Non-inferiority Trial of Iontophoretic Corneal Collagen Crosslinking (CXL) Compared to Standard Corneal Collagen Crosslinking in Progressive Keratoconus. (IONTO-CXL)
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|ClinicalTrials.gov Identifier: NCT01868620|
Recruitment Status : Terminated (The investigator decided to stop the trial due to a lack of inclusion.)
First Posted : June 4, 2013
Last Update Posted : July 16, 2019
The primary purpose of the protocol is to compare the current standard CXL with iontophoretic CXL to provide evidence in relation to the efficacy and safety in progressive keratoconus.
Corneal collagen crosslinking (CXL) is the first surgical procedure that appears to halt the progression of keratoconus. In the current standard CXL, the central corneal epithelium must be debrided to efficiently permeate the corneal stroma with riboflavin. The epithelium debridement can cause severe pain, infection and stromal haze. The study hypothesis is that iontophorese CXL is as effective as standard CXL to stabilize a progressive keratoconus.
|Condition or disease||Intervention/treatment||Phase|
|Progressive Keratoconus||Device: Iontophoretic CXL Device: Standard CXL||Not Applicable|
Keratoconus is a common bilateral progressive corneal ecstatic disease causing visual impairment by inducing irregular astigmatism and corneal opacities. This disorder typically begins during teenage years, progresses until the age of 30 to 40 years and, in severe forms, may need a corneal transplantation. CXL has changed the natural evolution of keratoconus. It creates links between collagen fibrils in order to rigidify the corneal stroma and slow down the progression of keratoconus. The corneal stroma is soaked with a riboflavin solution before being exposed to ultraviolet-A radiation.
In the current standard CXL, the central corneal epithelium must be debrided to allow the penetration of riboflavin into the cornea with a risk of side effects, such as pain for the first two post-operative days, temporary loss of visual acuity during the first three months, and serious complications such as infection and stromal opacity due to corneal scarring.
Iontophoresis is a non invasive technique in which a weak electric current is used to enhance the penetration of riboflavin into the cornea. The iontophoresis technique could allow intrastromal riboflavin diffusion, while keeping the corneal epithelium on, combining the efficiency of the standard procedure without the side effects of epithelial debridement.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||28 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||None (Open Label)|
|Official Title:||Non-inferiority Trial of Iontophoretic Corneal Collagen Crosslinking (CXL) Compared to Standard Corneal Collagen Crosslinking in Progressive Keratoconus.|
|Actual Study Start Date :||May 2013|
|Actual Primary Completion Date :||June 2016|
|Actual Study Completion Date :||March 2017|
Experimental: Iontophoretic CXL
The iontophoretic CXL involves a constant current source and two electrodes. The main electrode is a circular cup, with a surrounding annular suction ring to affix the device on the cornea during the procedure. The electrode itself is a stainless steel grid, placed into the cup at a minimal distance from the cornea. The reservoir is filled with riboflavin solution. The generator applies a constant current of 1mA for a preset period of 5 min. After the riboflavin administration by iontophoresis, the cornea is irradiated by a UVA light for 3mW/cm2 during 30 minutes.
Device: Iontophoretic CXL
Active Comparator: Standard CXL
In the standard CXL, the epithelium is mechanically removed. Then, a solution of riboflavin is instilled each minute for 30 minutes. Corneas are irradiated by a UVA light for 3mW/cm2 during 30 minutes.
Device: Standard CXL
- The main outcome parameter is the non-inferiority of iontophoretic CXL compared to standard CXL in progressive keratoconus [ Time Frame: Outcome measure is assessed at 1 year. ]Measuring maximum keratometry (K-max) derived from computerized videokeratography.
- Comparison of minimum keratometry [ Time Frame: 3 months ]Measure assessed by tomographic measurement.
- Comparison of mean keratometry [ Time Frame: At 1 year ]Tomographic measurement.
- Comparison of postoperative pain and complications during the follow up [ Time Frame: Outcome measure is assessed at 1 year and at 3 months ]
- Comparison of visual acuity [ Time Frame: Outcome measure is assessed at 1 year and at 3 months ]
- Intraoperative comparison of corneal concentration of riboflavin [ Time Frame: Outcome measure is assessed at 1 year and at 3 months ]
- Comparison of depth of treatment [ Time Frame: Outcome measure is assessed at 1 year and at 3 months ]By tomographic measurement
- Comparison of biomechanical parameters [ Time Frame: Outcome measure is assessed at 1 year and at 3 months ]By ORA (Ocular Response Analyzer)
- Comparison of corneal thickness [ Time Frame: Outcome measure is assessed at 1 year and at 3 months for the tomographic measurement. ]
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): NCT01868620
|University Hospital Toulouse|
|Toulouse, Midi-Pyrenees, France, 31059|
|Principal Investigator:||François MALECAZE, MD, PhD|