Comparison of Ex-PRESSTM Mini Glaucoma Shunt to Trabeculectomy in Subjects With Open Angle Glaucoma - Full Text View

Purpose

A prospective randomized trial to compare the safety and efficacy of the Ex-PRESS to trabeculectomy in patients with open angle glaucoma who failed medical or are allergic to medical treatment and for which filtering surgery is indicated

Condition	Intervention	Phase
Glaucoma	Procedure: Trabeculectomy Device: Ex-PRESS mini shunt	Phase 4


Study Type:	Interventional
Study Design:	Allocation: Randomized Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment
Official Title:	A Multi Center Study Comparing the Ex-PRESSTM Mini Glaucoma Shunt to Trabeculectomy in Subjects With Open Angle Glaucoma

Resource links provided by NLM:

Genetics Home Reference related topics: early-onset glaucoma

MedlinePlus related topics: Glaucoma

Genetic and Rare Diseases Information Center resources: Pigment-dispersion Syndrome

U.S. FDA Resources

Further study details as provided by University of Virginia:

Primary Outcome Measures:

Safety - Post operative safety profile defined as vitreous loss and hypotony (IOP≤5mmHg) and related complications (choroidal effusion, hyphema, shallow/flat AC, leaking bleb). [ Time Frame: 1d, 1w, 1m, 3m, 6m, 12m, 18m, 24m ]
Efficacy - The primary effectiveness measure will be qualified and complete success rate defined as IOP≤18mmHg with or without medications in the test group as compared to complete and qualified success rate in the concurrent control group at 12 months. [ Time Frame: 1d, 1w, 1m, 3m, 6m, 12m, 18m, 24m ]

Secondary Outcome Measures:

Safety - Comparison of the incidence of all adverse events that occur during the intra-operative and postoperative periods between the two study arms. [ Time Frame: 1d, 1w, 1m, 3m, 6m, 12m, 18m, 24m ]
Efficacy - The secondary effectiveness measure will be qualified and complete success rate defined as IOP≤18mmHg with or without medications in the test group as compared to qualified and complete success rate in the concurrent control group at 24 month [ Time Frame: 1d, 1w, 1m, 3m, 6m, 12m, 18m, 24m ]


Enrollment:	120
Study Start Date:	October 2006
Study Completion Date:	January 2012
Primary Completion Date:	January 2012 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Active Comparator: Control Arm Subjects undergoing trabeculectomy with the use of Mitomycin C	Procedure: Trabeculectomy Standard trabeculectomy procedure Creation of a fornix or limbal based conjunctival flap in upper quadrants Creation of a limbal-based scleral flap extending into clear cornea Delicate application of MMC solution onto sclerectomy bed. (MMC concentration 0.4mg/ml for 1-3 minutes) Creation of fistula 1mm x 2mm in size Iridectomy Suturing the scleral flap Repositioning of conjunctiva with sutures After procedure, antibiotics & steroids are administered topically; eye is covered with a pad - patient is discharged.
Experimental: Treatment Arm Subjects undergoing Ex-PRESS Under Scleral Flap implantation procedure with the use of Mitomycin C	Device: Ex-PRESS mini shunt Ex-PRESS implantation procedure: Creation of a fornix or limbal based conjunctival flap in upper quadrants Creation of limbal-based scleral flap extending into clear cornea Delicate application of MMC solution onto sclerectomy bed. (MMC concentration 0.4mg/ml for 1-3 minutes) Penetration into anterior chamber using 23-25G needle, halfway between the white sclera and clear cornea (in the center of the grey zone);creation of track incision at limbus Prior to implantation, a thorough mobility check should be performed Implantation of Ex-PRESS implant loaded on its introducer, through that pre-incision Withdrawal of introducer Tucking plate under the scleral flap, and verification of its position Suturing scleral flap After implantation procedure, antibiotics & steroids administered topically; eye is covered with a pad - patient is discharged.

Arms

Assigned Interventions

Active Comparator: Control Arm

Subjects undergoing trabeculectomy with the use of Mitomycin C

Procedure: Trabeculectomy

Standard trabeculectomy procedure

Creation of a fornix or limbal based conjunctival flap in upper quadrants
Creation of a limbal-based scleral flap extending into clear cornea
Delicate application of MMC solution onto sclerectomy bed. (MMC concentration 0.4mg/ml for 1-3 minutes)
Creation of fistula 1mm x 2mm in size
Iridectomy
Suturing the scleral flap
Repositioning of conjunctiva with sutures After procedure, antibiotics & steroids are administered topically; eye is covered with a pad - patient is discharged.

Experimental: Treatment Arm

Subjects undergoing Ex-PRESS Under Scleral Flap implantation procedure with the use of Mitomycin C

Device: Ex-PRESS mini shunt

Ex-PRESS implantation procedure:

Creation of a fornix or limbal based conjunctival flap in upper quadrants
Creation of limbal-based scleral flap extending into clear cornea
Delicate application of MMC solution onto sclerectomy bed. (MMC concentration 0.4mg/ml for 1-3 minutes)
Penetration into anterior chamber using 23-25G needle, halfway between the white sclera and clear cornea (in the center of the grey zone);creation of track incision at limbus
Prior to implantation, a thorough mobility check should be performed
Implantation of Ex-PRESS implant loaded on its introducer, through that pre-incision
Withdrawal of introducer
Tucking plate under the scleral flap, and verification of its position
Suturing scleral flap After implantation procedure, antibiotics & steroids administered topically; eye is covered with a pad - patient is discharged.

Eligibility


Ages Eligible for Study:	18 Years and older (Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Adult subject over the age of 18
Subject diagnosed with open angle glaucoma (POAG, PXFG or PDSG) or ocular hypertension
Subject is a candidate for filtering surgery with intraoperative anti-metabolites
IOP > 18 mmHg on maximum tolerated medial therapy based on two measurements taken 1 hour apart at the same visit.
Subject willing to attend all follow-up evaluations
Subject willing to sign informed consent.

Exclusion Criteria:

Subject diagnosed with: PACG, NTG, secondary glaucoma, neovascular glaucoma
Subject has history of glaucoma surgery (filtering, glaucoma drainage device, cyclo destructive procedures)
Subject has history of penetrating keratoplasty (PKP)
Subject underwent large incision extra capsular cataract extraction
Subject had cataract phacoemulsification within the last month
Subject has a visually significant cataract that is planned for extraction at the time of filtering surgery or within 12 months thereafter
Any ocular disease or history in the operated eye other than glaucoma and cataract, such as uveitis, ocular infection, severe dry eye, severe blepharitis , active proliferative retinopathy, ICE syndrome, epithelial or fibrous down growth, aphakia, and ocular pathology that may interfere with accurate IOP measurements
Subject has vitreous present in the anterior chamber for which vitrectomy is anticipated
IOP of ≤18mmHg
Subject participates in any other concurrent ocular investigation.

Contacts and Locations

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00444080

Locations


United States, California
University of California
San Francisco, California, United States, 94143-0730
United States, Florida
University of Florida
Gainesville, Florida, United States, 32610
United States, Missouri
Washington University
St. Louis, Missouri, United States, 63110
United States, Oklahoma
Dean A. McGee Eye Institute
Oklahoma City, Oklahoma, United States, 73104
United States, Pennsylvania
Wills EYE Institute
Philadelphia, Pennsylvania, United States, 19066
Allegheny Ophthalmic & Orbital Associates, P.C.
Pittsburgh, Pennsylvania, United States, 15212
United States, Tennessee
University of Tennessee
Memphis, Tennessee, United States, 38163
Canada
Osler Eyecare
Brompton, Canada

Sponsors and Collaborators

University of Virginia

Investigators


Principal Investigator:	Peter A. Netland, MD, PhD	University of Virginia

More Information

Additional Information:

Related Info This link exits the ClinicalTrials.gov site

Publications:

Maris PJ Jr, Ishida K, Netland PA. Comparison of trabeculectomy with Ex-PRESS miniature glaucoma device implanted under scleral flap. J Glaucoma. 2007 Jan;16(1):14-9.

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Netland 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.


Responsible Party:	University of Virginia
ClinicalTrials.gov Identifier:	NCT00444080 History of Changes
Other Study ID Numbers:	14967
Study First Received:	March 5, 2007
Last Updated:	February 1, 2013

Keywords provided by University of Virginia:


Ex-PRESS TRABECULECTOMY

Additional relevant MeSH terms:


Glaucoma Glaucoma, Open-Angle Ocular Hypertension Eye Diseases

ClinicalTrials.gov processed this record on July 26, 2017