Trabectome Versus Trabeculectomy With Mitomycin C in Patients With Open Angle Glaucoma

This study is ongoing, but not recruiting participants.
Information provided by (Responsible Party):
Karim Damji, University of Alberta Identifier:
First received: May 11, 2009
Last updated: June 8, 2015
Last verified: June 2015

The purpose of this study is to compare the efficacy and safety of Trabectome versus Trabeculectomy with adjunctive Mitomycin C, combined with cataract surgery, in patients with open angle glaucoma.

Condition Intervention Phase
Open Angle Glaucoma
Procedure: Trabectome-IOL
Procedure: Trab-IOL
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Prospective Randomized Controlled Trial of Trabectome Versus Trabeculectomy With Mitomycin C in Patients With Open Angle Glaucoma

Resource links provided by NLM:

Further study details as provided by University of Alberta:

Primary Outcome Measures:
  • Mean IOP at 6 months [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  • Surgical complication rates [ Time Frame: intraoperative and postoperative up to 12 months ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Mean difference in IOP from baseline to 6 months [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  • Mean IOP at 12 months [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  • Quality of life measures [ Time Frame: preoperative and postoperative at 6 and 12 months ] [ Designated as safety issue: No ]
  • Mean number of glaucoma medications [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  • Visual acuity [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  • Need for additional laser (excluding suture lysis) and surgical interventions [ Time Frame: 12 months ] [ Designated as safety issue: No ]

Enrollment: 19
Study Start Date: November 2009
Estimated Study Completion Date: December 2015
Estimated Primary Completion Date: December 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Trabectome-IOL
Combined Trabectome and cataract extraction with intraocular lens insertion
Procedure: Trabectome-IOL

Trabectome removes an arc of trabecular meshwork and inner wall of Schlemm's canal to enhance aqueous outflow through natural drainage pathways.

Trabectome will be done first, followed by cataract surgery because Trabectome requires a clear view through the cornea using a goniolens, and this view may be compromised after cataract surgery.

Active Comparator: Trab-IOL
Combined Trabeculetomy with Mitomycin C and cataract extraction with intraocular lens insertion
Procedure: Trab-IOL

Trabeculectomy bypasses the normal aqueous outflow channels of the eye and creates an external filtration pathway (called a filtering bleb) for aqueous to drain and be reabsorbed back into the circulation. Mitomycin C is an agent used during this procedure to decrease scar formation around the new passage.

Cataract surgery will be done first, followed by Trabeculectomy with Mitomycin C.

Detailed Description:

Background: Trabeculectomy with adjunctive use of Mitomycin C (Trab MMC) is the standard incisional procedure to lower intraocular pressure (IOP) in adults with open angle glaucoma (OAG). Trab MMC has been shown to effectively lower IOP, however, it can be associated with a number of serious complications, such as hypotony maculopathy, choroidal effusion or hemorrhage, and endophthalmitis, as well as less serious complications that may affect vision related quality of life such as bleb dysesthesia.

A newer technology, referred to as the Trabectome (NeoMedix Corp., San Juan Capistrano, CA), removes an arc of trabecular meshwork and inner wall of Schlemm's canal with microcautery and appears to lower IOP effectively with fewer and less serious complications than Trab MMC. However, more studies are needed to determine the long term safety and efficacy of this relatively new procedure.

In addition, for OAG patients with visually significant cataracts, either Trab MMC or Trabectome can be combined with cataract surgery.

Study Objective: To compare the efficacy and safety of Trabectome versus Trab MMC, in combination with cataract extraction by phacoemulsification and intraocular lens implant, for control of IOP in OAG, including pseudoexfoliative glaucoma.

Methods: Single center, single surgeon, prospective randomized controlled trial. A total of 52 eligible participants, 26 per study arm would need to be recruited for 90% power. One eye per study patient will be enrolled and randomized to Trabectome combined with cataract surgery (Trabectome-IOL) or Trab MMC combined with cataract surgery (Trab-IOL).

Postoperative visits will take place at the discretion of the surgeon but will include at least visits at day 1, week 1, and months 1, 3, 6, and 12. Postoperative glaucoma medications will be added in a stepped regimen as appropriate, along with additional laser or surgical procedures if needed.

Current Study Status: Enrolment has been closed due to clearer indications for each technique over time leading to lack of clinical equipoise essential for patient randomization/recruitment. This has been discussed with the data safety monitoring board who agree that it is reasonable to end enrollment and complete followup and analysis on patients already recruited in the trial.


Ages Eligible for Study:   40 Years to 85 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Age 40-85 years
  2. Open angle glaucoma (including pseudo exfoliative glaucoma)
  3. Open angles (≥ Shaffer grade II)
  4. Inadequately controlled IOP requiring surgical intervention
  5. Visually significant cataract
  6. Willing to complete quality of life questionnaires
  7. Capable of informed consent and available for at least 1 year follow-up

Exclusion Criteria:

  1. Any form of angle closure glaucoma
  2. Secondary open angle glaucomas
  3. Absence of clear angle landmarks on gonioscopy
  4. Other ocular disease that may affect assessments of visual acuity, visual field, or accurate tonometry
  5. Previous angle surgery or filtering procedure
  6. Steroid use within the preceding 3 months
  7. Presence of significant co-morbidities
  Contacts and Locations
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Please refer to this study by its identifier: NCT00901108

Canada, Alberta
Royal Alexandra Hospital
Edmonton, Alberta, Canada, T5H 3V9
Sponsors and Collaborators
University of Alberta
Principal Investigator: Karim F Damji, MD FRCSC MBA University of Alberta
  More Information

No publications provided

Responsible Party: Karim Damji, Professor, University of Alberta Identifier: NCT00901108     History of Changes
Other Study ID Numbers: UAKD-001
Study First Received: May 11, 2009
Last Updated: June 8, 2015
Health Authority: Canada: Ethics Review Committee
Canada: Health Canada

Keywords provided by University of Alberta:
open angle glaucoma

Additional relevant MeSH terms:
Glaucoma, Open-Angle
Eye Diseases
Ocular Hypertension
Alkylating Agents
Antibiotics, Antineoplastic
Antineoplastic Agents
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Nucleic Acid Synthesis Inhibitors
Pharmacologic Actions
Therapeutic Uses processed this record on October 09, 2015