (mmHg).
Incidence of ocular Treatment Emergent Adverse Events (TEAEs)
TEAEs are AE reported from the time of the first application of the medical device (MD). TEAEs will be recorded and reported on the case report form (CRF). They will be tabulated by System Organ Class (SOC) and Preferred Term (PT) after medical coding using the Medical Dictionary for Regulatory Activities (MedDRA).
Incidence of serious ocular Treatment Emergent Adverse Events
Serious TEAEs are AE reported from the time of the first application of the medical device (MD) that led to: death; to a serious deterioration in health that resulted in a life-threatening illness or injury, or resulted in a permanent impairment of a body structure or a body function, or required in-patient hospitalization or prolongation of existing hospitalization, or resulted in medical or surgical intervention to prevent life threatening illness or injury or permanent impairment to a body structure or a body function; led to foetal distress, foetal death or a congenital abnormality or birth defect.
Change at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6) of Intraocular pressure (IOP)
IOP will be measured with Goldmann tonometer at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6) and expressed in millimeters of mercury (mmHg).
Central corneal Thickness changes at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6)
Central corneal thickness (CCT) will be measured by non-contact specular microscopy at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6)
Incidence and grade of anterior chamber inflammation (cells and flare measurement)
Assessment of anterior chamber inflammation will be performed by slit-lamp biomicroscopy at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6). Slit-lamp examination (SLE) will be performed before and after the instillation of dilating eye drops. Anterior chamber (AC) inflammation will be assessed and graded according to the SUN (Standarization of Uveitis Nomenclature) clinical scoring system. Anterior Chamber Cells grading: Grade 0, cells in field (field size is a 1 mm by 1 mm slit beam) <1 Grade 0.5+, cells in field 1-5 Grade 1+, cells in field 6-15 Grade 2+, cells in field 16-25 Grade 4+, cells in field >50 Anterior Chamber Flare Grading: Grade 0, none Grade 1+, Faint Grade 2+, Moderate (iris and lens details clear) Grade 3+, Marked (iris and lens details hazy) Grade 4+, Intense (fibrin or plastic acqueous)
Changes at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6) of corneal edema
Epithelial corneal edema will be assessed with specular microscopy at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6)
Change at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6) of corneal endothelial morphology
It will be assessed by non-contact specular microscopy at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6). Endothelial cell morphology will be analyzed manually or using automated measurements with the retracing method using the manufacturer's built-in image analysis software.
Changes at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6) of UDVA (Uncorrected distance visual acuity)
It will be measured using the Snellen chart at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6). Visual acuity values will be expressed in decimal, fraction or logMAR. All assessments will be performed using standard charts and procedures at specified visual angle, illumination and contrast.
Changes at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6) of BCVA (Best corrected distance visual acuity)
It will be measured using the Snellen chart at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6). Visual acuity values will be expressed in decimal, fraction or logMAR. All assessments will be performed using standard charts and procedures at specified visual angle, illumination and contrast.

Full Information

First Posted
June 13, 2023
Last Updated
September 25, 2023
Sponsor
Fidia Farmaceutici s.p.a.
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1. Study Identification

Unique Protocol Identification Number
NCT06062771
Brief Title
Efficacy and Safety of the Use of Ophthalmic Viscosurgical Devices (OVD) FIDIAL PLUS vs IAL®-F During Cataract Surgery
Official Title
A Prospective, Single-center, Within Patient Randomized, Noninferiority, Controlled, Single-masked Clinical Investigation to Evaluate Efficacy and Safety of the Use of Ophthalmic Viscosurgical Devices (OVD) FIDIAL PLUS vs IAL®-F During Cataract Surgery
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Completed
Study Start Date
July 23, 2022 (Actual)
Primary Completion Date
November 1, 2022 (Actual)
Study Completion Date
January 1, 2023 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Fidia Farmaceutici s.p.a.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
This is a Prospective, single-center, randomized, controlled, paired-eye, single-masked clinical investigation to compare the efficacy and safety of FIDIAL PLUS (bacterial derived 1.8% sodium hyaluronate OVD) and IAL®-F (comparable animal derived 1.8% sodium hyaluronate OVD) while used during phacoemulsification cataract surgery.
Detailed Description
Viscoelastics, also referred to as OVDs (ophthalmic viscosurgical devices), are viscous substances that are routinely used in cataract surgery. The most basic benefit of OVD use in ophthalmic surgery is maintaining the anterior chamber during surgical maneuvers. One of the main aspects in OVD use remains the protection of intraocular structures and in particular of corneal endothelium cells (CECs) during cataract surgery.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cataract
Keywords
Ophthalmic Viscosurgical Devices, Corneal endothelium cells, Cataract Surgery, Hyaluronic acid

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Model Description
Each eye will be randomly assigned to Test or Reference such as the subject has one eye treated with FIDIAL PLUS solution and the other with IAL-F solution. For all subjects the worst eye will be operated on first.
Masking
Participant
Allocation
Randomized
Enrollment
50 (Actual)

8. Arms, Groups, and Interventions

Arm Title
FIDIAL PLUS
Arm Type
Experimental
Arm Description
Solution of NaHA 20 mg/1.1 ml pre-filled syringe for intraocular use. 1.8% solution of sodium hyaluronate that is derived from a bacterial fermentation (not of animal origin).
Arm Title
IAL®-F
Arm Type
Active Comparator
Arm Description
Solution of NaHA 20 mg/1.1 ml pre-filled syringe for intraocular use. Animal derived 1.8% sodium hyaluronate OVD.
Intervention Type
Device
Intervention Name(s)
FIDIAL PLUS
Intervention Description
1.8% solution of sodium hyaluronate that is derived from a bacterial fermentation (not of animal origin).
Intervention Type
Device
Intervention Name(s)
IAL®-F
Intervention Description
Animal derived 1.8% sodium hyaluronate equivalent to FIDIAL PLUS
Primary Outcome Measure Information:
Title
Change of corneal endothelium cell density after phacoemulsification cataract surgery with use of two different OVD (Ophthalmic Viscosurgical Devices)
Description
This outcome will be calculated as percentage of corneal endothelial cells loss at day 28 (T3/T6) when compared with baseline (T0). This will be assessed as a paired t-test comparing the mean percentage change of FIDIAL PLUS against the mean percentage change from baseline of IAL®-F at Day 28. Corneal endothelial cell density will be measured by non-contact specular microscopy.
Time Frame
28 days per eye
Secondary Outcome Measure Information:
Title
Incidence of a significant (≥30 mmHg) rise in IOP (Intraocular pressure) during study duration
Description
This will be assessed using McNemar's test to assess the difference in proportion of eyes with a significant rise in IOP during the investigation to the proportion of eyes without a significant rise in IOP during the investigation. IOP will be measured with Goldmann tonometer and expressed in millimeters of mercury (mmHg).
Time Frame
28 days per eye
Title
Incidence of ocular Treatment Emergent Adverse Events (TEAEs)
Description
TEAEs are AE reported from the time of the first application of the medical device (MD). TEAEs will be recorded and reported on the case report form (CRF). They will be tabulated by System Organ Class (SOC) and Preferred Term (PT) after medical coding using the Medical Dictionary for Regulatory Activities (MedDRA).
Time Frame
up to 28 days
Title
Incidence of serious ocular Treatment Emergent Adverse Events
Description
Serious TEAEs are AE reported from the time of the first application of the medical device (MD) that led to: death; to a serious deterioration in health that resulted in a life-threatening illness or injury, or resulted in a permanent impairment of a body structure or a body function, or required in-patient hospitalization or prolongation of existing hospitalization, or resulted in medical or surgical intervention to prevent life threatening illness or injury or permanent impairment to a body structure or a body function; led to foetal distress, foetal death or a congenital abnormality or birth defect.
Time Frame
up to 28 days
Title
Change at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6) of Intraocular pressure (IOP)
Description
IOP will be measured with Goldmann tonometer at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6) and expressed in millimeters of mercury (mmHg).
Time Frame
Changes at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6)
Title
Central corneal Thickness changes at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6)
Description
Central corneal thickness (CCT) will be measured by non-contact specular microscopy at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6)
Time Frame
Changes at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6)
Title
Incidence and grade of anterior chamber inflammation (cells and flare measurement)
Description
Assessment of anterior chamber inflammation will be performed by slit-lamp biomicroscopy at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6). Slit-lamp examination (SLE) will be performed before and after the instillation of dilating eye drops. Anterior chamber (AC) inflammation will be assessed and graded according to the SUN (Standarization of Uveitis Nomenclature) clinical scoring system. Anterior Chamber Cells grading: Grade 0, cells in field (field size is a 1 mm by 1 mm slit beam) <1 Grade 0.5+, cells in field 1-5 Grade 1+, cells in field 6-15 Grade 2+, cells in field 16-25 Grade 4+, cells in field >50 Anterior Chamber Flare Grading: Grade 0, none Grade 1+, Faint Grade 2+, Moderate (iris and lens details clear) Grade 3+, Marked (iris and lens details hazy) Grade 4+, Intense (fibrin or plastic acqueous)
Time Frame
Changes at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6)
Title
Changes at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6) of corneal edema
Description
Epithelial corneal edema will be assessed with specular microscopy at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6)
Time Frame
Changes at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6)
Title
Change at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6) of corneal endothelial morphology
Description
It will be assessed by non-contact specular microscopy at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6). Endothelial cell morphology will be analyzed manually or using automated measurements with the retracing method using the manufacturer's built-in image analysis software.
Time Frame
Changes at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6)
Title
Changes at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6) of UDVA (Uncorrected distance visual acuity)
Description
It will be measured using the Snellen chart at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6). Visual acuity values will be expressed in decimal, fraction or logMAR. All assessments will be performed using standard charts and procedures at specified visual angle, illumination and contrast.
Time Frame
Changes at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6)
Title
Changes at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6) of BCVA (Best corrected distance visual acuity)
Description
It will be measured using the Snellen chart at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6). Visual acuity values will be expressed in decimal, fraction or logMAR. All assessments will be performed using standard charts and procedures at specified visual angle, illumination and contrast.
Time Frame
Changes at day 1 (T1/T4), day 7 (T2/T5) and day 28 (T3/T6)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subject able to comprehend the full nature and the purpose of the study; Subjects able to cooperate with the Investigator and to comply with the requirements of the entire study; Subject provided written informed consent to participate in the study obtained according to Good Clinical Practice (GCP); Females of childbearing potential (i.e., not permanently sterilised - post hysterectomy or tubal ligation status - or not postmenopausal) must have a negative urine pregnancy test result at Screening and surgery days and must use an appropriate method of contraception for at least 30 days before inclusion in the study and during the whole study period, according to the definition in ICH M3 Guideline. The following criteria apply to both eyes: Nuclear cataract with visual acuity between 20/200 (logmar 1.0) and 20/32 (logmar 0.2); Intraocular pressure (IOP) between 14 and 21 mmHg (Goldmann tonometer); Previous refraction between -5 and +3 diopters in spherical equivalent; Corneas perfectly transparent without leukoma or other corneal pathology. Exclusion Criteria: Any acute, chronic or uncontrolled disease as severe heart failure, recent cardiovascular event, respiratory failure, severe hepatic or renal disease, poorly controlled diabetes mellitus, active severe autoimmune disease, active malignancy etc. that in the opinion of the Investigator, would increase the risk of operation or affect the outcome of the study; Epilepsy and any other condition that would prevent cooperation during surgery, including head tremor, deafness, neck or back problems, restless legs syndrome, claustrophobia etc.; Have a history of allergic/hypersensitivity reaction to sodium hyaluronate (NaHA); Participation in another clinical trial within the past 30 days; The following criteria apply both eyes: Corneal endothelium cell density less than 1800 cells/mm square; Pseudoexfoliation syndrome (PEX) or suspected zonular compromise of any origin; Corneal angle narrow or/and glaucoma; Anterior segment pathology likely to increase the risk of an adverse outcome for phacoemulsification cataract surgery (e.g., pseudoexfoliation syndrome, synechiae, iris atrophy, inadequate dilation, shallow anterior chamber, traumatic cataract, lens subluxation etc.); Any corneal irregularity or leukoma (as assessed by slit lamp and specular microscope pachymetry); Complicated cataracts; Subjects requiring implantation of toric lenses; Proliferative retinopathy, macular degeneration or oedema of any origin. Other ocular pathology that may compromise vision despite successful cataract surgery; Signs of ocular or systemic infection and/or inflammation; Previous intraocular surgery, refractive surgery or severe ocular trauma.
Facility Information:
Facility Name
Azienda Ospedaliera Universitaria Integrata di Verona
City
Verona
ZIP/Postal Code
37126
Country
Italy

12. IPD Sharing Statement

Learn more about this trial

Efficacy and Safety of the Use of Ophthalmic Viscosurgical Devices (OVD) FIDIAL PLUS vs IAL®-F During Cataract Surgery

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