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A Study of a New Surgical Treatment of Macular Hole Retinal Detachment in High Myopia

Primary Purpose

Macular Holes, Retinal Detachment, High Myopia

Status
Unknown status
Phase
Not Applicable
Locations
China
Study Type
Interventional
Intervention
Group 1
Group 2
Sponsored by
Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Macular Holes focused on measuring Operation mode, Air tamponade, High myopia, Macular hole retinal detachment

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Prior written informed consent should be obtained before any assessment is carried out;
  2. Participants are more than 18 years of age, and less than 75 years of age, male or female Chinese patients;
  3. Visual impairment is caused by macular hole associated with retinal detachment secondary to high myopia;
  4. Axial length ≥ 26mm, or the refractive error ≥ -6.0D

Exclusion Criteria:

  1. Failure to comply with research or follow-up procedures;
  2. Diabetes with uncontrolled blood glucose (defined as fasting plasma glucose more than 7.0mmol/L or blood glucose more than 11.1mmol/ L 2 hours postprandial), and / or with diabetic retinopathy;
  3. Poor control of blood pressure in hypertensive patients (defined as blood pressure >150/95mmHg, including antihypertensive medication);
  4. With surgical contraindication due to other local or systemic conditions at screening or baseline;
  5. With any active ocular or periocular infection or inflammation (e.g., blepharitis, conjunctivitis, keratitis, scleritis, uveitis, endophthalmitis) at screening or baseline;
  6. With uncontrolled glaucoma at screening or baseline (IOP ≥ 30mmHg when receiving medical treatment or as judged by the researchers);
  7. With the presence of iris neovascularization or neovascular glaucoma at screening or baseline;
  8. With ocular diseases which may interfere the study results at screening or baseline , including severe vitreous hemorrhage, peripheral retinal hole, proliferative diabetic retinopathy, proliferative vitreoretinopathy ( ≥ Level C ), choroidal detachment;
  9. With other causes which may result in macular hole associated-retinal detachment at screening or baseline,except high myopia;
  10. Previously underwent scleral buckling surgery;
  11. With current or planned medication known to have toxic effects on the lens, retina or optic nerve, including hydroxychloroquine, chloroquine, hydroxychloroquine, tamoxifen, phenothiazine and ethambutol;
  12. With laboratory abnormalities, such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TB), gamma-glutamyl transferase (GGT), lactate dehydrogenase (LDH), exceeded the normal limit by more than 2 times, and serum creatinine or blood urea nitrogen exceeded 1.2 times the normal limit;
  13. With abnormal coagulation function (defined as more than normal prothrombin time for 3 seconds or more, more than 1.5 of the international standard ratio (INR), activated partial thromboplastin time of 10 seconds or longer than the upper limit of normal time); 14) Patients who participated in any clinical study of medication within 3 months prior to screening (excluding vitamins and minerals)

Exit criteria:

  1. Due to adverse events, especially severe adverse events, the researchers consider withdrawal of patients based on concerns of safety and ethics;
  2. Drop out;
  3. The patients voluntarily withdraw the informed consent;
  4. Serious violation of the study protocol due to the subjects or investigators' reasons;
  5. Other reasons that the researchers believe for quitting the study

Sites / Locations

  • Shanghai General Hospital, Shanghai Jiao Tong University School of MedicineRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

Group 1

Group 2

Arm Description

Group 1: The patients in Group 1 are treated by the surgical method of standard 3-port 23 gauge pars plana vitrectomy + internal limiting membrane peeling + air-fluid exchange + silicone oil infusion

Group 2: The patients in Group 2 are treated by the surgical method of standard 3-port 23 gauge pars plana vitrectomy + internal limiting membrane peeling + inverted internal limiting membrane insertion + air-fluid exchange

Outcomes

Primary Outcome Measures

Macular hole closure rate
Fundus examination combined with optical coherence tomography (OCT) are performed 3 months after surgery.

Secondary Outcome Measures

Best corrected visual acuity
Best corrected visual acuity are performed 6 months after the surgery.
Best corrected visual acuity
Best corrected visual acuity are performed 12 months after the surgery.
Reattachment rate of retinal detachment
Use fundus examination combined with B-scan ultrasound, optical coherence tomography (OCT) to observe the reattachment rate of retinal detachment within 12 months after the surgery.(The reattachment rate assessment is performed 12 months after the first surgery among the patients with air tamponade. The reattachment rate assessment is performed 12 months after the first surgery among the patients with silicone oil tamponade, and the silicone oil removal is performed 6 months after the previous surgery.)
Reattachment rate of retinal detachment
Use fundus examination combined with B-scan ultrasound, optical coherence tomography (OCT) to observe the reattachment rate of retinal detachment within 12 months after the surgery.(The reattachment rate assessment is performed 12 months after the first surgery among the patients with air tamponade. The reattachment rate assessment is performed 12 months after the first surgery among the patients with silicone oil tamponade, and the silicone oil removal is performed 6 months after the previous surgery.)
Postoperative complication rate of ocular adverse events
Evaluate the ocular adverse events within 12 months after operation.
Postoperative complication rate of the non ocular adverse events
Evaluate the non ocular adverse events within 12 months after operation.
Postoperative complication rate of severe adverse events
Evaluate the severe adverse events within 12 months after operation.

Full Information

First Posted
December 6, 2017
Last Updated
December 19, 2017
Sponsor
Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine
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1. Study Identification

Unique Protocol Identification Number
NCT03383731
Brief Title
A Study of a New Surgical Treatment of Macular Hole Retinal Detachment in High Myopia
Official Title
A Single Center, Randomized and Controlled Clinical Study of Inverted Internal Limiting Membrane Insertion Combined With Air Tamponade in the Treatment of Macular Hole Retinal Detachment in High Myopia
Study Type
Interventional

2. Study Status

Record Verification Date
December 2017
Overall Recruitment Status
Unknown status
Study Start Date
April 7, 2017 (Actual)
Primary Completion Date
April 6, 2020 (Anticipated)
Study Completion Date
April 6, 2020 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine

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 study evaluates the surgical outcomes of inverted internal limiting membrane insertion combined with air tamponade in the treatment of macular hole retinal detachment (MHRD) in high myopia, and also to compare the treatment efficacy and safety between different surgical approaches of MHRD
Detailed Description
This study uses a new surgical method (vitrectomy combined with inverted internal limiting membrane insertion and intraocular sterilized air tamponade) to assess its effectiveness and safety on the prognosis of macular hole retinal detachment secondary to high myopia, and also compares this new type of surgery with the current commonly used surgery (vitrectomy combined with internal limiting membrane peeling + silicone oil infusion).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Macular Holes, Retinal Detachment, High Myopia
Keywords
Operation mode, Air tamponade, High myopia, Macular hole retinal detachment

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
This is a prospective, randomized, controlled study involving multiple visits within 12 months. The patients with macular hole retinal detachment caused by high myopia are randomly divided into 2 treatment groups. Group 1: standard 3-port 23 gauge pars plana vitrectomy + internal limiting membrane peeling + air-fluid exchange + silicone oil infusion Group 2: standard 3-port 23 gauge pars plana vitrectomy + internal limiting membrane peeling + inverted internal limiting membrane insertion + air-fluid exchange
Masking
Outcomes Assessor
Masking Description
In this study, the third party independent evaluation method is used to evaluate the results of the study. The analyzer is in the masking state, and the subjects and the surgeons are in the non-masking state..
Allocation
Randomized
Enrollment
38 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Group 1
Arm Type
Active Comparator
Arm Description
Group 1: The patients in Group 1 are treated by the surgical method of standard 3-port 23 gauge pars plana vitrectomy + internal limiting membrane peeling + air-fluid exchange + silicone oil infusion
Arm Title
Group 2
Arm Type
Experimental
Arm Description
Group 2: The patients in Group 2 are treated by the surgical method of standard 3-port 23 gauge pars plana vitrectomy + internal limiting membrane peeling + inverted internal limiting membrane insertion + air-fluid exchange
Intervention Type
Procedure
Intervention Name(s)
Group 1
Intervention Description
the surgical method of standard 3-port 23 gauge pars plana vitrectomy + internal limiting membrane peeling + air-fluid exchange + silicone oil infusion
Intervention Type
Procedure
Intervention Name(s)
Group 2
Intervention Description
the surgical method of standard 3-port 23 gauge pars plana vitrectomy + internal limiting membrane peeling + inverted internal limiting membrane insertion + air-fluid exchange
Primary Outcome Measure Information:
Title
Macular hole closure rate
Description
Fundus examination combined with optical coherence tomography (OCT) are performed 3 months after surgery.
Time Frame
3 months after operation
Secondary Outcome Measure Information:
Title
Best corrected visual acuity
Description
Best corrected visual acuity are performed 6 months after the surgery.
Time Frame
6 months after the operation
Title
Best corrected visual acuity
Description
Best corrected visual acuity are performed 12 months after the surgery.
Time Frame
12 months after the operation
Title
Reattachment rate of retinal detachment
Description
Use fundus examination combined with B-scan ultrasound, optical coherence tomography (OCT) to observe the reattachment rate of retinal detachment within 12 months after the surgery.(The reattachment rate assessment is performed 12 months after the first surgery among the patients with air tamponade. The reattachment rate assessment is performed 12 months after the first surgery among the patients with silicone oil tamponade, and the silicone oil removal is performed 6 months after the previous surgery.)
Time Frame
6 months after the operation
Title
Reattachment rate of retinal detachment
Description
Use fundus examination combined with B-scan ultrasound, optical coherence tomography (OCT) to observe the reattachment rate of retinal detachment within 12 months after the surgery.(The reattachment rate assessment is performed 12 months after the first surgery among the patients with air tamponade. The reattachment rate assessment is performed 12 months after the first surgery among the patients with silicone oil tamponade, and the silicone oil removal is performed 6 months after the previous surgery.)
Time Frame
12 months after the operation
Title
Postoperative complication rate of ocular adverse events
Description
Evaluate the ocular adverse events within 12 months after operation.
Time Frame
Within 12 months after operation
Title
Postoperative complication rate of the non ocular adverse events
Description
Evaluate the non ocular adverse events within 12 months after operation.
Time Frame
Within 12 months after operation
Title
Postoperative complication rate of severe adverse events
Description
Evaluate the severe adverse events within 12 months after operation.
Time Frame
Within 12 months after operation
Other Pre-specified Outcome Measures:
Title
The number of people whose best corrected visual acuity (BCVA) result improves
Description
The number of people whose BCVA result improves by more than 1 row, 2 rows and 3 rows comparing to the baseline at a time
Time Frame
12 months after the operation
Title
The number of people whose BCVA result decreases
Description
The number of people whose BCVA result decreases by 3 rows comparing to the baseline at a time
Time Frame
12 months after the operation
Title
The difference of multifocal electroretinogram (ERG) results
Description
The difference of multifocal ERG results between each group from 1 week to the 6th month after surgery
Time Frame
6 months after the operation
Title
The difference of multifocal ERG results
Description
The difference of multifocal ERG results between each group from 1 week to the 12th month after surgery
Time Frame
12 months after the operation
Title
The change of microperimetry analysis results
Description
The change of microperimetry analysis results from 1 week to the 6th month after surgery relative to baseline, and the difference between each group
Time Frame
6 months after the operation
Title
The change of microperimetry analysis results
Description
The change of microperimetry analysis results from 1 week to the 12th month after surgery relative to baseline, and the difference between each group
Time Frame
12 months after the operation
Title
The change of the extent of foveal ellipsoid zone damage
Description
The change of the extent of foveal ellipsoid zone damage from baseline to the 6th month after the surgery relative to baseline, and the difference between each group
Time Frame
6 months after the operation
Title
The change of the external limiting membrane integrity of fovea
Description
The change of the external limiting membrane integrity of fovea from baseline to the 6th month after the surgery relative to baseline, and the difference between each group
Time Frame
6 months after the operation
Title
The change of the extent of foveal ellipsoid zone damage
Description
The change of the extent of foveal ellipsoid zone damage from baseline to the 12th month after the surgery relative to baseline, and the difference between each group
Time Frame
12 months after the operation
Title
The change of the external limiting membrane integrity of fovea
Description
The change of the external limiting membrane integrity of fovea from baseline to the 12th month after the surgery relative to baseline, and the difference between each group
Time Frame
12 months after the operation
Title
The number of retreatment and retreatment modalities
Description
λ Describe the number of retreatment and retreatment modalities for patients with different surgical procedures over a period of 12 months
Time Frame
within 12 months after the operation

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Prior written informed consent should be obtained before any assessment is carried out; Participants are more than 18 years of age, and less than 75 years of age, male or female Chinese patients; Visual impairment is caused by macular hole associated with retinal detachment secondary to high myopia; Axial length ≥ 26mm, or the refractive error ≥ -6.0D Exclusion Criteria: Failure to comply with research or follow-up procedures; Diabetes with uncontrolled blood glucose (defined as fasting plasma glucose more than 7.0mmol/L or blood glucose more than 11.1mmol/ L 2 hours postprandial), and / or with diabetic retinopathy; Poor control of blood pressure in hypertensive patients (defined as blood pressure >150/95mmHg, including antihypertensive medication); With surgical contraindication due to other local or systemic conditions at screening or baseline; With any active ocular or periocular infection or inflammation (e.g., blepharitis, conjunctivitis, keratitis, scleritis, uveitis, endophthalmitis) at screening or baseline; With uncontrolled glaucoma at screening or baseline (IOP ≥ 30mmHg when receiving medical treatment or as judged by the researchers); With the presence of iris neovascularization or neovascular glaucoma at screening or baseline; With ocular diseases which may interfere the study results at screening or baseline , including severe vitreous hemorrhage, peripheral retinal hole, proliferative diabetic retinopathy, proliferative vitreoretinopathy ( ≥ Level C ), choroidal detachment; With other causes which may result in macular hole associated-retinal detachment at screening or baseline,except high myopia; Previously underwent scleral buckling surgery; With current or planned medication known to have toxic effects on the lens, retina or optic nerve, including hydroxychloroquine, chloroquine, hydroxychloroquine, tamoxifen, phenothiazine and ethambutol; With laboratory abnormalities, such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TB), gamma-glutamyl transferase (GGT), lactate dehydrogenase (LDH), exceeded the normal limit by more than 2 times, and serum creatinine or blood urea nitrogen exceeded 1.2 times the normal limit; With abnormal coagulation function (defined as more than normal prothrombin time for 3 seconds or more, more than 1.5 of the international standard ratio (INR), activated partial thromboplastin time of 10 seconds or longer than the upper limit of normal time); 14) Patients who participated in any clinical study of medication within 3 months prior to screening (excluding vitamins and minerals) Exit criteria: Due to adverse events, especially severe adverse events, the researchers consider withdrawal of patients based on concerns of safety and ethics; Drop out; The patients voluntarily withdraw the informed consent; Serious violation of the study protocol due to the subjects or investigators' reasons; Other reasons that the researchers believe for quitting the study
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Fenghua Wang
Phone
+8618917504061
Email
shretina@sjtu.edu.cn
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Fenghua Wang
Organizational Affiliation
Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine
City
Shanghai
State/Province
Shanghai
ZIP/Postal Code
200080
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Fenghua Wang
Phone
+8618917504061
Email
shretina@sjtu.edu.cn

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Statistical Analysis Plan that underlie results in a publication
IPD Sharing Time Frame
starting 6 months after publication
IPD Sharing Access Criteria
Dr Fenghua Wang and Dr Ying Zheng will review requests and criteria.
Citations:
PubMed Identifier
4595402
Citation
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Results Reference
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21421206
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Citation
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A Study of a New Surgical Treatment of Macular Hole Retinal Detachment in High Myopia

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