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

NCT ID: NCT00444080

Last Updated: 2020-10-14

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

120 participants

Study Classification

INTERVENTIONAL

Study Start Date

2006-10-31

Study Completion Date

2012-01-31

Brief Summary

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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. Surgical success was defined as 5 mmHg ≤ intraocular pressure ≤ 18 mmHg, with or without medications, without further glaucoma surgery. Postoperative intraocular pressure, number of medications, complications and success rates were followed for 2 years.

Detailed Description

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Conditions

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Glaucoma

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Control Arm

Subjects undergoing trabeculectomy with the use of Mitomycin C

Group Type ACTIVE_COMPARATOR

Trabeculectomy

Intervention Type PROCEDURE

Standard trabeculectomy procedure

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

Treatment Arm

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

Group Type EXPERIMENTAL

Ex-PRESS mini shunt

Intervention Type DEVICE

Ex-PRESS implantation procedure:

1. Creation of a fornix or limbal based conjunctival flap in upper quadrants
2. Creation of limbal-based scleral flap extending into clear cornea
3. Delicate application of MMC solution onto sclerectomy bed. (MMC concentration 0.4mg/ml for 1-3 minutes)
4. 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
5. Prior to implantation, a thorough mobility check should be performed
6. Implantation of Ex-PRESS implant loaded on its introducer, through that pre-incision
7. Withdrawal of introducer
8. Tucking plate under the scleral flap, and verification of its position
9. Suturing scleral flap After implantation procedure, antibiotics \& steroids administered topically; eye is covered with a pad - patient is discharged.

Interventions

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Trabeculectomy

Standard trabeculectomy procedure

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

Intervention Type PROCEDURE

Ex-PRESS mini shunt

Ex-PRESS implantation procedure:

1. Creation of a fornix or limbal based conjunctival flap in upper quadrants
2. Creation of limbal-based scleral flap extending into clear cornea
3. Delicate application of MMC solution onto sclerectomy bed. (MMC concentration 0.4mg/ml for 1-3 minutes)
4. 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
5. Prior to implantation, a thorough mobility check should be performed
6. Implantation of Ex-PRESS implant loaded on its introducer, through that pre-incision
7. Withdrawal of introducer
8. Tucking plate under the scleral flap, and verification of its position
9. Suturing scleral flap After implantation procedure, antibiotics \& steroids administered topically; eye is covered with a pad - patient is discharged.

Intervention Type DEVICE

Eligibility Criteria

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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.
Minimum Eligible Age

18 Years

Maximum Eligible Age

100 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Virginia

OTHER

Sponsor Role lead

Responsible Party

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Peter Netland, MD

Vernah Scott Moyston Professor, Chair, Department of Ophthalmology

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Peter A. Netland, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Virginia

Locations

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University of California

San Francisco, California, United States

Site Status

University of Florida

Gainesville, Florida, United States

Site Status

Washington University

St Louis, Missouri, United States

Site Status

Dean A. McGee Eye Institute

Oklahoma City, Oklahoma, United States

Site Status

Wills EYE Institute

Philadelphia, Pennsylvania, United States

Site Status

Allegheny Ophthalmic & Orbital Associates, P.C.

Pittsburgh, Pennsylvania, United States

Site Status

University of Tennessee

Memphis, Tennessee, United States

Site Status

Osler Eyecare

Mississauga, Ontario, Canada

Site Status

Countries

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United States Canada

References

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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.

Reference Type RESULT
PMID: 24210765 (View on PubMed)

Park J, Rittiphairoj T, Wang X, E JY, Bicket AK. Device-modified trabeculectomy for glaucoma. Cochrane Database Syst Rev. 2023 Mar 13;3(3):CD010472. doi: 10.1002/14651858.CD010472.pub3.

Reference Type DERIVED
PMID: 36912740 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Related Links

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https://pubmed.ncbi.nlm.nih.gov/24210765/

Study results indexed on Pub Med

Other Identifiers

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14967

Identifier Type: -

Identifier Source: org_study_id

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