Endothelial Cell Loss in Pseudophakic Patients Receiving a Paul Glaucoma Drainage Device With Its Tube Inserted in the Anterior Versus Posterior Chamber: a Randomized Controlled Trial
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Paul glaucoma drainage device (GDD).
- Who it may be relevant to
- Registry conditions: Glaucoma. Basic parameters: 18 years — 100 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Netherlands
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Overview
Rationale: Glaucoma is a group of diseases characterized by progressive neuropathy of the optic nerve associated with visual field loss. Current glaucoma management aims to preserve visual function throughout life by reducing the intraocular pressure. This can be achieved by medical therapy or by surgical procedures such as implantation of a glaucoma drainage device (GDD). Conventionally, the tube of such a device is positioned in the anterior chamber (AC). Unfortunately, the presence of the tube in the AC may have a significant negative impact on the number of endothelial cells of the cornea and may even lead to corneal decompensation. Alternatively, the tube can be positioned in the posterior chamber (i.e. behind the iris). In this study, both procedures will be compared. Objective: Primary: to determine the loss of corneal endothelial cells after implantation of a Paul GDD with its tube either anterior or posterior of the iris. Secondary: to compare efficacy and safety of both procedures. Study design: Prospective, randomised, treatment controlled clinical trial. Study population: Pseudophakic patients with glaucoma who need a GDD. Intervention: Implantation of a Paul GDD with its tube anterior/posterior of the iris. Main study parameters/endpoints: Endothelial cell loss of the cornea. Nature and extent of the burden and risks associated with participation, benefit and group relatedness: At present potential benefits and drawbacks of positioning the Paul tube behind the iris are insufficiently known, successful positioning of the tube may require slightly more surgery time and the risk of hyphaema may be higher. It is expected, that in the long run damage to the corneal endothelium is less. Risks of study-related assessments are negligible, burden is low, extra time is about 35+15+35+35 minutes (total 2h).
Interventions
- Device Paul glaucoma drainage device (GDD)
Implantation of the GDD
Primary outcome measures
- Change of endothelial cell density (ECD) [Time frame: Baseline and 2 years]
Secondary outcome measures (4)
- ECD [Time frame: Baseline, 6, 12 and 24 months]
- Intraocular pressure [Time frame: Baseline, 1, 3, 6, 12 and 24 months]
- Position of the tube [Time frame: Baseline, 6, 12 and 24 months]
- Adverse events [Time frame: Time of surgery, 1, 3, 6, 12, 24 months]
Eligibility criteria
Inclusion criteria
- Age > 18 years
- Informed consent
- Pseudophakic
- Open angle glaucoma, pseudoexfoliation glaucoma, pigment dispersion glaucoma or angle closure glaucoma with sufficiently deep anterior chamber
- Endothelial image at baseline of fair or good quality
Exclusion criteria
- Iridocorneal endothelial syndrome or posterior polymorphous dystrophy
- Eyes with a history of penetrating trauma
- Eyes with a history of (intra)ocular surgery other than uncomplicated cataract surgery
- Eyes with corneal disease
- Synechiae posterior
- Pregnant and lactating women
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Allocation
- Randomized
- Model
- Parallel assignment
- Masking
- Single blind
- Primary purpose
- Treatment
Study locations
Netherlands · 1 center
- Oogziekenhuis Rotterdam — Rotterdam
Identifiers
NCT: NCT05500469 · OZR-2022-03 · NL81305.078.22 · MEC-2022-0364