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Corneal Collagen Crosslinking and Intacs for Keratoconus and Ectasia (CXL)

This study is ongoing, but not recruiting participants.
Sponsor:
ClinicalTrials.gov Identifier:
NCT01112072
First Posted: April 28, 2010
Last Update Posted: December 8, 2016
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
Information provided by (Responsible Party):
Cornea and Laser Eye Institute
  Purpose
This study will determine the efficacy of corneal collagen crosslinking (CXL) combined with Intacs for the treatment of keratoconus and corneal ectasia. The goal of CXL is to decrease the progression of keratoconus, while Intacs has been shown to decrease corneal steepness in keratoconus. This study will attempt to determine the relative efficacy of the two procedures either performed at the same session versus CXL performed 3 months after Intacs.

Condition Intervention Phase
Keratoconus Corneal Ectasia Drug: Riboflavin Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Randomized Study of Safety and Effectiveness of Corneal Collagen Crosslinking and Intacs for Treatment of Keratoconus and Corneal Ectasia

Resource links provided by NLM:

Genetics Home Reference related topics: keratoconus
MedlinePlus related topics: Corneal Disorders
Drug Information available for: Riboflavin
Genetic and Rare Diseases Information Center resources: Keratoconus
U.S. FDA Resources

Further study details as provided by Cornea and Laser Eye Institute:

Primary Outcome Measures:
  • Maximum keratometry [ Time Frame: 1 year ]

Secondary Outcome Measures:
  • Best Corrected Visual Acuity [ Time Frame: 1 year ]
Estimated Enrollment: 160
Study Start Date: April 2010
Estimated Study Completion Date: December 2017
Estimated Primary Completion Date: December 2017 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Intacs combined with CXL
Intacs placement followed by collagen crosslinking with UV light and riboflavin
 Drug: Riboflavin
Corneal epithelium removed followed by riboflavin drop administration every 2 minutes for 30 minutes followed by UV light exposure with additional riboflavin administration every 2 minutes for 30 minutes. Subjects will be randomized to receive Intacs placement either immediately before CXL or 3 months before CXL.
Other Names:
  • Intracorneal Ring Segments
  • Cornea Collagen Crosslinking
Active Comparator: Intacs followed by CXL
Intacs placement, to be followed by corneal collagen crosslinking with UV light and riboflavin 3 months later
 Drug: Riboflavin
Corneal epithelium removed followed by riboflavin drop administration every 2 minutes for 30 minutes followed by UV light exposure with additional riboflavin administration every 2 minutes for 30 minutes. Subjects will be randomized to receive Intacs placement either immediately before CXL or 3 months before CXL.
Other Names:
  • Intracorneal Ring Segments
  • Cornea Collagen Crosslinking

Detailed Description:
The purpose of this is to ascertain the possible additive effect of the two treatments to both improve the quality of the corneal optics (i.e. improve corneal topography regularity) and to stabilize the cornea. Previous investigations have shown that Intacs surgery, indeed, does improve corneal topography and improve contact lens tolerance and spectacle corrected visual acuity, as well as uncorrected visual acuity in some patients. Investigations of CXL have shown the procedure not only to decrease keratoconus progression, but also to decrease the steepness of the cone and improve uncorrected and best corrected visual acuity in some cases. Since the mechanism of improvement differs between the procedures, this suggests a potential additive effect of the two on the patient's ultimate visual outcome. Thus, the patient would be afforded two potential benefits: (1) the potential of a more robust visual outcome and (2) stabilization of the keratoconic cornea on the longer term.
  Eligibility

Information from the National Library of Medicine

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Ages Eligible for Study:   21 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • 21 years of age or older
  • Having a diagnosis of keratoconus or corneal ectasia after corneal refractive surgery (e.g., LASIK, photorefractive keratectomy [PRK], or epi-LASIK)
  • Subjects who meet the manufacturer's nomogram recommendations for Intacs segments
  • Topography consistent with keratoconus or post-surgical corneal ectasia.
  • BSCVA worse than 20/20 (<55 letters on ETDRS chart)

Exclusion Criteria:

  • Eyes classified as either normal, atypical normal, or keratoconus suspect on the severity grading scheme.
  • Corneal pachymetry ≤ 400 microns at the thinnest point measured by Pentacam in the eye(s) to be treated when the isotonic riboflavin solution is used or ≤ 300 microns when the hypotonic riboflavin us used, provided that the corneal thickness after treatment with the hypotonic riboflavin solution is > 400 microns. Corneal pachymetry ≤ 450 microns at the proposed insertion site for the Intacs
  • Previous ocular condition (other than refractive error) in the eye(s) to be treated that may predispose the eye for future complications
  • History of corneal disease
  • History of chemical injury or delayed epithelial healing in the eye(s) to be treated.
  • Pregnancy (including plan to become pregnant) or lactation during the course of the study
  • A known sensitivity to study medications
  • Subjects with nystagmus or any other condition that would prevent a steady gaze during the CXL and Intacs treatment or other diagnostic tests.
  • Subjects with a current condition that, in the investigator's opinion, would interfere with or prolong epithelial healing.
  Contacts and Locations
Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01112072


Locations
United States, New Jersey
Cornea and Laser Eye Institute
Teaneck, New Jersey, United States, 07666
Sponsors and Collaborators
Cornea and Laser Eye Institute
Investigators
Principal Investigator: Peter Hersh, M.D. Cornea and Laser Eye Institute
  More Information

Responsible Party: Cornea and Laser Eye Institute
ClinicalTrials.gov Identifier: NCT01112072     History of Changes
Other Study ID Numbers: CLEI-Intacs-CXL
First Submitted: April 26, 2010
First Posted: April 28, 2010
Last Update Posted: December 8, 2016
Last Verified: July 2016

Keywords provided by Cornea and Laser Eye Institute:
keratoconus
corneal ectasia
collagen crosslinking
 riboflavin
cornea
ultraviolet

Additional relevant MeSH terms:
Keratoconus
Dilatation, Pathologic
Corneal Diseases
Eye Diseases
Pathological Conditions, Anatomical
Riboflavin
Vitamin B Complex
 Vitamins
Micronutrients
Growth Substances
Physiological Effects of Drugs
Photosensitizing Agents
Dermatologic Agents


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