Cataract Surgery with Near Normal Eye Pressure in Patients with Diabetic Retinopathy

NCT06617273 | Active Not Recruiting

• 1 other identifier: NNIOP-PHACO
• Study Type: interventional
• Target: 72
• Locations: 1 country
• Sites: 1

Brief Summary

Diabetes mellitus is a chronic metabolic disease that can lead to visual impairment and eye complications such as diabetic retinopathy and diabetic macular edema. Diabetics are considered a vulnerable patient group for cataract surgery, as microincision phacoemulsification (MICS) in diabetics is associated with a higher risk of postoperative swelling of the macula and cornea (macular or corneal edema). In addition, the ultrasound energy emitted during MICS, high and fluctuating intraocular pressure and the movement of surgical instruments and lens material are the main causes of surgical trauma. The medical device "Centurion Vision System" with the "Active Sentry" handpiece was developed specifically to improve the stability of the anterior chamber during surgery and to enable operations at low, almost normal physiological intraocular pressure settings. The central question of the study is therefore, whether a stable intraocular pressure close to physiological normal conditions (28 mmHg) during surgery can lead to a reduction in surgical trauma. In this prospective and randomized study, patients suffering from diabetes and having a planned bilateral MICS are included in one of two study arms: A) The participant is operated on with an IOP of 28 mm Hg in the better eye and an IOP of 50 mm Hg in the worse eye or B) the participant is operated on with an IOP of 28 mm Hg in the worse eye and an IOP of 50 mm Hg in the better eye.

Conditions

Diabetic Retinopathy; Cataract

Keywords

Diabetic Retinopathy; Phacoemulsification; Microincision Phacoemulsification; Cataract; Intraocular pressure; Active anterior chamber pressure

Outcome Measures

Primary Outcomes (1)

• Delta ACF

  Difference from pre- to postoperative ACF (delta ACF) at day 1 (FU1) and day 7 (FU2) after cataract surgery.

  1 week

Secondary Outcomes (12)

• BCVA

  1 month

• 5mm corneal volume

  1 month

• Anterior chamber depth

  1 month

• Mydriatic pupil width

  1 month

• Endothelial cell density

  1 month

Study Arms (2)

A) IOP 28mmHg on the better eye and IOP 50mmHg on the worse eye

OTHER

Near normal intraocular pressure cataract surgery using active anterior chamber pressure sensing and regulation

Device: Ophthalmosurgical handpiece with active anterior chamber pressure sensing and regulation

B) IOP 28mmHg on worse eye and IOP 50mmHg on the better eye

OTHER

Near normal intraocular pressure cataract surgery using active anterior chamber pressure sensing and regulation

Device: Ophthalmosurgical handpiece with active anterior chamber pressure sensing and regulation

Interventions

Ophthalmosurgical handpiece with active anterior chamber pressure sensing and regulation DEVICE

Cataract surgery in patients with diabetic retinopathy using active anterior chamber pressure sensing and regulation

A) IOP 28mmHg on the better eye and IOP 50mmHg on the worse eye; B) IOP 28mmHg on worse eye and IOP 50mmHg on the better eye

Eligibility Criteria

• Age: 50 Years - 85 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Indication for immediate sequential bilateral microincision cataract surgery
• Diagnosis of Diabetes Mellitus treated with oral medication or insulin therapy and confirmed by HbA1c ≥6,5 %
• Presence of diabetic retinopathy grade ≥1 on the international clinical diabetic retinopathy (ICDR) severity scale
• LOCS 2-4 with no more than 1 grade difference between both eyes
• Male or female patient aged 50 - 85 years of age at time of consent
• Understands and agrees to comply with the study procedures and provides written informed consent as documented by signature

You may not qualify if:

• Participation in another clinical trial within 30 days before pre-screening and throughout the trial
• Prior intraocular surgery of any type
• History of diabetic macular edema
• Presence of macular edema, defined as central retinal thickness of \>300 µm plus intraretinal or subretinal fluid on OCT within range of 1mm of foveal center
• Presence of any retinal or choroidal disease, other than diabetes, that could affect retinal thickness
• Known history of uveitis
• Documented use of systemic or topical steroid or other immunosuppressive medication within the last 3 months
• ACF \>10 ph/ms. ACF difference between right and left eye \> 4ph/ms
• Difference of DRP grading between right and left eye of more than 1 grade (ICDR)
• Inability to measure total macular volume due to, but not limed to, too dense cataract, vitreous bleeding
• Woman of childbearing potential (WOCBP) who is breastfeeding, has a positive urine pregnancy test, is not willing to undergo a urine pregnancy test upon entering or exiting the study, intends to become pregnant during the study, or does not agree to use adequate birth control methods for the duration of the study
• Patients in possession of an active implantable medical device (AIMD)

Sponsors & Collaborators

• Medical University Innsbruck: lead

Study Sites (1)

Medical University Innsbruck, University Hospital for Ophthalmology and Optometry

Innsbruck, 6020, Austria

Location

MeSH Terms

Conditions

Diabetic Retinopathy; Cataract

Condition Hierarchy (Ancestors)

Retinal Diseases; Eye Diseases; Diabetic Angiopathies; Vascular Diseases; Cardiovascular Diseases; Diabetes Complications; Diabetes Mellitus; Endocrine System Diseases; Lens Diseases

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: controlled randomized, comparative

Study Record Dates

• First Submitted: September 11, 2024
• First Posted: September 27, 2024
• Study Start: August 21, 2024
• Primary Completion: September 1, 2025
• Study Completion: September 30, 2025
• Last Updated: September 27, 2024

Record last verified: 2024-09

Data Sharing

• IPD Sharing: Will not share

Locations

AU (1)