Cryoapplication Versus Anti-VEGF Before Diabetic Vitrectomy

NCT ID: NCT05514925

Last Updated: 2022-08-31

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

PHASE4

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-11-21

Study Completion Date

2022-12-31

Brief Summary

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Pars-plana vitrectomy (PPV) is the cornerstone of surgical treatment for eyes with complicated proliferative diabetic retinopathy. Anti-VEGF intravitreal injection before PPV has shown a good effect on surgical outcomes. However, many patients present with co-morbidities that contraindicate the usage of anti-VEGF in the pre-operative period. Thus, cryoapplication, an old therapeutic tool for proliferative diabetic retinopathy may be a good alternative. The investigators present herein a comparative study between peripheral retinal cryoapplication and anti-VEGF before vitrectomy for complicated proliferative diabetic retinopathy.

Detailed Description

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Pars-plana vitrectomy (PPV) is the cornerstone of surgical treatment of complicated proliferative diabetic retinopathy allowing the removal of vitreous opacity and releasing tractions from the retina. Surgical outcomes, however, are variable depending on a large array of pre, per, and post-operative conditions.

The preoperative anti-VEGF intravitreal injection has shown a good effect on surgical outcomes in patients with vitreous hemorrhage or tractional retinal detachment.

However, a great number of patients present with co-morbidities that contraindicate the usage of anti-VEGF in the pre-operative period.

Thus, an alternative to this adjunctive therapy is worth investigating. In another hand, cryoapplication, an old therapeutic tool for proliferative diabetic retinopathy had been used in patients with non-clear ocular media with vitreous hemorrhage.

The investigators present herein a comparative study between peripheral retinal cryoapplication and anti-VEGF before vitrectomy for complicated proliferative diabetic retinopathy.

Conditions

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Proliferative Diabetic Retinopathy Vitreous Hemorrhage Tractional Retinal Detachment

Keywords

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Retinal cryoapplication Anti-VEGF Vitrectomy

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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Preoperative Anti-VEGF Intravitreal Injection

Three to five days before vitrectomy, each participant received one intravitreal Bevacizumab injection (1.25 mg,0.05 ml).

Group Type ACTIVE_COMPARATOR

Bevacizumab Injection [Avastin]

Intervention Type DRUG

Intravitreal injection of bevacizumab (1.25 mg, 0.05 ml) in the inferior temporal quadrant of the eye, 4 mm behind the limbus in phakic eyes, and 3.5 mm in pseudophakic eyes.

Peripheral Retinal Cryoapplication

Four to six weeks before vitrectomy, each participant underwent peripheral retinal cryoapplication.

Group Type EXPERIMENTAL

Peripheral Retinal Cryoapplication

Intervention Type PROCEDURE

In the operating room under peribulbar anesthesia, four focal conjunctival incisions are made on each quadrant between the muscles insertions. The Tenon capsule is opened with scissors to expose the sclera. Four to six cryo-applications are made per quadrant, at the edge of muscle insertion and a line behind. The exposure time is 4 to 5 seconds. 7-0 resorbable sutures are then put on each quadrant to close the conjunctiva.

Interventions

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Bevacizumab Injection [Avastin]

Intravitreal injection of bevacizumab (1.25 mg, 0.05 ml) in the inferior temporal quadrant of the eye, 4 mm behind the limbus in phakic eyes, and 3.5 mm in pseudophakic eyes.

Intervention Type DRUG

Peripheral Retinal Cryoapplication

In the operating room under peribulbar anesthesia, four focal conjunctival incisions are made on each quadrant between the muscles insertions. The Tenon capsule is opened with scissors to expose the sclera. Four to six cryo-applications are made per quadrant, at the edge of muscle insertion and a line behind. The exposure time is 4 to 5 seconds. 7-0 resorbable sutures are then put on each quadrant to close the conjunctiva.

Intervention Type PROCEDURE

Other Intervention Names

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IVB CRYO

Eligibility Criteria

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Inclusion Criteria

* Type 1 or 2 diabetes mellitus
* Vitreous or retro-hyaloidal hemorrhage and/or tractional retinal detachment threatening or involving the macula
* No or less than 1000 impacts of preoperative retinal photocoagulation and/or iris rubeosis
* Only one eye per participant

Exclusion Criteria

* Negative light perception
* Previous vitrectomy
* Contraindication to anti-VEGF therapy or retinal cryoapplication
* Associated rhegmatogenous retinal detachment
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Khairallah Moncef

OTHER

Sponsor Role lead

Responsible Party

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Khairallah Moncef

Clinical Professor

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Imen Ksiaa, Assoc. Prof.

Role: PRINCIPAL_INVESTIGATOR

Fattouma Bourguiba University Hospital

Locations

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Fattouma Bourguiba University Hospital - Ophthalmology Department

Monastir, , Tunisia

Site Status RECRUITING

Countries

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Tunisia

Central Contacts

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Imen Ksiaa, Assoc. Prof.

Role: CONTACT

Phone: +21694994234

Email: [email protected]

Facility Contacts

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Imen Ksiaa, Assoc. Prof.

Role: primary

References

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Zhang ZH, Liu HY, Hernandez-Da Mota SE, Romano MR, Falavarjani KG, Ahmadieh H, Xu X, Liu K. Vitrectomy with or without preoperative intravitreal bevacizumab for proliferative diabetic retinopathy: a meta-analysis of randomized controlled trials. Am J Ophthalmol. 2013 Jul;156(1):106-115.e2. doi: 10.1016/j.ajo.2013.02.008.

Reference Type BACKGROUND
PMID: 23791371 (View on PubMed)

Arevalo JF, Lasave AF, Kozak I, Al Rashaed S, Al Kahtani E, Maia M, Farah ME, Cutolo C, Brito M, Osorio C, Navarro P, Wu L, Berrocal MH, Morales-Canton V, Serrano MA, Graue-Wiechers F, Sabrosa NA, Alezzandrini AA, Gallego-Pinazo R; Pan-American Collaborative Retina Study (PACORES) Group. Preoperative Bevacizumab for Tractional Retinal Detachment in Proliferative Diabetic Retinopathy: A Prospective Randomized Clinical Trial. Am J Ophthalmol. 2019 Nov;207:279-287. doi: 10.1016/j.ajo.2019.05.007. Epub 2019 May 13.

Reference Type BACKGROUND
PMID: 31095954 (View on PubMed)

Lim AS, Ang BC. Cryoapplication in diabetic retinopathy. Int Ophthalmol. 1986 May;9(2-3):139-41. doi: 10.1007/BF00159842.

Reference Type BACKGROUND
PMID: 3721714 (View on PubMed)

Other Identifiers

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IORG0009738 N95

Identifier Type: REGISTRY

Identifier Source: secondary_id

LR18SP09 N01

Identifier Type: -

Identifier Source: org_study_id