Descemet Membrane Endothelial Keratoplasty Combined With Intraocular Lens Exchange: Sequential Versus Combined Surgery

NCT ID: NCT04344522

Last Updated: 2020-08-12

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

UNKNOWN

Clinical Phase

NA

Total Enrollment

20 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-08-11

Study Completion Date

2021-11-01

Brief Summary

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Surgical treatment of corneal endothelial decompensation in the presence of an anterior chamber intraocular lens (AC IOL) is technically challenging. The ultimate management is to perform Descemet membrane endothelial keratoplasty (DMEK). However , unfolding the DMEK graft in the presence of an AC IOL can be difficult and injurious to the graft so the investigators recommend exchanging the AC IOL with a posterior chamber IOL first. In this study , the investigators aim to compare the outcome and complications of performing DMEK and IOL exchange as combined one stage surgery versus .sequential 2 stage procedure

Detailed Description

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Pseudophakic Bullous keratopathy is the second leading indication for endothelial keratoplasty. One of the main controversies in the management of PBK in the presence of an AC IOl is whether to retain the IOL or perform an IOL exchange with a PC IOL. The investigators believe that retention of an AC IOL can be hazardous to the DMEK graft due to reduced depth of the anterior chamber and traumatic touch between the graft and the IOL during graft unfolding and even postoperatively. On the other hand , performing an IOL exchange is relatively time consuming and requires excess manipulation of the iris tissue with the risk of intraoperative hyphema and postoperative inflammation which can affect the endothelial graft survival and cell count.

Aim of the study : to compare the outcome and complications between performing intraocular lens (IOL) exchange and Descemet membrane endothelial keratoplasty (DMEK) as single stage versus two stage procedure in the management of pseudophakic bullous keratopathy associated with anterior chamber IOL.

Methods :

The study will be a prospective randomized controlled trial. Eligible subjects with pseudophakic bullous keratopathy and AC IOL will be assigned into two groups each comprising 10 eyes. One group will undergo AC IOL exchange with posterior chamber (PC) IOL ( Poly methyl methacrylate (PMMA) lens or iris claw lens if there is no adequate capsular support) combined with DMEK in the same setting. The other group will undergo 2 stage procedure ; first one is IOL exchange , iridoplasty (if required) and inferior peripheral iridectomy and the second stage is DMEK one month later.

Conditions

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Pseudophakic Bullous Keratopathy Anterior Chamber Intraocular Lens

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SEQUENTIAL

randomized controlled trial
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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sequential 2 stage procedure

In this arm , the procedure will be performed in two stages ; the first stage will include performing IOL exchange together with iridoplasty ( if required) and inferior peripheral iridectomy (PI) and the second stage is performing DMEK one month later

Group Type EXPERIMENTAL

Descemet membrane endothelial keratoplasty DMEK

Intervention Type PROCEDURE

DMEK : it involves separating the Descemet membrane from a corneal donor graft , doing a descematorhexis in the recepient cornea , loading and injection of the graft into the anterior chamber , unfolding and fixing the graft to the recepient cornea by intracameral air bubble.

IOL exchange

Intervention Type PROCEDURE

IOL exchange : it involves performing a corneoscleral tunnel , freeing the AC IOL from any adhesions and explanting it through the tunnel , then implanting a posterior chamber PMMA lens or iris claw lens if there is no adequate capsular support.

iridoplasty

Intervention Type PROCEDURE

iridoplasty : repairing any iris defect by using 10/0 prolene.

Inferior peripheral iridectomy

Intervention Type PROCEDURE

Inferior peripheral iridectomy : performed by vannus scissor to avoid postoperative pupillary block due to the intracameral air .

combined single stage procedure

In this arm, both IOL exchange and DMEK will be performed in the same setting

Group Type EXPERIMENTAL

Descemet membrane endothelial keratoplasty DMEK

Intervention Type PROCEDURE

DMEK : it involves separating the Descemet membrane from a corneal donor graft , doing a descematorhexis in the recepient cornea , loading and injection of the graft into the anterior chamber , unfolding and fixing the graft to the recepient cornea by intracameral air bubble.

IOL exchange

Intervention Type PROCEDURE

IOL exchange : it involves performing a corneoscleral tunnel , freeing the AC IOL from any adhesions and explanting it through the tunnel , then implanting a posterior chamber PMMA lens or iris claw lens if there is no adequate capsular support.

iridoplasty

Intervention Type PROCEDURE

iridoplasty : repairing any iris defect by using 10/0 prolene.

Inferior peripheral iridectomy

Intervention Type PROCEDURE

Inferior peripheral iridectomy : performed by vannus scissor to avoid postoperative pupillary block due to the intracameral air .

Interventions

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Descemet membrane endothelial keratoplasty DMEK

DMEK : it involves separating the Descemet membrane from a corneal donor graft , doing a descematorhexis in the recepient cornea , loading and injection of the graft into the anterior chamber , unfolding and fixing the graft to the recepient cornea by intracameral air bubble.

Intervention Type PROCEDURE

IOL exchange

IOL exchange : it involves performing a corneoscleral tunnel , freeing the AC IOL from any adhesions and explanting it through the tunnel , then implanting a posterior chamber PMMA lens or iris claw lens if there is no adequate capsular support.

Intervention Type PROCEDURE

iridoplasty

iridoplasty : repairing any iris defect by using 10/0 prolene.

Intervention Type PROCEDURE

Inferior peripheral iridectomy

Inferior peripheral iridectomy : performed by vannus scissor to avoid postoperative pupillary block due to the intracameral air .

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

1. Patients having pseudophakic bullous keratopathy associated with an anterior chamber intraocular lens.
2. Age above 18 years old.

Exclusion Criteria

1. Patients with corneal stromal scarring .
2. Patients who had prior glaucoma drainage devices implantation. 3 Patient with non-repairable loss in the iris tissue.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Alexandria University

OTHER

Sponsor Role lead

Responsible Party

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Mohamed Kolaib

Ophthalmology resident

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Mohamed M Kolaib, MBBCh

Role: PRINCIPAL_INVESTIGATOR

Alexandria Faculty of Medicine

Mohamed B Goweida, MD

Role: STUDY_CHAIR

Alexandria Faculty of Medicine

Locations

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Faculty of Medicine

Alexandria, , Egypt

Site Status RECRUITING

Countries

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Egypt

Central Contacts

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Mohamed M Kolaib, MBBCh

Role: CONTACT

00201283674800

Mohamed B Goweida, MD

Role: CONTACT

00201011755557

Facility Contacts

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Mohamed M Kolaib, MBBCh

Role: primary

00201283674800

Mohamed B Goweida, MD

Role: backup

00201011755557

References

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Melles GR, Ong TS, Ververs B, van der Wees J. Preliminary clinical results of Descemet membrane endothelial keratoplasty. Am J Ophthalmol. 2008 Feb;145(2):222-227. doi: 10.1016/j.ajo.2007.09.021. Epub 2007 Dec 3.

Reference Type BACKGROUND
PMID: 18061137 (View on PubMed)

Ham L, Dapena I, van Luijk C, van der Wees J, Melles GR. Descemet membrane endothelial keratoplasty (DMEK) for Fuchs endothelial dystrophy: review of the first 50 consecutive cases. Eye (Lond). 2009 Oct;23(10):1990-8. doi: 10.1038/eye.2008.393. Epub 2009 Jan 30.

Reference Type BACKGROUND
PMID: 19182768 (View on PubMed)

Dapena I, Ham L, Melles GR. Endothelial keratoplasty: DSEK/DSAEK or DMEK--the thinner the better? Curr Opin Ophthalmol. 2009 Jul;20(4):299-307. doi: 10.1097/ICU.0b013e32832b8d18.

Reference Type BACKGROUND
PMID: 19417653 (View on PubMed)

Woo JH, Ang M, Htoon HM, Tan D. Descemet Membrane Endothelial Keratoplasty Versus Descemet Stripping Automated Endothelial Keratoplasty and Penetrating Keratoplasty. Am J Ophthalmol. 2019 Nov;207:288-303. doi: 10.1016/j.ajo.2019.06.012. Epub 2019 Jun 19.

Reference Type BACKGROUND
PMID: 31228467 (View on PubMed)

Pricopie S, Istrate S, Voinea L, Leasu C, Paun V, Radu C. Pseudophakic bullous keratopathy. Rom J Ophthalmol. 2017 Apr-Jun;61(2):90-94. doi: 10.22336/rjo.2017.17.

Reference Type BACKGROUND
PMID: 29450379 (View on PubMed)

Ravalico G, Botteri E, Baccara F. Long-term endothelial changes after implantation of anterior chamber intraocular lenses in cataract surgery. J Cataract Refract Surg. 2003 Oct;29(10):1918-23. doi: 10.1016/s0886-3350(02)02052-7.

Reference Type BACKGROUND
PMID: 14604711 (View on PubMed)

Liarakos VS, Ham L, Dapena I, Tong CM, Quilendrino R, Yeh RY, Melles GR. Endothelial keratoplasty for bullous keratopathy in eyes with an anterior chamber intraocular lens. J Cataract Refract Surg. 2013 Dec;39(12):1835-45. doi: 10.1016/j.jcrs.2013.05.045.

Reference Type BACKGROUND
PMID: 24286840 (View on PubMed)

Gupta PK, Bordelon A, Vroman DT, Afshari NA, Kim T. Early outcomes of descemet stripping automated endothelial keratoplasty in pseudophakic eyes with anterior chamber intraocular lenses. Am J Ophthalmol. 2011 Jan;151(1):24-28.e1. doi: 10.1016/j.ajo.2010.07.003. Epub 2010 Oct 20.

Reference Type BACKGROUND
PMID: 20970110 (View on PubMed)

Other Identifiers

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DMEK ACIOL

Identifier Type: -

Identifier Source: org_study_id

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