Randomized Trial Comparing Epiretinal Membrane Surgery With and Without Internal Limiting Membrane Removal

NCT ID: NCT01532765

Last Updated: 2018-09-21

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

NA

Total Enrollment

13 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-09-30

Study Completion Date

2017-03-22

Brief Summary

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Macular epiretinal membrane (ERM) is a semitranslucent, avascular, fibrocellular membrane on the inner surface along the internal limiting membrane (ILM) of the retina. ERM may cause symptomatic visual disturbances and vision loss. Since the 1970s, pars plana vitrectomy has been performed to remove the membranes with few complications, and surgical results are generally good. Recurrence rates of 5-16% have been reported. Recently, ILM peeling in ERM surgery have been popularized by a number of retrospective studies and one prospective case series to minimize the rate of ERM recurrences (16% recurrence in ERM surgery with ILM peel compares to 0% recurrence in ERM surgery without ILM peel). Surgical removal of the friable and transparent ILM is difficult and increases the risk of trauma to the retina. In addition, indocyanine green (ICG), a dye commonly used intra-operatively to enhance ILM visualization, is costly and has been shown to be toxic to the retina. The investigators study will be the first randomized-controlled multi-centred clinical trial to compare the outcomes of ERM surgery with and without ILM peeling. The results will help guide and standardize the surgical treatment of macular ERM; to minimize unnecessary surgical risks, as well as to help economize healthcare cost.

Detailed Description

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Conditions

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Epiretinal Membrane

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Epiretinal Membrane Surgery without ILM peel

Group Type ACTIVE_COMPARATOR

Pars plana vitrectomy and epiretinal membrane peel

Intervention Type PROCEDURE

23 gauge pars plana vitrectomy with diluted intravitreal triamcinolone for visualization

Epiretinal Membrane Surgery with ILM peel (ICG assisted)

Group Type ACTIVE_COMPARATOR

Pars plana vitrectomy and epiretinal membrane peel

Intervention Type PROCEDURE

23 gauge pars plana vitrectomy with diluted intravitreal triamcinolone for visualization

ILM peel assisted by ICG

Intervention Type PROCEDURE

Indocyanine green dye is prepared from 25mg powder vial from AKORN INC., 10 mL diluent provided in kit. This is further diluted to final concentration of 0.5mg/mL using 50% sterile dextrose solution

Combined CE & IOL and ERM surgery without ILM peel

Group Type ACTIVE_COMPARATOR

Pars plana vitrectomy and epiretinal membrane peel

Intervention Type PROCEDURE

23 gauge pars plana vitrectomy with diluted intravitreal triamcinolone for visualization

CE-IOL

Intervention Type PROCEDURE

Cataract extraction by phacoemulsification and insertion foldable posterior chamber intraocular lens implant

Combined CE & IOL and ERM surgery with ILM peel (ICG assisted)

Group Type ACTIVE_COMPARATOR

Pars plana vitrectomy and epiretinal membrane peel

Intervention Type PROCEDURE

23 gauge pars plana vitrectomy with diluted intravitreal triamcinolone for visualization

ILM peel assisted by ICG

Intervention Type PROCEDURE

Indocyanine green dye is prepared from 25mg powder vial from AKORN INC., 10 mL diluent provided in kit. This is further diluted to final concentration of 0.5mg/mL using 50% sterile dextrose solution

CE-IOL

Intervention Type PROCEDURE

Cataract extraction by phacoemulsification and insertion foldable posterior chamber intraocular lens implant

Interventions

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Pars plana vitrectomy and epiretinal membrane peel

23 gauge pars plana vitrectomy with diluted intravitreal triamcinolone for visualization

Intervention Type PROCEDURE

ILM peel assisted by ICG

Indocyanine green dye is prepared from 25mg powder vial from AKORN INC., 10 mL diluent provided in kit. This is further diluted to final concentration of 0.5mg/mL using 50% sterile dextrose solution

Intervention Type PROCEDURE

CE-IOL

Cataract extraction by phacoemulsification and insertion foldable posterior chamber intraocular lens implant

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* 18 years or older
* ERM on clinical exam and/or macular OCT
* Visual acuity of 20/40 or worse (attributable to ERM)

Exclusion Criteria

* Prior surgery for ERM in the "study eye"
* Macular edema secondary to arterial/venous occlusion(s)
* Central serous retinopathy
* Age related macular degeneration
* Diabetic cystoid macular edema
* Proliferative Diabetic Retinopathy
* Uveitis
Minimum Eligible Age

18 Years

Maximum Eligible Age

100 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Sunnybrook Health Sciences Centre

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Sunnybrook Health Sciences Centre

Toronto, Ontario, Canada

Site Status

St. Michael's Hospital

Toronto, Ontario, Canada

Site Status

Toronto Western Hospital

Toronto, Ontario, Canada

Site Status

Countries

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Canada

References

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Shimada H, Nakashizuka H, Hattori T, Mori R, Mizutani Y, Yuzawa M. Double staining with brilliant blue G and double peeling for epiretinal membranes. Ophthalmology. 2009 Jul;116(7):1370-6. doi: 10.1016/j.ophtha.2009.01.024. Epub 2009 May 8.

Reference Type BACKGROUND
PMID: 19427701 (View on PubMed)

Wise GN. Preretinal macular fibrosis. (An analysis of 90 cases). Trans Ophthalmol Soc U K (1962). 1972;92:131-40. No abstract available.

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PMID: 4515504 (View on PubMed)

Fraser-Bell S, Ying-Lai M, Klein R, Varma R; Los Angeles Latino Eye Study. Prevalence and associations of epiretinal membranes in latinos: the Los Angeles Latino Eye Study. Invest Ophthalmol Vis Sci. 2004 Jun;45(6):1732-6. doi: 10.1167/iovs.03-1295.

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Klein R, Klein BE, Wang Q, Moss SE. The epidemiology of epiretinal membranes. Trans Am Ophthalmol Soc. 1994;92:403-25; discussion 425-30. No abstract available.

Reference Type BACKGROUND
PMID: 7886875 (View on PubMed)

Hirokawa H, Jalkh AE, Takahashi M, Takahashi M, Trempe CL, Schepens CL. Role of the vitreous in idiopathic preretinal macular fibrosis. Am J Ophthalmol. 1986 Feb 15;101(2):166-9. doi: 10.1016/0002-9394(86)90589-1.

Reference Type BACKGROUND
PMID: 3946531 (View on PubMed)

Wise GN. Relationship of idiopathic preretinal macular fibrosis to posterior vitreous detachment. Am J Ophthalmol. 1975 Mar;79(3):358-62. doi: 10.1016/0002-9394(75)90606-6.

Reference Type BACKGROUND
PMID: 1121991 (View on PubMed)

Mitchell P, Smith W, Chey T, Wang JJ, Chang A. Prevalence and associations of epiretinal membranes. The Blue Mountains Eye Study, Australia. Ophthalmology. 1997 Jun;104(6):1033-40. doi: 10.1016/s0161-6420(97)30190-0.

Reference Type BACKGROUND
PMID: 9186446 (View on PubMed)

Kawasaki R, Wang JJ, Sato H, Mitchell P, Kato T, Kawata S, Kayama T, Yamashita H, Wong TY. Prevalence and associations of epiretinal membranes in an adult Japanese population: the Funagata study. Eye (Lond). 2009 May;23(5):1045-51. doi: 10.1038/eye.2008.238. Epub 2008 Aug 8.

Reference Type BACKGROUND
PMID: 19440207 (View on PubMed)

Smiddy WE, Maguire AM, Green WR, Michels RG, de la Cruz Z, Enger C, Jaeger M, Rice TA. Idiopathic epiretinal membranes. Ultrastructural characteristics and clinicopathologic correlation. Ophthalmology. 1989 Jun;96(6):811-20; discussion 821. doi: 10.1016/s0161-6420(89)32811-9.

Reference Type BACKGROUND
PMID: 2740079 (View on PubMed)

Wiznia RA. Posterior vitreous detachment and idiopathic preretinal macular gliosis. Am J Ophthalmol. 1986 Aug 15;102(2):196-8. doi: 10.1016/0002-9394(86)90144-3.

Reference Type BACKGROUND
PMID: 3740180 (View on PubMed)

Sidd RJ, Fine SL, Owens SL, Patz A. Idiopathic preretinal gliosis. Am J Ophthalmol. 1982 Jul;94(1):44-8. doi: 10.1016/0002-9394(82)90189-1.

Reference Type BACKGROUND
PMID: 7091281 (View on PubMed)

Bellhorn MB, Friedman AH, Wise GN, Henkind P. Ultrastructure and clinicopathologic correlation of idiopathic preretinal macular fibrosis. Am J Ophthalmol. 1975 Mar;79(3):366-73. doi: 10.1016/0002-9394(75)90608-x.

Reference Type BACKGROUND
PMID: 1121993 (View on PubMed)

Clarkson JG, Green WR, Massof D. A histopathologic review of 168 cases of preretinal membrane. 1977. Retina. 2005 Jul-Aug;25(5 Suppl):1-17. doi: 10.1097/00006982-200507001-00006. No abstract available.

Reference Type BACKGROUND
PMID: 16049358 (View on PubMed)

Appiah AP, Hirose T, Kado M. A review of 324 cases of idiopathic premacular gliosis. Am J Ophthalmol. 1988 Nov 15;106(5):533-5. doi: 10.1016/0002-9394(88)90581-8.

Reference Type BACKGROUND
PMID: 3189467 (View on PubMed)

Ting FS, Kwok AK. Treatment of epiretinal membrane: an update. Hong Kong Med J. 2005 Dec;11(6):496-502.

Reference Type BACKGROUND
PMID: 16340027 (View on PubMed)

Michels RG. A clinical and histopathologic study of epiretinal membranes affecting the macula and removed by vitreous surgery. Trans Am Ophthalmol Soc. 1982;80:580-656. No abstract available.

Reference Type BACKGROUND
PMID: 6763804 (View on PubMed)

Puliafito CA, Hee MR, Lin CP, Reichel E, Schuman JS, Duker JS, Izatt JA, Swanson EA, Fujimoto JG. Imaging of macular diseases with optical coherence tomography. Ophthalmology. 1995 Feb;102(2):217-29. doi: 10.1016/s0161-6420(95)31032-9.

Reference Type BACKGROUND
PMID: 7862410 (View on PubMed)

Falkner-Radler CI, Glittenberg C, Hagen S, Benesch T, Binder S. Spectral-domain optical coherence tomography for monitoring epiretinal membrane surgery. Ophthalmology. 2010 Apr;117(4):798-805. doi: 10.1016/j.ophtha.2009.08.034. Epub 2010 Jan 4.

Reference Type BACKGROUND
PMID: 20045567 (View on PubMed)

Fraser-Bell S, Guzowski M, Rochtchina E, Wang JJ, Mitchell P. Five-year cumulative incidence and progression of epiretinal membranes: the Blue Mountains Eye Study. Ophthalmology. 2003 Jan;110(1):34-40. doi: 10.1016/s0161-6420(02)01443-4.

Reference Type BACKGROUND
PMID: 12511343 (View on PubMed)

Kwok AKh, Lai TY, Yuen KS. Epiretinal membrane surgery with or without internal limiting membrane peeling. Clin Exp Ophthalmol. 2005 Aug;33(4):379-85. doi: 10.1111/j.1442-9071.2005.01015.x.

Reference Type BACKGROUND
PMID: 16033350 (View on PubMed)

Grewing R, Mester U. Results of surgery for epiretinal membranes and their recurrences. Br J Ophthalmol. 1996 Apr;80(4):323-6. doi: 10.1136/bjo.80.4.323.

Reference Type BACKGROUND
PMID: 8703883 (View on PubMed)

Park DW, Dugel PU, Garda J, Sipperley JO, Thach A, Sneed SR, Blaisdell J. Macular pucker removal with and without internal limiting membrane peeling: pilot study. Ophthalmology. 2003 Jan;110(1):62-4. doi: 10.1016/s0161-6420(02)01440-9.

Reference Type BACKGROUND
PMID: 12511347 (View on PubMed)

Bovey EH, Uffer S, Achache F. Surgery for epimacular membrane: impact of retinal internal limiting membrane removal on functional outcome. Retina. 2004 Oct;24(5):728-35. doi: 10.1097/00006982-200410000-00007.

Reference Type BACKGROUND
PMID: 15492626 (View on PubMed)

Burk SE, Da Mata AP, Snyder ME, Rosa RH Jr, Foster RE. Indocyanine green-assisted peeling of the retinal internal limiting membrane. Ophthalmology. 2000 Nov;107(11):2010-4. doi: 10.1016/s0161-6420(00)00375-4.

Reference Type BACKGROUND
PMID: 11054324 (View on PubMed)

Gale JS, Proulx AA, Gonder JR, Mao AJ, Hutnik CM. Comparison of the in vitro toxicity of indocyanine green to that of trypan blue in human retinal pigment epithelium cell cultures. Am J Ophthalmol. 2004 Jul;138(1):64-9. doi: 10.1016/j.ajo.2004.02.061.

Reference Type BACKGROUND
PMID: 15234283 (View on PubMed)

Yuen D, Gonder J, Proulx A, Liu H, Hutnik C. Comparison of the in vitro safety of intraocular dyes using two retinal cell lines: a focus on brilliant blue G and indocyanine green. Am J Ophthalmol. 2009 Feb;147(2):251-259.e2. doi: 10.1016/j.ajo.2008.08.031. Epub 2008 Nov 7.

Reference Type BACKGROUND
PMID: 18992870 (View on PubMed)

Lim JW, Kim HK, Cho DY. Macular function and ultrastructure of the internal limiting membrane removed during surgery for idiopathic epiretinal membrane. Clin Exp Ophthalmol. 2011 Jan;39(1):9-14. doi: 10.1111/j.1442-9071.2010.02377.x.

Reference Type BACKGROUND
PMID: 20662848 (View on PubMed)

Lee JW, Kim IT. Outcomes of idiopathic macular epiretinal membrane removal with and without internal limiting membrane peeling: a comparative study. Jpn J Ophthalmol. 2010 Mar;54(2):129-34. doi: 10.1007/s10384-009-0778-0. Epub 2010 Apr 18.

Reference Type BACKGROUND
PMID: 20401561 (View on PubMed)

Other Identifiers

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422-2010

Identifier Type: -

Identifier Source: org_study_id

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