S-BLR Versus C-BLR for CI-IXT in Children

NCT ID: NCT04064112

Last Updated: 2023-12-20

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

NA

Total Enrollment

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-10-18

Study Completion Date

2023-02-11

Brief Summary

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This is a multi-center, randomized single-blind controlled trial to compare the effectiveness of S-BLR with C-BLR for the treatment of CI-IXT in children.

Specific Aim 1 (Primary): To compare the surgical successful rate of S-BLR with C-BLR for the treatment of CI-IXT in children.

Specific Aim 2 (Secondary): To study the suboptimal surgical outcomes between S-BLR and C-BLR for the treatment of CI-IXT in children.

Detailed Description

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Using conventional surgical procedures, higher postoperative near undercorrection and/or distant overcorrection rates were observed in CI-IXT. To achieve better outcome, S-BLR was introduced. Previous studies showed its efficacy in reducing near exodeviation, distant exodeviation, and NDD. So far, only limited studies have directly evaluated the surgical outcomes between S-BLR and C-BLR. The pilot study done by Snir et al included 12 patients with S-BLR and 6 patients with C-BLR and the success rates of S-BLR vs C-BLR were 92% vs 0 at one-year follow-up. The retrospective study done by Song et al included 17 patients undergoing S-BLR and 14 patients undergoing C-BLR. With stricter successful criteria, the success rates of S-BLR vs C-BLR were 35% vs 7% at six-month follow-up. A large randomized trial is needed to compare the surgical successful rate and suboptimal surgical outcomes of S-BLR with C-BLR in children with CI-IXT.

The proposed trial will be conducted in 6 different study sites working in the field of pediatric ophthalmology and strabismus.Each site will have one certified surgeon to do all surgeries. Under general anesthesia, the LR recession is performed using an inferior-temporal fornix incision. For S-BLR, the lower horn of the LR is recessed based on near exodeviation and the upper horn is recessed based on distant exodeviation. For C-BLR, the LR is recessed based on distant exodeviation. Surgical dose is according to the largest preoperative exodeviation at distance (6 meters) or near (1/3 meter) by the prism and alternate cover test(PACT). The extent of the recession is based on Parks' surgical dosage schedule.

Conditions

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Convergence Insufficiency Intermittent Exotropia (CI-IXT)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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S-BLR

For S-BLR, the lower horn of the LR is recessed based on near exodeviation and the upper horn is recessed based on distant exodeviation.

Group Type EXPERIMENTAL

S-BLR

Intervention Type PROCEDURE

Surgery of slanted bilateral LR recession for CI-IXT patients

C-BLR

For C-BLR, the LR is recessed based on distant exodeviation.

Group Type ACTIVE_COMPARATOR

C-BLR

Intervention Type PROCEDURE

Surgery of conventional bilateral lateral rectus recession for CI-IXT patients

Interventions

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S-BLR

Surgery of slanted bilateral LR recession for CI-IXT patients

Intervention Type PROCEDURE

C-BLR

Surgery of conventional bilateral lateral rectus recession for CI-IXT patients

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Exodeviation at least 15 at distance (6 meters);
* Exodeviation at most 50 at near (1/3 meter);
* Greater exodeviation at near than at distance by 10 or more;
* Control score of exodeviation greater than 3;
* Best-corrected visual acuity of 20/40 or better in the worse eye, and interocular difference of less than 2 lines;
* Myopia5.00D, hyperopia3.0D and anisometropia≤2.5D based on cycloplegic refraction
* Optical correction needed for at least 2 weeks before evaluation of exodeviation: myopia0.5D or astigmatism1.5D in either eye, or anisometropia1.0D;
* Written informed consent given by participants and their parents or legal guardians.

Exclusion Criteria

* Prior strabismus surgery or botulinum toxin injection;
* Coexisting vertical deviation greater than 5, oblique muscle dysfunction, torsional deviation, dissociated vertical deviation, A-V pattern, or other conditions requiring horizontal rectus transposition, oblique surgery or vertical rectus surgery;
* Paralytic or restrictive strabismus;
* Lateral incomitance (greater exodeviation in right or left gaze position than in primary position by 5 or more with appropriate optical correction);
* Ocular disease other than strabismus or refractive error;
* Previous intraocular or refractive surgery;
* Craniofacial malformations affecting the orbit;
* Significant neurological disorders;
* Birth date34 weeks or birth weight1500 gram.

Abbreviations: CI-IXT, convergence insufficiency intermittent exotropia; D, diopter.
Minimum Eligible Age

5 Years

Maximum Eligible Age

12 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Children's Hospital of Fudan University

OTHER

Sponsor Role collaborator

Xinhua Hospital, Shanghai Jiao Tong University School of Medicine

OTHER

Sponsor Role collaborator

Shanghai Jiao Tong University School of Medicine

OTHER

Sponsor Role collaborator

Tianjin Eye Hospital

OTHER

Sponsor Role collaborator

Renmin Hospital of Wuhan University

OTHER

Sponsor Role collaborator

AIER Eye Hospital (Kunming)

UNKNOWN

Sponsor Role collaborator

Chen Zhao

OTHER

Sponsor Role lead

Responsible Party

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Chen Zhao

Vice President of Department of Ophthalmology and Visual Science

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Chen Zhao, Doctor

Role: STUDY_CHAIR

Eye & ENT Hospital of Fudan University

Xiaoli Kang, Doctor

Role: PRINCIPAL_INVESTIGATOR

Xinhua Hospital, Shanghai Jiao Tong University

Yueping Li, Doctor

Role: PRINCIPAL_INVESTIGATOR

Tianjin Eye Hospital

Lianhong Zhou, Doctor

Role: PRINCIPAL_INVESTIGATOR

Renmin Hospital of Wuhan University

Jing Yao, Doctor

Role: STUDY_DIRECTOR

Eye & ENT Hospital of Fudan University

Chenhao Yang, Doctor

Role: PRINCIPAL_INVESTIGATOR

Children's Hospital of Fudan University

Jiangtao Xu, Doctor

Role: PRINCIPAL_INVESTIGATOR

AIER Eye Hospital (Kunming)

Locations

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Eye & ENT Hospital of Fudan University

Shanghai, , China

Site Status

Countries

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China

References

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Burian HM. Exodeviations: their classification, diagnosis and treatment. Am J Ophthalmol. 1966 Dec;62(6):1161-6. doi: 10.1016/0002-9394(66)92570-0. No abstract available.

Reference Type BACKGROUND
PMID: 5957892 (View on PubMed)

Raab EL, Parks MM. Recession of the lateral recti. Effect of Preoperative fusion and distance-near relationship. Arch Ophthalmol. 1975 Aug;93(8):584-6. doi: 10.1001/archopht.1975.01010020568002.

Reference Type BACKGROUND
PMID: 1156220 (View on PubMed)

Snir M, Axer-Siegel R, Shalev B, Sherf I, Yassur Y. Slanted lateral rectus recession for exotropia with convergence weakness. Ophthalmology. 1999 May;106(5):992-6. doi: 10.1016/S0161-6420(99)00522-9.

Reference Type BACKGROUND
PMID: 10328402 (View on PubMed)

Chun BY, Kang KM. Early results of slanted recession of the lateral rectus muscle for intermittent exotropia with convergence insufficiency. J Ophthalmol. 2015;2015:380467. doi: 10.1155/2015/380467. Epub 2015 Jan 26.

Reference Type BACKGROUND
PMID: 25688298 (View on PubMed)

Farid MF, Abdelbaset EA. Surgical outcomes of three different surgical techniques for treatment of convergence insufficiency intermittent exotropia. Eye (Lond). 2018 Apr;32(4):693-700. doi: 10.1038/eye.2017.259. Epub 2017 Dec 22.

Reference Type BACKGROUND
PMID: 29271419 (View on PubMed)

Chen X, Fu Z, Yu J, Ding H, Bai J, Chen J, Gong Y, Zhu H, Yu R, Liu H. Prevalence of amblyopia and strabismus in Eastern China: results from screening of preschool children aged 36-72 months. Br J Ophthalmol. 2016 Apr;100(4):515-9. doi: 10.1136/bjophthalmol-2015-306999. Epub 2015 Aug 10.

Reference Type BACKGROUND
PMID: 26261229 (View on PubMed)

Yang HK, Hwang JM. Surgical outcomes in convergence insufficiency-type exotropia. Ophthalmology. 2011 Aug;118(8):1512-7. doi: 10.1016/j.ophtha.2011.01.004. Epub 2011 Apr 7.

Reference Type BACKGROUND
PMID: 21474185 (View on PubMed)

Wang B, Wang L, Wang Q, Ren M. Comparison of different surgery procedures for convergence insufficiency-type intermittent exotropia in children. Br J Ophthalmol. 2014 Oct;98(10):1409-13. doi: 10.1136/bjophthalmol-2013-304442. Epub 2014 May 19.

Reference Type BACKGROUND
PMID: 24842862 (View on PubMed)

Ma L, Yang L, Li N. Bilateral lateral rectus muscle recession for the convergence insufficiency type of intermittent exotropia. J AAPOS. 2016 Jun;20(3):194-196.e1. doi: 10.1016/j.jaapos.2016.01.014. Epub 2016 May 6.

Reference Type BACKGROUND
PMID: 27164428 (View on PubMed)

Choi DG, Rosenbaum AL. Medial rectus resection(s) with adjustable suture for intermittent exotropia of the convergence insufficiency type. J AAPOS. 2001 Feb;5(1):13-7. doi: 10.1067/mpa.2001.111137.

Reference Type BACKGROUND
PMID: 11182666 (View on PubMed)

BURIAN HM, SPIVEY BE. THE SURGICAL MANAGEMENT OF EXODEVIATIONS. Am J Ophthalmol. 1965 Apr;59:603-20. No abstract available.

Reference Type BACKGROUND
PMID: 14270998 (View on PubMed)

Kraft SP, Levin AV, Enzenauer RW. Unilateral surgery for exotropia with convergence weakness. J Pediatr Ophthalmol Strabismus. 1995 May-Jun;32(3):183-7. doi: 10.3928/0191-3913-19950501-12.

Reference Type BACKGROUND
PMID: 7636700 (View on PubMed)

Other Identifiers

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2019C-PEDIG

Identifier Type: -

Identifier Source: org_study_id