The American Glaucoma Society (AGS) Second Aqueous Shunt Implant vs. Transscleral Cyclophotocoagulation Treatment Study (ASSISTS)

NCT ID: NCT02691455

Last Updated: 2021-11-02

Study Results

Results available

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Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

NA

Total Enrollment

50 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-02-29

Study Completion Date

2020-09-30

Brief Summary

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Outcomes of subjects with uncontrolled glaucoma with a single existing aqueous tube shunt implant undergoing a second aqueous shunt to transscleral diode laser cyclophotocoagulation.

Detailed Description

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This is a study comparing short- (1 year), mid- (3 years), and long-term (5 years) cumulative incidences of failures in participants who undergo a second aqueous shunt (SAS) to those cumulative incidences of failures in participants who undergo a second aqueous shunt (SAS) to those cumulative incidences of failures in participants who undergo transscleral diode laser cyclophotocoagulation (TLC) for eyes with uncontrolled glaucoma with a single existing aqueous tube shunt procedure.

Conditions

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Glaucoma

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Second Aqueous Shunt

Second Aqueous Shunt

Either a Baerveldt Glaucoma Implant 350-mm2 BG101-350 or an Ahmed Model FP7 Flexible Plate must be used for all participants unless there is insufficient space, in which case a Baerveldt Glaucoma Implant 250-mm2 BG103-250 may be used.

Group Type ACTIVE_COMPARATOR

Baerveldt Glaucoma Implant 350-mm2 / BG101-350

Intervention Type DEVICE

Ahmed Model FP7 Flexible Plate

Intervention Type DEVICE

Baerveldt Glaucoma Implant 250-mm2 / BG103-250

Intervention Type DEVICE

Transscleral Cyclophotocoagulation

Transscleral Diode Laser Cyclophotocoagulation

Group Type ACTIVE_COMPARATOR

Transscleral Diode Laser Cyclophotocoagulation

Intervention Type PROCEDURE

Recommended setting are 2000 milliwatt (mW) for 2 seconds, 1850 mW for 3 seconds or 1750 mW for 4 second duration, titrating the energy up or down just below where a pop is heard.

Interventions

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Baerveldt Glaucoma Implant 350-mm2 / BG101-350

Intervention Type DEVICE

Transscleral Diode Laser Cyclophotocoagulation

Recommended setting are 2000 milliwatt (mW) for 2 seconds, 1850 mW for 3 seconds or 1750 mW for 4 second duration, titrating the energy up or down just below where a pop is heard.

Intervention Type PROCEDURE

Ahmed Model FP7 Flexible Plate

Intervention Type DEVICE

Baerveldt Glaucoma Implant 250-mm2 / BG103-250

Intervention Type DEVICE

Other Intervention Names

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Transscleral Diode Laser Cyclophotocoagulation (TLC)

Eligibility Criteria

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Inclusion Criteria

* Women and men 18 to 85 years of age
* Glaucoma not adequately controlled (IOP \>18 mmHg on maximum tolerated topical therapy) with a single aqueous shunt (AS).
* Best-corrected visual acuity (BCVA) of hand motion (HM) or better in the study eye

Exclusion Criteria

* Monocular
* Presence of more than one AS in the study eye
* Previous cyclodestruction in the study eye
* Presence of active iris neovascularization in the study eye
* Binocular diplopia
* Presence of scleral buckle in the study eye
* History or scleritis in either eye
* History of scleromalacia in the study eye
* Insufficient conjunctiva to cover AS in the study eye
* IOP cannot be accurately measured with Goldmann applanation, Pneumotonometry, or Tono-Pen in the study eye
* Presence of silicone oil in the study eye
* Presence of retinal detachment in the study eye
* Presence of intraocular or orbital tumor affecting the study eye
* Need for cataract extraction or concurrent procedure at the time of study treatment, except tectonic aqueous shunt revisions for both groups is allowed.
* In the opinion of the investigator, should not be enrolled in this study
* Unwilling or unable to give consent and satisfy requirements of the study
Minimum Eligible Age

18 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Robert Feldman

OTHER

Sponsor Role lead

Responsible Party

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Robert Feldman

M.D.

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Robert Feldman, MD

Role: STUDY_CHAIR

Robert Cizik Eye Clinic

Locations

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University of California San Diego - Shiley Eye Institute

La Jolla, California, United States

Site Status

University of Southern California

Los Angeles, California, United States

Site Status

Bascom Palmer Eye Institute - Miami

Miami, Florida, United States

Site Status

Bascom Palmer Eye Institute

Palm Beach Gardens, Florida, United States

Site Status

Northwestern University - Feinberg School of Medicine

Chicago, Illinois, United States

Site Status

Stiles Eyecare Excellence and Glaucoma Institute

Overland Park, Kansas, United States

Site Status

New England Eye Center - Tufts Medical Center

Boston, Massachusetts, United States

Site Status

Massachusetts Eye and Ear Infirmary

Boston, Massachusetts, United States

Site Status

Glaucoma Consultants of St. Louis

Chesterfield, Missouri, United States

Site Status

Rutgers; New Jersey Medical School; IOVS

Newark, New Jersey, United States

Site Status

Glaucoma Institute of Northern NJ, LLC

Rochelle Park, New Jersey, United States

Site Status

New York Eye and Ear Infirmary of Mount Sinai

New York, New York, United States

Site Status

Edward Harkness Eye Institute / Columbia University Medical Center

New York, New York, United States

Site Status

UNC Kittner Eye Center

Chapel Hill, North Carolina, United States

Site Status

Devers Eye Institute/Legacy Health

Portland, Oregon, United States

Site Status

Wills Eye Hospital

Philadelphia, Pennsylvania, United States

Site Status

UPMC Eye Center

Pittsburgh, Pennsylvania, United States

Site Status

Vanderbilt Eye Institute

Nashville, Tennessee, United States

Site Status

Robert Cizik Eye Clinic

Houston, Texas, United States

Site Status

University of Virginia Health System

Charlottesville, Virginia, United States

Site Status

Virginia Eye Institute

Richmond, Virginia, United States

Site Status

University of Washington Medicine Eye Institute

Seattle, Washington, United States

Site Status

WVU Eye Institute

Morgantown, West Virginia, United States

Site Status

Countries

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Canada United States

References

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Arora KS, Robin AL, Corcoran KJ, Corcoran SL, Ramulu PY. Use of Various Glaucoma Surgeries and Procedures in Medicare Beneficiaries from 1994 to 2012. Ophthalmology. 2015 Aug;122(8):1615-24. doi: 10.1016/j.ophtha.2015.04.015. Epub 2015 Jun 16.

Reference Type BACKGROUND
PMID: 26092196 (View on PubMed)

Gedde SJ, Schiffman JC, Feuer WJ, Herndon LW, Brandt JD, Budenz DL; Tube versus Trabeculectomy Study Group. Treatment outcomes in the Tube Versus Trabeculectomy (TVT) study after five years of follow-up. Am J Ophthalmol. 2012 May;153(5):789-803.e2. doi: 10.1016/j.ajo.2011.10.026. Epub 2012 Jan 15.

Reference Type BACKGROUND
PMID: 22245458 (View on PubMed)

Budenz DL, Barton K, Gedde SJ, Feuer WJ, Schiffman J, Costa VP, Godfrey DG, Buys YM; Ahmed Baerveldt Comparison Study Group. Five-year treatment outcomes in the Ahmed Baerveldt comparison study. Ophthalmology. 2015 Feb;122(2):308-16. doi: 10.1016/j.ophtha.2014.08.043. Epub 2014 Oct 17.

Reference Type BACKGROUND
PMID: 25439606 (View on PubMed)

Anand A, Tello C, Sidoti PA, Ritch R, Liebmann JM. Sequential glaucoma implants in refractory glaucoma. Am J Ophthalmol. 2010 Jan;149(1):95-101. doi: 10.1016/j.ajo.2009.07.019. Epub 2009 Oct 17.

Reference Type BACKGROUND
PMID: 19837382 (View on PubMed)

Burgoyne JK, WuDunn D, Lakhani V, Cantor LB. Outcomes of sequential tube shunts in complicated glaucoma. Ophthalmology. 2000 Feb;107(2):309-14. doi: 10.1016/s0161-6420(99)00039-1.

Reference Type BACKGROUND
PMID: 10690831 (View on PubMed)

Ness PJ, Khaimi MA, Feldman RM, Tabet R, Sarkisian SR Jr, Skuta GL, Chuang AZ, Mankiewicz KA. Intermediate term safety and efficacy of transscleral cyclophotocoagulation after tube shunt failure. J Glaucoma. 2012 Feb;21(2):83-8. doi: 10.1097/IJG.0b013e31820bd1ce.

Reference Type BACKGROUND
PMID: 21336148 (View on PubMed)

Jimenez-Roman J, Gil-Carrasco F, Costa VP, Schimiti RB, Lerner F, Santana PR, Vascocellos JP, Castillejos-Chevez A, Turati M, Fabre-Miranda K. Intraocular pressure control after the implantation of a second Ahmed glaucoma valve. Int Ophthalmol. 2016 Jun;36(3):347-53. doi: 10.1007/s10792-015-0125-z. Epub 2015 Sep 3.

Reference Type BACKGROUND
PMID: 26334729 (View on PubMed)

Semchyshyn TM, Tsai JC, Joos KM. Supplemental transscleral diode laser cyclophotocoagulation after aqueous shunt placement in refractory glaucoma. Ophthalmology. 2002 Jun;109(6):1078-84. doi: 10.1016/s0161-6420(02)01019-9.

Reference Type BACKGROUND
PMID: 12045047 (View on PubMed)

Smith M, Buys YM, Trope GE. Second Ahmed valve insertion in the same eye. J Glaucoma. 2009 Apr-May;18(4):336-40. doi: 10.1097/IJG.0b013e318182edfb.

Reference Type BACKGROUND
PMID: 19365202 (View on PubMed)

Godfrey DG, Krishna R, Greenfield DS, Budenz DL, Gedde SJ, Scott IU. Implantation of second glaucoma drainage devices after failure of primary devices. Ophthalmic Surg Lasers. 2002 Jan-Feb;33(1):37-43.

Reference Type BACKGROUND
PMID: 11820661 (View on PubMed)

Ko SJ, Hwang YH, Ahn SI, Kim HK. Surgical Outcomes of Additional Ahmed Glaucoma Valve Implantation in Refractory Glaucoma. J Glaucoma. 2016 Jun;25(6):e620-4. doi: 10.1097/IJG.0000000000000298.

Reference Type BACKGROUND
PMID: 26091182 (View on PubMed)

Francis BA, Kawji AS, Vo NT, Dustin L, Chopra V. Endoscopic cyclophotocoagulation (ECP) in the management of uncontrolled glaucoma with prior aqueous tube shunt. J Glaucoma. 2011 Oct;20(8):523-7. doi: 10.1097/IJG.0b013e3181f46337.

Reference Type BACKGROUND
PMID: 21048513 (View on PubMed)

Sood S, Beck AD. Cyclophotocoagulation versus sequential tube shunt as a secondary intervention following primary tube shunt failure in pediatric glaucoma. J AAPOS. 2009 Aug;13(4):379-83. doi: 10.1016/j.jaapos.2009.05.006.

Reference Type BACKGROUND
PMID: 19683190 (View on PubMed)

Schaefer JL, Levine MA, Martorana G, Koenigsman H, Smith MF, Sherwood MB. Failed glaucoma drainage implant: long-term outcomes of a second glaucoma drainage device versus cyclophotocoagulation. Br J Ophthalmol. 2015 Dec;99(12):1718-24. doi: 10.1136/bjophthalmol-2015-306725. Epub 2015 May 29.

Reference Type BACKGROUND
PMID: 26024673 (View on PubMed)

Gabelt BT, Kaufman PL. Changes in aqueous humor dynamics with age and glaucoma. Prog Retin Eye Res. 2005 Sep;24(5):612-37. doi: 10.1016/j.preteyeres.2004.10.003.

Reference Type BACKGROUND
PMID: 15919228 (View on PubMed)

Ma JX, Chuang AZ, Feldman RM, Mansberger SL, Tanna AP, Blieden LS, Shoham D, Bell NP, Gross RL, Pasquale LR, Greenfield DS, Liebmann JM, Weinreb RN; ASSISTS Study Group. Direct Costs of Second Aqueous Shunt Implant Versus Transscleral Cyclophotocoagulation (The Assists Trial). J Glaucoma. 2023 Mar 1;32(3):145-150. doi: 10.1097/IJG.0000000000002143. Epub 2023 Feb 1.

Reference Type DERIVED
PMID: 36848258 (View on PubMed)

Feldman RM, Chuang AZ, Mansberger SL, Tanna AP, Blieden LS, Bell NP, Gross RL, Pasquale LR, Greenfield DS, Liebmann JM, Weinreb RN; ASSISTS Group. Outcomes of the Second Aqueous Shunt Implant Versus Transscleral Cyclophotocoagulation Treatment Study: A Randomized Comparative Trial. J Glaucoma. 2022 Sep 1;31(9):701-709. doi: 10.1097/IJG.0000000000002079. Epub 2022 Jul 21.

Reference Type DERIVED
PMID: 35901309 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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HSC-MS-15-1053

Identifier Type: -

Identifier Source: org_study_id