The Impact of Topical Prostaglandins on the Biomechanical Properties of the Cornea in Patients With Open Angle Glaucoma
NCT ID: NCT02388360
Last Updated: 2021-02-26
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
COMPLETED
Clinical Phase
PHASE4
Total Enrollment
35 participants
Study Classification
INTERVENTIONAL
Study Start Date
2013-05-06
Study Completion Date
2016-11-16
Brief Summary
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The purpose of this study is to determine the influence of topical prostaglandin analog (PGA) medication on corneal biomechanical properties in patients undergoing PGA treatment for open-angle glaucoma.
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Detailed Description
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Patients: Thirty five patients (seventy eyes) with bilateral open angle glaucoma on monotherapy with topical PGA medication in both eyes were recruited from the Montreal Glaucoma Institute, Montreal, QC, Canada. Informed consent was acquired from all participants. The research protocol of this study adhered to the tenets of the Declaration of Helsinki. It was approved by the Maisonneuve-Rosemont Hospital Ethics committee (Montreal, QC, Canada) and all patients signed a research consent form.
Study Procedures: Consenting patients undergoing topical PGA treatment in both eyes were asked to discontinue the PGA in their best eye and to continue the administration of PGA in the contralateral eye. All measurements were taken before PGA cessation (Visit 1) and repeated 6 weeks after cessation (Visit 2). Patients then restarted the application of PGA to the experimental eye and all measurements were repeated once more after an additional 6 weeks (Visit 3).
The best eye was selected based on less glaucoma damages. It was defined by the results of the Humphrey Visual Field (HFA, Carl Zeiss Meditec, Inc., Dublin, CA), Heidelberg Retinal Tomograph (HRT II, Heidelberg Engineering GmbH, Heidelberg, Germany) and Optical Coherence Tomography (CIRRUS HD-OCT, Carl Zeiss Meditec, Inc., Dublin, CA). The Humphrey Visual Field defines early glaucoma as a mean defect (MD) of -2.00 to -6.00 db, moderate glaucoma as a MD of -6.10 to -12.0 db and advanced as a MD less than -12.0 db. The Optical Coherence Tomography enables the identification of the better linear Cup/Disk ratio, Rim area, RNFL thickness and ganglion cells analysis between both of the patient's eyes. The lesser of the maximum IOP values recorded in each of the patient's eyes also contributed to the selection of the best eye.
Instruments: The Ocular Response Analyzer (ORA) (Reichert, INC, Depew, NY) was used to assess the biomechanical properties of the cornea. This instrument utilizes a dynamic bi-directional applanation process to measure the biomechanical properties of cornea and estimate IOP. A rapid air pulse applies force to the cornea and an advanced electro-optical system monitors corneal deformation. A precisely-metered collimated-air-pulse pushes the cornea inwards, past a flat state and into a slight concavity. Milliseconds after applanation, the air pump shuts off and the pressure gradually declines. As the pressure decreases, the cornea first passes through an applanated state before resuming its original curved structure. The applanation detection system monitors the corneal movement throughout the entire process. Two separate pressure values are derived from the INWARD and OUTWARD applanation events. The difference between these two pressure values is termed CH. This biomechanical property reflects corneal absorption and dissipation of the energy from an applied force. Derived from the measurement of CH is the Corneal resistance factor (CRF). CRF represents the cornea's ability to resist deformation in the presence of an external force.
Goldmann applanation tonometry (Haag-Streit AG, Koeniz, Switzerland) is still recognized as the gold standard for measuring IOP in glaucoma patients and it was performed in all patients at all visits. The ORA takes the CH and CRF measurements into account to generate the corneal-compensated intraocular pressure (IOPcc) value, which is mean to be less affected by corneal biomechanical properties than the Goldmann-IOP. The IOP bias is estimated as the difference between IOPcc and Goldmann-IOP (IOPcc - Goldmann IOP). A positive bias value indicates that the IOPcc is larger than the Goldmann-IOP, meaning that Goldman tonometry underestimated IOP in comparison to the IOPcc.
Four ORA measurements were taken per eye and the mean value was recorded for each parameter (CH, CRF and IOPcc). Central corneal thickness (CCT) was measured by ultrasound pachymetry (DGH Technology, INC, Exton, PA) and the average of three measurements was recorded. All study measurements were performed by the same trained observer (RM), with the same equipment and at the same time of day. All of the equipment needed for this research was calibrated prior to each use.
Statistical Analysis: The hypothesis of no effect regarding the discontinuation of PGA on the biomechanical properties was examined by a linear mixed-effect model using the nlme package in R. Random-effects were defined on two levels: the patient (level-1) and the eye within each patient (level-2). Those random-effects were added to the model to account for the intra-individual variance due to the repeated-measure design. Age was also included in the model as a covariate. Contrasts between the eyes and times were estimated using adjusted p-values to control for familywise error rate using multcomp package in R.
Study Procedures: Consenting patients undergoing topical PGA treatment in both eyes were asked to discontinue the PGA in their best eye and to continue the administration of PGA in the contralateral eye. All measurements were taken before PGA cessation (Visit 1) and repeated 6 weeks after cessation (Visit 2). Patients then restarted the application of PGA to the experimental eye and all measurements were repeated once more after an additional 6 weeks (Visit 3).
The best eye was selected based on less glaucoma damages. It was defined by the results of the Humphrey Visual Field (HFA, Carl Zeiss Meditec, Inc., Dublin, CA), Heidelberg Retinal Tomograph (HRT II, Heidelberg Engineering GmbH, Heidelberg, Germany) and Optical Coherence Tomography (CIRRUS HD-OCT, Carl Zeiss Meditec, Inc., Dublin, CA). The Humphrey Visual Field defines early glaucoma as a mean defect (MD) of -2.00 to -6.00 db, moderate glaucoma as a MD of -6.10 to -12.0 db and advanced as a MD less than -12.0 db. The Optical Coherence Tomography enables the identification of the better linear Cup/Disk ratio, Rim area, RNFL thickness and ganglion cells analysis between both of the patient's eyes. The lesser of the maximum IOP values recorded in each of the patient's eyes also contributed to the selection of the best eye.
Instruments: The Ocular Response Analyzer (ORA) (Reichert, INC, Depew, NY) was used to assess the biomechanical properties of the cornea. This instrument utilizes a dynamic bi-directional applanation process to measure the biomechanical properties of cornea and estimate IOP. A rapid air pulse applies force to the cornea and an advanced electro-optical system monitors corneal deformation. A precisely-metered collimated-air-pulse pushes the cornea inwards, past a flat state and into a slight concavity. Milliseconds after applanation, the air pump shuts off and the pressure gradually declines. As the pressure decreases, the cornea first passes through an applanated state before resuming its original curved structure. The applanation detection system monitors the corneal movement throughout the entire process. Two separate pressure values are derived from the INWARD and OUTWARD applanation events. The difference between these two pressure values is termed CH. This biomechanical property reflects corneal absorption and dissipation of the energy from an applied force. Derived from the measurement of CH is the Corneal resistance factor (CRF). CRF represents the cornea's ability to resist deformation in the presence of an external force.
Goldmann applanation tonometry (Haag-Streit AG, Koeniz, Switzerland) is still recognized as the gold standard for measuring IOP in glaucoma patients and it was performed in all patients at all visits. The ORA takes the CH and CRF measurements into account to generate the corneal-compensated intraocular pressure (IOPcc) value, which is mean to be less affected by corneal biomechanical properties than the Goldmann-IOP. The IOP bias is estimated as the difference between IOPcc and Goldmann-IOP (IOPcc - Goldmann IOP). A positive bias value indicates that the IOPcc is larger than the Goldmann-IOP, meaning that Goldman tonometry underestimated IOP in comparison to the IOPcc.
Four ORA measurements were taken per eye and the mean value was recorded for each parameter (CH, CRF and IOPcc). Central corneal thickness (CCT) was measured by ultrasound pachymetry (DGH Technology, INC, Exton, PA) and the average of three measurements was recorded. All study measurements were performed by the same trained observer (RM), with the same equipment and at the same time of day. All of the equipment needed for this research was calibrated prior to each use.
Statistical Analysis: The hypothesis of no effect regarding the discontinuation of PGA on the biomechanical properties was examined by a linear mixed-effect model using the nlme package in R. Random-effects were defined on two levels: the patient (level-1) and the eye within each patient (level-2). Those random-effects were added to the model to account for the intra-individual variance due to the repeated-measure design. Age was also included in the model as a covariate. Contrasts between the eyes and times were estimated using adjusted p-values to control for familywise error rate using multcomp package in R.
Conditions
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Glaucoma, Open-Angle
Study Design
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Allocation Method
NA
Intervention Model
SINGLE_GROUP
Primary Study Purpose
TREATMENT
Blinding Strategy
NONE
Study Groups
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topical prostaglandin analogs
Group Type
OTHER
topical prostaglandin analogs
Intervention Type
DRUG
Interventions
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topical prostaglandin analogs
Intervention Type
DRUG
Eligibility Criteria
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Inclusion Criteria
* patients with bilateral open angle glaucoma on monotherapy with topical PGA medication in both eyes
Exclusion Criteria
* corneal disease (such as Fuchs' endothelial dystrophy or keratoconus)
* past history of corneal trauma or surgery (including refractive surgery) that may affect hysteresis measurements
* contact lens wearers
* uncontrolled glaucoma or advanced visual field (VF) damage (mean defect \< -12.0 db)
* patients taking systemic prostaglandin medication, non-steroidal anti-inflammatory drugs, or undergoing hormone replacement therapy
* past history of corneal trauma or surgery (including refractive surgery) that may affect hysteresis measurements
* contact lens wearers
* uncontrolled glaucoma or advanced visual field (VF) damage (mean defect \< -12.0 db)
* patients taking systemic prostaglandin medication, non-steroidal anti-inflammatory drugs, or undergoing hormone replacement therapy
Minimum Eligible Age
40 Years
Maximum Eligible Age
85 Years
Eligible Sex
ALL
Accepts Healthy Volunteers
No
Sponsors
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Maisonneuve-Rosemont Hospital
OTHER
Sponsor Role
lead
Responsible Party
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Dr. Paul Harasymowycz
Paul Harasymowycz, MD
Responsibility Role
PRINCIPAL_INVESTIGATOR
Principal Investigators
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Paul Harasymowycz, Dr
Role: PRINCIPAL_INVESTIGATOR
Maisonneuve-Rosemont Hospital
Locations
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Montreal Glaucoma Institut
Montreal, Quebec, Canada
Site Status
Countries
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Canada
References
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Detry-Morel M, Jamart J, Hautenauven F, Pourjavan S. Comparison of the corneal biomechanical properties with the Ocular Response Analyzer(R) (ORA) in African and Caucasian normal subjects and patients with glaucoma. Acta Ophthalmol. 2012 Mar;90(2):e118-24. doi: 10.1111/j.1755-3768.2011.02274.x. Epub 2011 Oct 11.
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Tsikripis P, Papaconstantinou D, Koutsandrea C, Apostolopoulos M, Georgalas I. The effect of prostaglandin analogs on the biomechanical properties and central thickness of the cornea of patients with open-angle glaucoma: a 3-year study on 108 eyes. Drug Des Devel Ther. 2013 Oct 4;7:1149-56. doi: 10.2147/DDDT.S50622. eCollection 2013.
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Gordon MO, Beiser JA, Brandt JD, Heuer DK, Higginbotham EJ, Johnson CA, Keltner JL, Miller JP, Parrish RK 2nd, Wilson MR, Kass MA. The Ocular Hypertension Treatment Study: baseline factors that predict the onset of primary open-angle glaucoma. Arch Ophthalmol. 2002 Jun;120(6):714-20; discussion 829-30. doi: 10.1001/archopht.120.6.714.
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Lopilly Park HY, Kim JH, Lee KM, Park CK. Effect of prostaglandin analogues on tear proteomics and expression of cytokines and matrix metalloproteinases in the conjunctiva and cornea. Exp Eye Res. 2012 Jan;94(1):13-21. doi: 10.1016/j.exer.2011.10.017. Epub 2011 Nov 4.
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Tao Y, Bazan HE, Bazan NG. Platelet-activating factor enhances urokinase-type plasminogen activator gene expression in corneal epithelium. Invest Ophthalmol Vis Sci. 1996 Sep;37(10):2037-46.
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Lindsey JD, Kashiwagi K, Kashiwagi F, Weinreb RN. Prostaglandins alter extracellular matrix adjacent to human ciliary muscle cells in vitro. Invest Ophthalmol Vis Sci. 1997 Oct;38(11):2214-23.
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Lindsey JD, Kashiwagi K, Kashiwagi F, Weinreb RN. Prostaglandin action on ciliary smooth muscle extracellular matrix metabolism: implications for uveoscleral outflow. Surv Ophthalmol. 1997 Feb;41 Suppl 2:S53-9. doi: 10.1016/s0039-6257(97)80008-2.
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Mayo C, Ren R, Rich C, Stepp MA, Trinkaus-Randall V. Regulation by P2X7: epithelial migration and stromal organization in the cornea. Invest Ophthalmol Vis Sci. 2008 Oct;49(10):4384-91. doi: 10.1167/iovs.08-1688. Epub 2008 May 23.
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Sagara T, Gaton DD, Lindsey JD, Gabelt BT, Kaufman PL, Weinreb RN. Topical prostaglandin F2alpha treatment reduces collagen types I, III, and IV in the monkey uveoscleral outflow pathway. Arch Ophthalmol. 1999 Jun;117(6):794-801. doi: 10.1001/archopht.117.6.794.
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Chronopoulos A, Tang A, Beglova E, Trackman PC, Roy S. High glucose increases lysyl oxidase expression and activity in retinal endothelial cells: mechanism for compromised extracellular matrix barrier function. Diabetes. 2010 Dec;59(12):3159-66. doi: 10.2337/db10-0365. Epub 2010 Sep 7.
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Mathew JH, Bergmanson JP, Doughty MJ. Fine structure of the interface between the anterior limiting lamina and the anterior stromal fibrils of the human cornea. Invest Ophthalmol Vis Sci. 2008 Sep;49(9):3914-8. doi: 10.1167/iovs.07-0707.
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Scott JE, Dyne KM, Thomlinson AM, Ritchie M, Bateman J, Cetta G, Valli M. Human cells unable to express decoron produced disorganized extracellular matrix lacking "shape modules" (interfibrillar proteoglycan bridges). Exp Cell Res. 1998 Aug 25;243(1):59-66. doi: 10.1006/excr.1998.4089.
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He J, Bazan NG, Bazan HE. Alkali-induced corneal stromal melting prevention by a novel platelet-activating factor receptor antagonist. Arch Ophthalmol. 2006 Jan;124(1):70-8. doi: 10.1001/archopht.124.1.70.
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BACKGROUND
Meda R, Wang Q, Paoloni D, Harasymowycz P, Brunette I. The impact of chronic use of prostaglandin analogues on the biomechanical properties of the cornea in patients with primary open-angle glaucoma. Br J Ophthalmol. 2017 Feb;101(2):120-125. doi: 10.1136/bjophthalmol-2016-308432. Epub 2016 May 9.
Reference Type
DERIVED
Other Identifiers
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MaisonneuveRH
Identifier Type: -
Identifier Source: org_study_id
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