Macular EdemaNCT00612261
Sheathotomy vs. Intravitreal Triamcinolone for Branch Retinal Vein Occlusion
A study testing Arteriovenous Crossing Sheathotomy and Intravitreal Triamcinolone Acetonide Injection in people with Macular Edema and Branch Retinal Vein Occlusion, run by Yonsei University at 1 site in South Korea.
Trial summary
Branch retinal vein occlusion (BRVO) is a common retinal vascular disease occurring in a significant number of individuals older than 50 years.The most common cause of visual disturbance in BRVO patients is macular edema, which has been reported in 60% of patients. Read more about this study
- Who is it for?
- Any age
- Conditions the study is for
- Macular Edema, Branch Retinal Vein Occlusion
- What is being tested?
- Arteriovenous Crossing Sheathotomy and Intravitreal Triamcinolone Acetonide Injection
- Type of treatment
- Injection or infusion, Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 40 participants
- Where
- 1 siteSouth Korea
- Study dates
- Oct 2006to Aug 2007
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages Any age
- All sexes
- No healthy volunteers
- Child, Adult, Older adult
Who may be able to join
- recent onset (within the 6 months prior to enrollment) of macular edema resulting from BRVO
- best corrected Early Treatment Diabetic Retinopathy Study (ETDRS) scores ≤ 40 letters (Snellen equivalent ≤ 20/40
- intraretinal hemorrhages involving the foveal centers
- generalized breakdown of the inner blood-retina barrier, as documented by diffuse fluorescein leakage on angiography, or diffuse thickening of the retina on optical coherence tomography (OCT), with involvement of the foveal center and most of the macular area, and with foveal thicknesses ≥ 250 micrometer
Who cannot join
- prior history of intraocular surgery including cataract extraction
- prior history of laser treatments including panretinal photocoagulation and focal/grid macular photocoagulation
- prior history of elevated intraocular pressure secondary to steroid treatment
- prior history of glaucoma or ocular hypertension
- presence of comorbid ocular conditions that might affect visual acuity (VA).
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Arteriovenous Crossing Sheathotomy Versus Intravitreal Triamcinolone Acetonide Injection for Treatment of Macular Edema Associated With Branch Retinal Vein Occlusion
Branch retinal vein occlusion (BRVO) is a common retinal vascular disease occurring in a significant number of individuals older than 50 years.The most common cause of visual disturbance in BRVO patients is macular edema, which has been reported in 60% of patients. Macular grid laser photocoagulation has been shown to be effective in the treatment of macular edema arising from BRVO. Some eyes are resistant to conventional grid laser treatment, and the conventional treatment is not useful in patients with intraretinal hemorrhages that may interfere with laser photocoagulation. Moreover, several studies have shown that conventional grid laser treatment for macular edema may be associated with complications.
Intravitreal triamcinolone acetonide (IVTA) injection has recently been reported to be effective in the treatment of macular edema of various etiologies.On the other hand, arteriovenous sheathotomy is a surgical method suggested for treatment of macular edema in BRVO patients, and has been reported to be efficacious in patients refractory to conventional focal or grid laser macular photocoagulation.Both treatment modalities have been reported to be associated with reductions in central macular thicknesses and improved visual acuities.
The purpose of the study is to compare the efficacies of arteriovenous (AV) sheathotomy and intravitreal triamcinolone (IVTA) injection in the treatment of macular edema associated with branch retinal vein occlusion (BRVO).
- Conditions
- Macular Edema, Branch Retinal Vein Occlusion
- Being tested
- Arteriovenous Crossing Sheathotomy, Intravitreal Triamcinolone Acetonide Injection
- Keywords
- Branch retinal vein occlusion; treatment
- Medical subject headings
- Macular Edema, Retinal Vein Occlusion
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Arteriovenous Crossing SheathotomyProcedure or surgery
In each sheathotomy patient, a standard pars plana vitrectomy is performed, followed by surgical separation of the posterior cortical vitreous from the optic nerve and posterior retina. After the relevant arteriovenous crossing site is identified based on preoperative FA, a bent microvitreoretinal blade is used to open the internal limiting membrane and the nerve fiber layer over the artery, with the incision commencing 100-200 micrometer proximal to the AV crossing. The incision is continued parallel to and under the retinal arteriole, with a gentle lifting motion, until the common AV crossing sheath is encountered and incised in a side-to-side manner. The completion of AV dissection is confirmed by an elevation of the overlying artery.
Intravitreal Triamcinolone Acetonide InjectionProcedure or surgery
The IVTA group receive intravitreal injection of 4 mg/0.1 mL triamcinolone acetonide (40 mg/mL; Tamceton®; Hanall Pharmaceutical, Seoul, Korea). The injections are performed using 0.5% proparacaine drops (Alcaine®; Alcon Laboratories, Fort Worth, TX) for topical anesthesia under sterile conditions. The drug is injected through the inferotemporal pars plana using a 30-gauge needle. The correct intravitreal localization of the suspension, and perfusion of the optic nerve head, are then confirmed by indirect ophthalmoscopy.
| Study group | Role | What they receive |
|---|---|---|
| 1 | Experimental | The group 1 patients receive AV sheathotomy for macular edema secondary to branch retinal vein occlusion. Receives: Procedure: Arteriovenous Crossing Sheathotomy |
| 2 | Active comparator | The group 2 patients receive IVTA. Receives: Procedure: Intravitreal Triamcinolone Acetonide Injection |
What is being measured
The primary outcome is the main question the study is designed to answer.
best-corrected ETDRS visual acuity score
Measured: baseline, at 1,3,6 months after either treatment
Secondary outcomes (1)
complication rate
Measured: at 1,3,6 months after either treatment
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted11 Feb 2008 (estimated)
- Study startOct 2006
- Primary completionAug 2007
- Study completionAug 2007
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (11)Papers the sponsor has linked to this study.
- Other trials for Macular EdemaStudies of the same condition, open and under way.
- More trials run by Yonsei UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 40 participants (actual)
Sponsor and investigators
- Lead sponsor
- Yonsei University
- Sponsor type
- University, hospital or other
- Investigators
- Hyoung Jun Koh, MD, PhD, Principal investigator, Yonsei University Heath System
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT00612261
- Sponsor's protocol ID
- koh003
- Status last verified
- Jan 2008
- First submitted
- 25 Jan 2008
- Last updated
- 11 Feb 2008
- Results posted
- No
- Data monitoring committee
- Yes
Publications
Parodi MB, Spasse S, Iacono P, Di Stefano G, Canziani T, Ravalico G. Subthreshold grid laser treatment of macular edema secondary to branch retinal vein occlusion with micropulse infrared (810 nanometer) diode laser. Ophthalmology. 2006 Dec;113(12):2237-42. doi: 10.1016/j.ophtha.2006.05.056. Epub 2006 Sep 25.
PubMed 16996596Chen SD, Sundaram V, Lochhead J, Patel CK. Intravitreal triamcinolone for the treatment of ischemic macular edema associated with branch retinal vein occlusion. Am J Ophthalmol. 2006 May;141(5):876-883. doi: 10.1016/j.ajo.2005.12.011. Epub 2006 Mar 9.
PubMed 16527226Lee H, Shah GK. Intravitreal triamcinolone as primary treatment of cystoid macular edema secondary to branch retinal vein occlusion. Retina. 2005 Jul-Aug;25(5):551-5. doi: 10.1097/00006982-200507000-00001.
PubMed 16077348Chalam KV, Shah GY, Shah VA. Vitrectomy with or without arteriovenous adventitial sheathotomy for macular edema associated with branch retinal vein occlusion. Am J Ophthalmol. 2005 Jun;139(6):1146; author reply 1146-7. doi: 10.1016/j.ajo.2005.02.024. No abstract available.
PubMed 15953467Hayashi K, Hayashi H. Intravitreal versus retrobulbar injections of triamcinolone for macular edema associated with branch retinal vein occlusion. Am J Ophthalmol. 2005 Jun;139(6):972-82. doi: 10.1016/j.ajo.2004.12.087.
PubMed 15953425Horio N, Horiguchi M. Effect of arteriovenous sheathotomy on retinal blood flow and macular edema in patients with branch retinal vein occlusion. Am J Ophthalmol. 2005 Apr;139(4):739-40. doi: 10.1016/j.ajo.2004.10.026.
PubMed 15808186Lakhanpal RR, Javaheri M, Ruiz-Garcia H, De Juan E Jr, Humayun MS. Transvitreal limited arteriovenous-crossing manipulation without vitrectomy for complicated branch retinal vein occlusion using 25-gauge instrumentation. Retina. 2005 Apr-May;25(3):272-80. doi: 10.1097/00006982-200504000-00004.
PubMed 15805902Ozkiris A, Evereklioglu C, Erkilic K, Ilhan O. The efficacy of intravitreal triamcinolone acetonide on macular edema in branch retinal vein occlusion. Eur J Ophthalmol. 2005 Jan-Feb;15(1):96-101. doi: 10.1177/112067210501500115.
PubMed 15751246Ozkiris A, Evereklioglu C, Erkilic K, Dogan H. Intravitreal triamcinolone acetonide for treatment of persistent macular oedema in branch retinal vein occlusion. Eye (Lond). 2006 Jan;20(1):13-7. doi: 10.1038/sj.eye.6701803.
PubMed 15723039Yamamoto S, Saito W, Yagi F, Takeuchi S, Sato E, Mizunoya S. Vitrectomy with or without arteriovenous adventitial sheathotomy for macular edema associated with branch retinal vein occlusion. Am J Ophthalmol. 2004 Dec;138(6):907-14. doi: 10.1016/j.ajo.2004.06.061.
PubMed 15629280Garcia-Arumi J, Martinez-Castillo V, Boixadera A, Blasco H, Corcostegui B. Management of macular edema in branch retinal vein occlusion with sheathotomy and recombinant tissue plasminogen activator. Retina. 2004 Aug;24(4):530-40. doi: 10.1097/00006982-200408000-00005.
PubMed 15300073
Study at a glance
From the registry record, last updated by the sponsor on 11 Feb 2008. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Arteriovenous Crossing Sheathotomy Versus Intravitreal Triamcinolone Acetonide Injection for Treatment of Macular Edema Associated With Branch Retinal Vein Occlusion
- ClinicalTrials.gov ID
- NCT00612261
- Acronym / sponsor ID
- koh003
- Conditions
- Macular Edema, Branch Retinal Vein Occlusion
- Keywords
- Branch retinal vein occlusion; treatment
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 40 participants (actual)
- Lead sponsor
- Yonsei UniversityUniversity, hospital or other
- Study start
- Oct 2006
- Primary completion
- Aug 2007 (actual)
- Study completion
- Aug 2007 (actual)
- First posted
- 11 Feb 2008 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Branch retinal vein occlusion (BRVO) is a common retinal vascular disease occurring in a significant number of individuals older than 50 years.The most common cause of visual disturbance in BRVO patients is macular edema, which has been reported in 60% of patients. Macular grid laser photocoagulation has been shown to be effective in the treatment of macular edema arising from BRVO. Some eyes are resistant to conventional grid laser treatment, and the conventional treatment is not useful in patients with intraretinal hemorrhages that may interfere with laser photocoagulation. Moreover, several studies have shown that conventional grid laser treatment for macular edema may be associated with complications.
Intravitreal triamcinolone acetonide (IVTA) injection has recently been reported to be effective in the treatment of macular edema of various etiologies.On the other hand, arteriovenous sheathotomy is a surgical method suggested for treatment of macular edema in BRVO patients, and has been reported to be efficacious in patients refractory to conventional focal or grid laser macular photocoagulation.Both treatment modalities have been reported to be associated with reductions in central macular thicknesses and improved visual acuities.
The purpose of the study is to compare the efficacies of arteriovenous (AV) sheathotomy and intravitreal triamcinolone (IVTA) injection in the treatment of macular edema associated with branch retinal vein occlusion (BRVO).
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| 1 | Experimental | Procedure: Arteriovenous Crossing SheathotomyThe group 1 patients receive AV sheathotomy for macular edema secondary to branch retinal vein occlusion. |
| 2 | Active comparator | Procedure: Intravitreal Triamcinolone Acetonide InjectionThe group 2 patients receive IVTA. |
Who may qualify
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult, Older adult
Key inclusion criteria (4 listed)
- recent onset (within the 6 months prior to enrollment) of macular edema resulting from BRVO
- best corrected Early Treatment Diabetic Retinopathy Study (ETDRS) scores ≤ 40 letters (Snellen equivalent ≤ 20/40
- intraretinal hemorrhages involving the foveal centers
- generalized breakdown of the inner blood-retina barrier, as documented by diffuse fluorescein leakage on angiography, or diffuse thickening of the retina on optical coherence tomography (OCT), with involvement of the foveal center and most of the macular area, and with foveal thicknesses ≥ 250 micrometer
Key exclusion criteria (5 listed)
- prior history of intraocular surgery including cataract extraction
- prior history of laser treatments including panretinal photocoagulation and focal/grid macular photocoagulation
- prior history of elevated intraocular pressure secondary to steroid treatment
- prior history of glaucoma or ocular hypertension
- presence of comorbid ocular conditions that might affect visual acuity (VA).
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Arteriovenous Crossing SheathotomyIn each sheathotomy patient, a standard pars plana vitrectomy is performed, followed by surgical separation of the posterior cortical vitreous from the optic nerve and posterior retina. After the relevant arteriovenous crossing site is identified based on preoperative FA, a bent microvitreoretinal blade is used to open the internal limiting membrane and the nerve fiber layer over the artery, with the incision commencing 100-200 micrometer proximal to the AV crossing. The incision is continued parallel to and under the retinal arteriole, with a gentle lifting motion, until the common AV crossing sheath is encountered and incised in a side-to-side manner. The completion of AV dissection is confirmed by an elevation of the overlying artery. | Procedure or surgery | 1 |
| Intravitreal Triamcinolone Acetonide InjectionThe IVTA group receive intravitreal injection of 4 mg/0.1 mL triamcinolone acetonide (40 mg/mL; Tamceton®; Hanall Pharmaceutical, Seoul, Korea). The injections are performed using 0.5% proparacaine drops (Alcaine®; Alcon Laboratories, Fort Worth, TX) for topical anesthesia under sterile conditions. The drug is injected through the inferotemporal pars plana using a 30-gauge needle. The correct intravitreal localization of the suspension, and perfusion of the optic nerve head, are then confirmed by indirect ophthalmoscopy. | Procedure or surgery | 2 |
Primary outcome
best-corrected ETDRS visual acuity score
Time frame: baseline, at 1,3,6 months after either treatment
1 secondary outcome
complication rate
Time frame: at 1,3,6 months after either treatment
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 11 Feb 2008.
- Background: PubMed 16996596Parodi MB, Spasse S, Iacono P, Di Stefano G, Canziani T, Ravalico G. Subthreshold grid laser treatment of macular edema secondary to branch retinal vein occlusion with micropulse infrared (810 nanometer) diode laser. Ophthalmology. 2006 Dec;113(12):2237-42. doi: 10.1016/j.ophtha.2006.05.056. Epub 2006 Sep 25.
- Background: PubMed 16527226Chen SD, Sundaram V, Lochhead J, Patel CK. Intravitreal triamcinolone for the treatment of ischemic macular edema associated with branch retinal vein occlusion. Am J Ophthalmol. 2006 May;141(5):876-883. doi: 10.1016/j.ajo.2005.12.011. Epub 2006 Mar 9.
- Background: PubMed 16077348Lee H, Shah GK. Intravitreal triamcinolone as primary treatment of cystoid macular edema secondary to branch retinal vein occlusion. Retina. 2005 Jul-Aug;25(5):551-5. doi: 10.1097/00006982-200507000-00001.
- Background: PubMed 15953467Chalam KV, Shah GY, Shah VA. Vitrectomy with or without arteriovenous adventitial sheathotomy for macular edema associated with branch retinal vein occlusion. Am J Ophthalmol. 2005 Jun;139(6):1146; author reply 1146-7. doi: 10.1016/j.ajo.2005.02.024. No abstract available.
- Background: PubMed 15953425Hayashi K, Hayashi H. Intravitreal versus retrobulbar injections of triamcinolone for macular edema associated with branch retinal vein occlusion. Am J Ophthalmol. 2005 Jun;139(6):972-82. doi: 10.1016/j.ajo.2004.12.087.
- Background: PubMed 15808186Horio N, Horiguchi M. Effect of arteriovenous sheathotomy on retinal blood flow and macular edema in patients with branch retinal vein occlusion. Am J Ophthalmol. 2005 Apr;139(4):739-40. doi: 10.1016/j.ajo.2004.10.026.
- Background: PubMed 15805902Lakhanpal RR, Javaheri M, Ruiz-Garcia H, De Juan E Jr, Humayun MS. Transvitreal limited arteriovenous-crossing manipulation without vitrectomy for complicated branch retinal vein occlusion using 25-gauge instrumentation. Retina. 2005 Apr-May;25(3):272-80. doi: 10.1097/00006982-200504000-00004.
- Background: PubMed 15751246Ozkiris A, Evereklioglu C, Erkilic K, Ilhan O. The efficacy of intravitreal triamcinolone acetonide on macular edema in branch retinal vein occlusion. Eur J Ophthalmol. 2005 Jan-Feb;15(1):96-101. doi: 10.1177/112067210501500115.
- Background: PubMed 15723039Ozkiris A, Evereklioglu C, Erkilic K, Dogan H. Intravitreal triamcinolone acetonide for treatment of persistent macular oedema in branch retinal vein occlusion. Eye (Lond). 2006 Jan;20(1):13-7. doi: 10.1038/sj.eye.6701803.
- Background: PubMed 15629280Yamamoto S, Saito W, Yagi F, Takeuchi S, Sato E, Mizunoya S. Vitrectomy with or without arteriovenous adventitial sheathotomy for macular edema associated with branch retinal vein occlusion. Am J Ophthalmol. 2004 Dec;138(6):907-14. doi: 10.1016/j.ajo.2004.06.061.
- Background: PubMed 15300073Garcia-Arumi J, Martinez-Castillo V, Boixadera A, Blasco H, Corcostegui B. Management of macular edema in branch retinal vein occlusion with sheathotomy and recombinant tissue plasminogen activator. Retina. 2004 Aug;24(4):530-40. doi: 10.1097/00006982-200408000-00005.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Hyoung Jun Koh, MD, PhD principal investigator
Yonsei University Heath System
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Arteriovenous Crossing Sheathotomy and Intravitreal Triamcinolone Acetonide Injection in people with Macular Edema and Branch Retinal Vein Occlusion, run by Yonsei University at 1 site in South Korea.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 11 Feb 2008. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in South Korea. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
best-corrected ETDRS visual acuity score (time frame: baseline, at 1,3,6 months after either treatment). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT00612261, which also lists 11 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 Feb 2008.