GLAUCOMANCT02665884
Diurnal Fluctuations of Intraocular Pressure in EX-Press Valve Blebs in Glaucoma Patients
An observational study of GLAUCOMA, run by Hillel Yaffe Medical Center at 1 site in Israel.
Trial summary
Diurnal fluctuations of intraocular pressure in EX-Press Valve Blebs in Glaucoma Patients Intraocular pressure (IOP) reduction is the mainstay of glaucoma management. (1) Open-angle glaucoma (OAG) is generally managed by decreasing the intraocular pressure (IOP) to a level that the physician believes will prevent… Read more about this study
- Who is it for?
- Ages 30 to 80 years
- Conditions the study is for
- GLAUCOMA
- What is being tested?
- Intraocular Pressure Measurement
- How many people
- 40 participants
- Where
- 1 siteIsrael
- Study dates
- Feb 2016to Feb 2017
- Phase
- Observational
- 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 30 to 80 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Study population: The study will include 20 open-angle glaucoma (OAG) patients underwent Ex-Press filtration surgery, and 20 OAG patients treated with medications alone.
Who may be able to join
- Glaucoma patients that underwent EX-PRESS surgery
Who cannot join
- Angle closure glaucoma
- Neovascular glaucoma
- High refractive error
Trial locations and contacts
1 site in 1 country.
About this study
Diurnal fluctuations of intraocular pressure in EX-Press Valve Blebs in Glaucoma Patients
Intraocular pressure (IOP) reduction is the mainstay of glaucoma management. (1) Open-angle glaucoma (OAG) is generally managed by decreasing the intraocular pressure (IOP) to a level that the physician believes will prevent further glaucomatous damage. However, in a significant proportion of patients, the visual fields continue to deteriorate in spite of office pressures within the range of normal values (8). It has been suggested that the progressive damage in some cases could be caused by peaks of IOP or diurnal IOP variability not detected by tonometry during office hours. It is possible that certain drugs or surgical interventions are more effective than others in dampening these fluctuations. The purpose of our study is to compare the diurnal IOP fluctuations in glaucoma patients treated with medications or Ex-press filtration surgery.
Read the detailed description
Diurnal fluctuations of intraocular pressure in EX-Press Valve Blebs in Glaucoma Patients
Department of Ophthalmology, Hillel-Yaffe Medical Center, affiliated with the Bruce Rappaport School of Medicine, The Technion, Haifa, Israel
Introduction:
Intraocular pressure (IOP) reduction is the mainstay of glaucoma management. (1) Medication alone is sometimes not sufficient to reduce excessively high IOP, and pharmaceutical intolerance may develop or damage can occur to the optic nerve, warranting surgical intervention. (2) The filtering bleb is considered to be the cornerstone of IOP control after glaucoma filtration surgery drainage device implantation. (3) It enables the flow of the aqueous humor from the anterior chamber to the subconjunctiva, episclera, sclera and choroid, thereby lowering the IOP. (4-6) Filtration and drainage devices, such as the EX-Press device (Alcon Laboratories, Fort Worth, Texas, USA), offer a surgical alternative to glaucoma medical therapy. (7) Open-angle glaucoma (OAG) is generally managed by decreasing the intraocular pressure (IOP) to a level that the physician believes will prevent further glaucomatous damage. However, in a significant proportion of patients, the visual fields continue to deteriorate in spite of office pressures within the range of normal values (8). It has been suggested that the progressive damage in some cases could be caused by peaks of IOP or diurnal IOP variability not detected by tonometry during office hours. (9, 10) In another study, Asrani et al. (11) showed that IOP fluctuations are an independent risk factor in patients with glaucoma and as such may need to be treated specifically. It is possible that certain drugs or surgical interventions are more effective than others in dampening these fluctuations. The purpose of our study is to compare the diurnal IOP fluctuations in glaucoma patients treated with medications or Ex-press filtration surgery.
Materials and Methods The study will include 20 open-angle glaucoma (OAG) patients underwent Ex-Press filtration surgery, and 20 OAG patients treated with medications alone. All patients will have 12 IOP measurements with 2 hours interval, starting at 10 AM until 10 AM of the following morning.
ICARE® PRO tonometer (Icare Finland Oy, Espoo, Finland) will be used for the measurement of IOP. The rebound motion of its light weighted probe will be recorded during contact of the probe with the cornea. (12, 13) The rate of deceleration of the probe is a function of IOP. The ICARE® PRO has a built-in inclination sensor that allows downward measurement of the eye in the supine position as well as in the normal upright sitting position. ICARE® PRO allows for measurement of IOP in the seated and supine positions. During IOP recording, patients will be supine or upright, and the tip of the probe will be applied perpendicular to the cornea. Two markers engraved on the piston of the probe indicated its ideal positioning. The reliability of the measurement is displayed on the ICARE® PRO tonometer screen and guided our measurements.
Fluctuations in IOP will be compared between the Ex-press filtration surgery eye and the fellow (intra-group comparison). Inter-group comparison of IOP fluctuation will be performed between the Ex-press filtration surgery eye and medically treated eye of different patients.
- Conditions
- GLAUCOMA
- Being tested
- Intraocular Pressure Measurement
- Medical subject headings
- Glaucoma
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Intraocular Pressure MeasurementOther
Diurnal fluctuations of intraocular pressure will be measured and compared
| Study group | Role | What they receive |
|---|---|---|
| Glaucoma EX-PRESS | Glaucoma patients who underwent glaucoma surgery between the years 2014-2015 and had diurnal intraocular pressure measurements over 24 hours. Receives: Other: Intraocular Pressure Measurement | |
| Control Group | Glaucoma patients who had been treated with anti-glaucoma drops and had diurnal intraocular pressure measurements over 24 hours. Receives: Other: Intraocular Pressure Measurement |
What is being measured
The primary outcome is the main question the study is designed to answer.
Comparison of diurnal fluctuations of intraocular pressure
Comparison of diurnal fluctuations of intraocular pressure in glaucoma patients with and without EX-Press valve surgery
Measured: One year
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted28 Jan 2016 (estimated)
- Study startFeb 2016
- Primary completionFeb 2017 (estimated)
- Study completionFeb 2017 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (13)Papers the sponsor has linked to this study.
- Other trials for GLAUCOMAStudies of the same condition, open and under way.
- 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
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 40 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Hillel Yaffe Medical Center
- Sponsor type
- Other government
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02665884
- Sponsor's protocol ID
- 0085-15-HYMC
- Status last verified
- Nov 2015
- First submitted
- 29 Nov 2015
- Last updated
- 28 Jan 2016
- Results posted
- No
- Data monitoring committee
- No
- Individual data sharing
- No
Publications
The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration.The AGIS Investigators. Am J Ophthalmol. 2000 Oct;130(4):429-40. doi: 10.1016/s0002-9394(00)00538-9.
PubMed 11024415Watson PG. When to operate on open angle glaucoma. Eye (Lond). 1987;1 ( Pt 1):51-4. doi: 10.1038/eye.1987.8.
PubMed 2881812Levene RZ. Glaucoma filtering surgery: factors that determine pressure control. Ophthalmic Surg. 1984 Jun;15(6):475-83.
PubMed 6462607Picht G, Grehn F. Classification of filtering blebs in trabeculectomy: biomicroscopy and functionality. Curr Opin Ophthalmol. 1998 Apr;9(2):2-8. doi: 10.1097/00055735-199804000-00002.
PubMed 10180508Hu CY, Matsuo H, Tomita G, Suzuki Y, Araie M, Shirato S, Tanaka S. Clinical characteristics and leakage of functioning blebs after trabeculectomy with mitomycin-C in primary glaucoma patients. Ophthalmology. 2003 Feb;110(2):345-52. doi: 10.1016/S0161-6420(02)01739-6.
PubMed 12578779DeBry PW, Perkins TW, Heatley G, Kaufman P, Brumback LC. Incidence of late-onset bleb-related complications following trabeculectomy with mitomycin. Arch Ophthalmol. 2002 Mar;120(3):297-300. doi: 10.1001/archopht.120.3.297.
PubMed 11879132Netland PA, Sarkisian SR Jr, Moster MR, Ahmed II, Condon G, Salim S, Sherwood MB, Siegfried CJ. Randomized, prospective, comparative trial of EX-PRESS glaucoma filtration device versus trabeculectomy (XVT study). Am J Ophthalmol. 2014 Feb;157(2):433-440.e3. doi: 10.1016/j.ajo.2013.09.014. Epub 2013 Nov 7.
PubMed 24210765Kidd MN, O'Connor M. Progression of field loss after trabeculectomy: a five-year follow-up. Br J Ophthalmol. 1985 Nov;69(11):827-31. doi: 10.1136/bjo.69.11.827.
PubMed 4063249DRANCE SM. DIURNAL VARIATION OF INTRAOCULAR PRESSURE IN TREATED GLAUCOMA. SIGNIFICANCE IN PATIENTS WITH CHRONIC SIMPLE GLAUCOMA. Arch Ophthalmol. 1963 Sep;70:302-11. doi: 10.1001/archopht.1963.00960050304004. No abstract available.
PubMed 14048787Zeimer RC, Wilensky JT, Gieser DK, Viana MA. Association between intraocular pressure peaks and progression of visual field loss. Ophthalmology. 1991 Jan;98(1):64-9. doi: 10.1016/s0161-6420(91)32340-6.
PubMed 2023735Asrani S, Zeimer R, Wilensky J, Gieser D, Vitale S, Lindenmuth K. Large diurnal fluctuations in intraocular pressure are an independent risk factor in patients with glaucoma. J Glaucoma. 2000 Apr;9(2):134-42. doi: 10.1097/00061198-200004000-00002.
PubMed 10782622Iliev ME, Goldblum D, Katsoulis K, Amstutz C, Frueh B. Comparison of rebound tonometry with Goldmann applanation tonometry and correlation with central corneal thickness. Br J Ophthalmol. 2006 Jul;90(7):833-5. doi: 10.1136/bjo.2005.089870. Epub 2006 May 3.
PubMed 16672330Martinez-de-la-Casa JM, Garcia-Feijoo J, Castillo A, Garcia-Sanchez J. Reproducibility and clinical evaluation of rebound tonometry. Invest Ophthalmol Vis Sci. 2005 Dec;46(12):4578-80. doi: 10.1167/iovs.05-0586.
PubMed 16303951
Study at a glance
From the registry record, last updated by the sponsor on 28 Jan 2016. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Diurnal Fluctuations of Intraocular Pressure in EX-Press Valve Blebs in Glaucoma Patients
- ClinicalTrials.gov ID
- NCT02665884
- Acronym / sponsor ID
- 0085-15-HYMC
- Conditions
- GLAUCOMA
- Study type
- Observational
- Recruitment status
- Unknown status
- Enrolment
- 40 participants (estimated)
- Lead sponsor
- Hillel Yaffe Medical CenterOther government
- Study start
- Feb 2016
- Primary completion
- Feb 2017 (estimated)
- Study completion
- Feb 2017 (estimated)
- First posted
- 28 Jan 2016 (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.
Diurnal fluctuations of intraocular pressure in EX-Press Valve Blebs in Glaucoma Patients
Intraocular pressure (IOP) reduction is the mainstay of glaucoma management. (1) Open-angle glaucoma (OAG) is generally managed by decreasing the intraocular pressure (IOP) to a level that the physician believes will prevent further glaucomatous damage. However, in a significant proportion of patients, the visual fields continue to deteriorate in spite of office pressures within the range of normal values (8). It has been suggested that the progressive damage in some cases could be caused by peaks of IOP or diurnal IOP variability not detected by tonometry during office hours. It is possible that certain drugs or surgical interventions are more effective than others in dampening these fluctuations. The purpose of our study is to compare the diurnal IOP fluctuations in glaucoma patients treated with medications or Ex-press filtration surgery.
Detailed description
Diurnal fluctuations of intraocular pressure in EX-Press Valve Blebs in Glaucoma Patients
Department of Ophthalmology, Hillel-Yaffe Medical Center, affiliated with the Bruce Rappaport School of Medicine, The Technion, Haifa, Israel
Introduction:
Intraocular pressure (IOP) reduction is the mainstay of glaucoma management. (1) Medication alone is sometimes not sufficient to reduce excessively high IOP, and pharmaceutical intolerance may develop or damage can occur to the optic nerve, warranting surgical intervention. (2) The filtering bleb is considered to be the cornerstone of IOP control after glaucoma filtration surgery drainage device implantation. (3) It enables the flow of the aqueous humor from the anterior chamber to the subconjunctiva, episclera, sclera and choroid, thereby lowering the IOP. (4-6) Filtration and drainage devices, such as the EX-Press device (Alcon Laboratories, Fort Worth, Texas, USA), offer a surgical alternative to glaucoma medical therapy. (7) Open-angle glaucoma (OAG) is generally managed by decreasing the intraocular pressure (IOP) to a level that the physician believes will prevent further glaucomatous damage. However, in a significant proportion of patients, the visual fields continue to deteriorate in spite of office pressures within the range of normal values (8). It has been suggested that the progressive damage in some cases could be caused by peaks of IOP or diurnal IOP variability not detected by tonometry during office hours. (9, 10) In another study, Asrani et al. (11) showed that IOP fluctuations are an independent risk factor in patients with glaucoma and as such may need to be treated specifically. It is possible that certain drugs or surgical interventions are more effective than others in dampening these fluctuations. The purpose of our study is to compare the diurnal IOP fluctuations in glaucoma patients treated with medications or Ex-press filtration surgery.
Materials and Methods The study will include 20 open-angle glaucoma (OAG) patients underwent Ex-Press filtration surgery, and 20 OAG patients treated with medications alone. All patients will have 12 IOP measurements with 2 hours interval, starting at 10 AM until 10 AM of the following morning.
ICARE® PRO tonometer (Icare Finland Oy, Espoo, Finland) will be used for the measurement of IOP. The rebound motion of its light weighted probe will be recorded during contact of the probe with the cornea. (12, 13) The rate of deceleration of the probe is a function of IOP. The ICARE® PRO has a built-in inclination sensor that allows downward measurement of the eye in the supine position as well as in the normal upright sitting position. ICARE® PRO allows for measurement of IOP in the seated and supine positions. During IOP recording, patients will be supine or upright, and the tip of the probe will be applied perpendicular to the cornea. Two markers engraved on the piston of the probe indicated its ideal positioning. The reliability of the measurement is displayed on the ICARE® PRO tonometer screen and guided our measurements.
Fluctuations in IOP will be compared between the Ex-press filtration surgery eye and the fellow (intra-group comparison). Inter-group comparison of IOP fluctuation will be performed between the Ex-press filtration surgery eye and medically treated eye of different patients.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Glaucoma EX-PRESS | – | Other: Intraocular Pressure MeasurementGlaucoma patients who underwent glaucoma surgery between the years 2014-2015 and had diurnal intraocular pressure measurements over 24 hours. |
| Control Group | – | Other: Intraocular Pressure MeasurementGlaucoma patients who had been treated with anti-glaucoma drops and had diurnal intraocular pressure measurements over 24 hours. |
Who may qualify
- Ages
- 30 to 80 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- Study population
- The study will include 20 open-angle glaucoma (OAG) patients underwent Ex-Press filtration surgery, and 20 OAG patients treated with medications alone.
Key inclusion criteria (1 listed)
- Glaucoma patients that underwent EX-PRESS surgery
Key exclusion criteria (3 listed)
- Angle closure glaucoma
- Neovascular glaucoma
- High refractive error
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 |
|---|---|---|
| Intraocular Pressure MeasurementDiurnal fluctuations of intraocular pressure will be measured and compared | Other | Control Group, Glaucoma EX-PRESS |
Primary outcome
Comparison of diurnal fluctuations of intraocular pressure
Time frame: One year
Comparison of diurnal fluctuations of intraocular pressure in glaucoma patients with and without EX-Press valve surgery
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 28 Jan 2016.
- Results publication: PubMed 11024415The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration.The AGIS Investigators. Am J Ophthalmol. 2000 Oct;130(4):429-40. doi: 10.1016/s0002-9394(00)00538-9.
- Results publication: PubMed 2881812Watson PG. When to operate on open angle glaucoma. Eye (Lond). 1987;1 ( Pt 1):51-4. doi: 10.1038/eye.1987.8.
- Results publication: PubMed 6462607Levene RZ. Glaucoma filtering surgery: factors that determine pressure control. Ophthalmic Surg. 1984 Jun;15(6):475-83.
- Results publication: PubMed 10180508Picht G, Grehn F. Classification of filtering blebs in trabeculectomy: biomicroscopy and functionality. Curr Opin Ophthalmol. 1998 Apr;9(2):2-8. doi: 10.1097/00055735-199804000-00002.
- Results publication: PubMed 12578779Hu CY, Matsuo H, Tomita G, Suzuki Y, Araie M, Shirato S, Tanaka S. Clinical characteristics and leakage of functioning blebs after trabeculectomy with mitomycin-C in primary glaucoma patients. Ophthalmology. 2003 Feb;110(2):345-52. doi: 10.1016/S0161-6420(02)01739-6.
- Results publication: PubMed 11879132DeBry PW, Perkins TW, Heatley G, Kaufman P, Brumback LC. Incidence of late-onset bleb-related complications following trabeculectomy with mitomycin. Arch Ophthalmol. 2002 Mar;120(3):297-300. doi: 10.1001/archopht.120.3.297.
- Results publication: PubMed 24210765Netland PA, Sarkisian SR Jr, Moster MR, Ahmed II, Condon G, Salim S, Sherwood MB, Siegfried CJ. Randomized, prospective, comparative trial of EX-PRESS glaucoma filtration device versus trabeculectomy (XVT study). Am J Ophthalmol. 2014 Feb;157(2):433-440.e3. doi: 10.1016/j.ajo.2013.09.014. Epub 2013 Nov 7.
- Results publication: PubMed 4063249Kidd MN, O'Connor M. Progression of field loss after trabeculectomy: a five-year follow-up. Br J Ophthalmol. 1985 Nov;69(11):827-31. doi: 10.1136/bjo.69.11.827.
- Results publication: PubMed 14048787DRANCE SM. DIURNAL VARIATION OF INTRAOCULAR PRESSURE IN TREATED GLAUCOMA. SIGNIFICANCE IN PATIENTS WITH CHRONIC SIMPLE GLAUCOMA. Arch Ophthalmol. 1963 Sep;70:302-11. doi: 10.1001/archopht.1963.00960050304004. No abstract available.
- Results publication: PubMed 2023735Zeimer RC, Wilensky JT, Gieser DK, Viana MA. Association between intraocular pressure peaks and progression of visual field loss. Ophthalmology. 1991 Jan;98(1):64-9. doi: 10.1016/s0161-6420(91)32340-6.
- Results publication: PubMed 10782622Asrani S, Zeimer R, Wilensky J, Gieser D, Vitale S, Lindenmuth K. Large diurnal fluctuations in intraocular pressure are an independent risk factor in patients with glaucoma. J Glaucoma. 2000 Apr;9(2):134-42. doi: 10.1097/00061198-200004000-00002.
- Results publication: PubMed 16672330Iliev ME, Goldblum D, Katsoulis K, Amstutz C, Frueh B. Comparison of rebound tonometry with Goldmann applanation tonometry and correlation with central corneal thickness. Br J Ophthalmol. 2006 Jul;90(7):833-5. doi: 10.1136/bjo.2005.089870. Epub 2006 May 3.
- Individual participant dataSharing planned: No
Related trials for GLAUCOMA
Recruiting
Implementing AI-based Glaucoma Screening Within Federally Qualified Health Centers
Glaucoma, Ocular Hypertension
Not yet recruiting
AI-Assisted vs Conventional Teleglaucoma Referral
Glaucoma
Recruiting
Brain Stimulation Effects on Orientation and Mobility Skills in Adults With Vision Impairment
Retinitis Pigmentosa (RP), Rod Cone Dystrophy
Recruiting
Automated Applanation Tonometry - Updated
Glaucoma, Glaucoma, Suspect
RecruitingPhase 2
A Phase 2a Study Comparing the Efficacy, Safety and Tolerability of Pregabalin Eye Drops Comparing With Timolol Eye Drops in Adults With Glaucoma or High Eye Pressure.
Primary Open - Angle Glaucoma (POAG), Ocular Hypertension (OHT)
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.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of GLAUCOMA, run by Hillel Yaffe Medical Center at 1 site in Israel.
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 1 inclusion and 3 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: status not confirmed, as of the sponsor's last update on 28 Jan 2016. 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 Israel. 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?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact Yuval Cohen, MD., PhD (0586904951, dr.yuvalcohen@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Comparison of diurnal fluctuations of intraocular pressure (time frame: One year). 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 NCT02665884, which also lists 13 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 28 Jan 2016.