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Cystoid Macular EdemaPhase 3PREMEDNCT01774474

PRevention of Macular EDema After Cataract Surgery

A Phase 3 study testing Bromfenac, Dexamethasone and Bevacizumab in people with Cystoid Macular Edema and Cataract, run by Maastricht University Medical Center at 16 sites in 7 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Cystoid macular edema (CME) is a common cause of vision loss after cataract surgery. In the last few years, several new treatments have been tried to address the problem of CME after cataract surgery in diabetic and non-diabetic patients. Read more about this study

Who is it for?
Ages 21 years and older
Conditions the study is for
Cystoid Macular Edema, Cataract, Diabetes Mellitus
What is being tested?
Bromfenac, Dexamethasone and Bevacizumab
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,127 participants
Where
16 sitesin 7 countries
Study dates
10 Jul 2013to 4 Nov 2016
Phase
Phase 3
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 21 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • All patients undergoing routine phacoemulsification (one eye per patient)
  • willing and/or able to comply with the scheduled visits and other study procedures.
  • able to communicate properly and understand instructions.
  • accepting possible off-label use of intravitreal bevacizumab and/or subconjunctival preservative-free TA.
  • Exclusion criteria will be different for non-diabetic and diabetic patients. All ophthalmic exclusion criteria are applicable to the study eye only, unless stated otherwise.
  • General exclusion criteria for participation in this study are:
Show all 35Show fewer
  • age below 21 years old;
  • participation in another clinical study;
  • post-traumatic cataract;
  • combined surgery;
  • functional monoculus;
  • previous ocular surgery;
  • progressive glaucoma with severe visual field defects, use of anti-glaucomatous medication or steroid-induced IOP elevation that required IOP-lowering treatment;
  • IOP ≥ 25 mmHg;
  • history of any intraocular inflammation or uveitis;
  • history of pseudoexfoliation syndrome, which is expected to cause peroperative complications;
  • history of Fuchs' endothelial dystrophy or cornea guttata 3+;
  • history of retinal vein occlusion;
  • any macular pathology that might influence VA, other than DME;
  • use of intravitreal bevacizumab or ranibizumab in the previous 6 weeks or intravitreal aflibercept in the previous 10 weeks;
  • use of intra- or periocular corticosteroid injection in the previous 4 months;
  • current use of topical NSAIDs or corticosteroids;
  • use of systemic corticosteroids (≥ 20 mg prednisolone or equivalence);
  • history of relevant adverse events, including serious adverse events (SAE), occurring after administration of NSAIDs, acetylsalicylic acid, sodium sulphite, corticosteroids or bevacizumab;
  • contraindications for use of topical NSAIDs, topical or subconjunctival corticosteroids or intravitreal bevacizumab or related drugs;
  • Non-diabetic patients with a history of CME will be excluded from participation in the study.
  • Additionally, diabetic patients will be excluded from participation in case of:
  • macular edema with a CSMT ≥450 µm;
  • very severe NPDR or proliferative DR requiring panretinal photocoagulation or vitrectomy;
  • vitreous haemorrhage present during preoperative visit(s);
  • cerebrovascular accident (CVA), myocardial infarction (MI) or other thromboembolic events in the previous 3 months;
  • a history of recurrent thromboembolic events;
  • a history of severe systemic bleeding in the previous 3 months;
  • major surgery in the previous 3 months;
  • history of glaucoma;

Who cannot join

None listed.

Trial locations and contacts

16 sites in 7 countries.

16 sites in 7 countries

Netherlands9 sites
  • VU University Medical Center

    Amsterdam, 1081 HZ

  • Academic Medical Center

    Amsterdam

  • Amphia Hospital Breda

    Breda

  • Zuyderland Medical Center

    Heerlen, 6419 PC

  • Eye Hospital Zonnestraal

    Hilversum

  • University Eye Clinic Maastricht UMC+

    Maastricht, 6202 AZ

  • Medical Centre Haaglanden

    The Hague

  • St. Elisabeth Hospital

    Tilburg

  • Máxima Medical Center Veldhoven

    Veldhoven

Other trials in Netherlands

Austria2 sites
  • Vienna Institute for Research in Ocular Surgery, Hanusch Krankenhaus

    Vienna, A-1140

  • Hospital of the Brothers of Saint John of God

    Vienna

Other trials in Austria

Belgium1 site
  • University Hospital Antwerp

    Edegem, B-2650

Other trials in Belgium

Germany1 site
  • Goethe University

    Frankfurt am Main, 60590

Other trials in Germany

Hungary1 site
  • Semmelweis University

    Budapest, H-1085

Other trials in Hungary

Portugal1 site
  • University Hospital Coimbra

    Coimbra, 3000-075

Other trials in Portugal

Spain1 site
  • Instituto Microcirurgia Ocular

    Barcelona, 08035

Other trials in Spain

About this study

Cystoid macular edema (CME) is a common cause of vision loss after cataract surgery. In the last few years, several new treatments have been tried to address the problem of CME after cataract surgery in diabetic and non-diabetic patients. The investigators will perform a large RCT with the aim to provide more definite evidence-based recommendations for clinical guidelines to prevent the occurrence of CME after cataract surgery in patients with and without diabetes mellitus (DM).

Read the detailed description

The objective of this study is to evaluate the effect of different preventive strategies on the occurrence of CME after cataract surgery in non-diabetic and diabetic patients. The design of the study is a multicentre randomised controlled clinical trial. The study population will consist of 926 non-diabetic patients and 209 patients with diabetes mellitus (DM) who require cataract surgery in at least one eye. All patients will receive a phacoemulsification for cataract and placement of a posterior chamber intraocular lens (IOL).

In the non-diabetic population, the patients will receive either bromfenac 0.09% eye drops twice daily starting two days before surgery and continuing 2 weeks postoperative, dexamethasone 0.1% eye drops four times daily starting two days before surgery and continuing four times daily during the first postoperative week and one drop less per day every following week or a combination of both drugs.

In the diabetic population patients will receive either:

  • Topical bromfenac 0.09% and dexamethasone 0.1% in the aforementioned dose;
  • Topical bromfenac 0.09% and dexamethasone 0.1% in the aforementioned dose and a subconjunctival injection of 40 mg triamcinolone acetonide;
  • Topical bromfenac 0.09% and dexamethasone 0.1% in the aforementioned dose and an intravitreal injection of 1.25 mg bevacizumab;
  • Topical bromfenac 0.09% and dexamethasone 0.1% in the aforementioned dose, a subconjunctival injection of 40 mg triamcinolone acetonide and an intravitreal injection of 1.25 mg bevacizumab.

The primary endpoint is the change in central subfield mean macular thickness in the 1 mm area (central subfield macular thickness, CSMT) as compared to baseline within the first 6 weeks postoperative.

The secondary endpoint is the occurrence of postoperative clinically significant macular edema (CSME) within 12 weeks postoperatively. Other study endpoints are mean CDVA in logMAR at 6 weeks and 12 weeks postoperatively; OCT measured average retinal thickness in the central inner circle (3mm), the outer circle (6mm), and the macular volume at 6 weeks and 12 weeks postoperatively; intraocular pressure at 6 weeks and 12 weeks postoperatively.

In case of clinically significant macular edema, treatment will be initiated and its effect will be part of the evaluation at 12 weeks. Medical data of all patients who develop macular edema during this study will be checked at least 6 months after surgery.

Being tested
Bromfenac, Dexamethasone, Bevacizumab, Triamcinolone Acetonide
Keywords
Prevention
Medical subject headings
Macular Edema, Cataract, Diabetes Mellitus

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • BromfenacDrug

    Also called Yellox, Product code: EMEA/H/C/001198

  • DexamethasoneDrug

    Also called Dexamethasone ophthalmic solution, Product code (NL): RVG 56003

  • BevacizumabDrug

    Also called Avastin, Product code: EU/1/04/300/002

  • Triamcinolone AcetonideDrug

    Also called Triesence or Vistrec, Product code (NL): RVG 106092

Study groups in NCT01774474
Study groupRoleWhat they receive
Non diabetics: bromfenacActive comparatorbromfenac 0.09% eye drops twice daily starting two days before surgery and continuing 2 weeks postoperatively
Receives: Drug: Bromfenac
Non diabetics: dexamethasoneActive comparatordexamethasone 0.1% eye drops four times daily starting two days before surgery and continuing four times daily during the first postoperative week and one drop less per day every following week
Receives: Drug: Dexamethasone
Non diabetics: bromfenac & dexamethasoneActive comparatorbromfenac 0.09% eye drops twice daily starting two days before surgery and continuing 2 weeks postoperative \& dexamethasone 0.1% eye drops four times daily starting two days before surgery and continuing four times daily during the first postoperative week and one drop less per day every following week
Receives: Drug: Bromfenac; Drug: Dexamethasone
Diabetics: eye dropsActive comparatorbromfenac 0.09% eye drops twice daily starting two days before surgery and continuing 2 weeks postoperative \& dexamethasone 0.1% eye drops four times daily starting two days before surgery and continuing four times daily during the first postoperative week and one drop less per day every following week
Receives: Drug: Bromfenac; Drug: Dexamethasone
Diabetics: eye drops & TAActive comparatorbromfenac 0.09% eye drops twice daily starting two days before surgery and continuing 2 weeks postoperative \& dexamethasone 0.1% eye drops four times daily starting two days before surgery and continuing four times daily during the first postoperative week and one drop less per day every following week \& a peroperative subconjunctival injection of 40 mg triamcinolone acetonide (TA, Triesence/Vistrec)
Receives: Drug: Bromfenac; Drug: Dexamethasone; Drug: Triamcinolone Acetonide
Diabetics: eye drops & bevacizumabActive comparatorbromfenac 0.09% eye drops twice daily starting two days before surgery and continuing 2 weeks postoperative \& dexamethasone 0.1% eye drops four times daily starting two days before surgery and continuing four times daily during the first postoperative week and one drop less per day every following week \& a peroperative intravitreal injection of 1.25 mg bevacizumab (Avastin)
Receives: Drug: Bromfenac; Drug: Dexamethasone; Drug: Bevacizumab
Diabetics: eye drops, TA & bevacizumabActive comparatorbromfenac 0.09% eye drops twice daily starting two days before surgery and continuing 2 weeks postoperative, dexamethasone 0.1% eye drops four times daily starting two days before surgery and continuing four times daily during the first postoperative week and one drop less per day every following week \& a peroperative subconjunctival injection of 40 mg triamcinolone acetonide (TA) \& a peroperative intravitreal injection of 1.25 mg bevacizumab
Receives: Drug: Bromfenac; Drug: Dexamethasone; Drug: Bevacizumab; Drug: Triamcinolone Acetonide

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in central subfield mean macular thickness as a measurement of efficacy

    The primary endpoint is the change in central subfield mean macular thickness in the 1 mm area (central subfield macular thickness, CSMT) as compared to baseline within the first 6 weeks postoperatively.

    Measured: 6 weeks postoperatively

Secondary outcomes (1)
  1. No. of subjects developing clinically significant macular edema as a measurement of efficacy

    The secondary endpoint is the occurrence of postoperative clinically significant macular edema (CSME) within 12 weeks postoperatively.

    Measured: 12 weeks postoperatively

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted24 Jan 2013 (estimated)
  2. Study start10 Jul 2013
  3. Primary completion4 Nov 2016
  4. Study completion4 Nov 2016

Resources

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 3
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Investigator
Enrolment
1,127 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01774474
Sponsor's protocol ID
NL42463.068.12
Acronym
PREMED
Status last verified
May 2016
First submitted
7 Jan 2013
Last updated
14 Apr 2017
Results posted
No
Data monitoring committee
Yes

Publications

  • Simons RWP, Wielders LHP, Nuijts RMMA, Veldhuizen CA, van den Biggelaar FJHM, Winkens B, Schouten JSAG, Dirksen CD; ESCRS PREMED Study Group. Economic evaluation of prevention of cystoid macular edema after cataract surgery in diabetic patients: ESCRS PREMED study report 6. J Cataract Refract Surg. 2022 May 1;48(5):555-563. doi: 10.1097/j.jcrs.0000000000000785.

    PubMed 34417781
  • Simons RWP, Wielders LHP, Dirksen CD, Veldhuizen CA, van den Biggelaar FJHM, Winkens B, Schouten JSAG, Nuijts RMMA; ESCRS PREMED Study Group. Economic evaluation of prevention of cystoid macular edema after cataract surgery in patients without diabetes: ESCRS PREMED study report 4. J Cataract Refract Surg. 2021 Mar 1;47(3):331-339. doi: 10.1097/j.jcrs.0000000000000449.

    PubMed 33009281

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Bromfenac, Dexamethasone and Bevacizumab in people with Cystoid Macular Edema and Cataract, run by Maastricht University Medical Center at 16 sites in 7 countries.

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 35 inclusion and 0 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 14 Apr 2017. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 16 sites in Netherlands, Austria, Belgium, Germany, Hungary and 2 more countries. 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.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

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?

Change in central subfield mean macular thickness as a measurement of efficacy (time frame: 6 weeks postoperatively). 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 NCT01774474, which also lists 2 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 14 Apr 2017.

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