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GlaucomaNCT03187418

Treatment Outcomes of MicroPulse Trans-scleral Cyclophotocoagulation in Uncontrolled Glaucoma

A study testing MicroPulse® P3 Glaucoma Device (MP3) in people with Glaucoma and Glaucoma, Open-Angle, run by Centre hospitalier de l'Université de Montréal (CHUM) at 1 site in Canada.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The goal of this study is to evaluate the efficacy and safety of the novel form of trans-scleral cyclophotocoagulation using micropulse diode laser and trans-pars plana treatment (Micropulse TSCPC, mTSCPC MP3, IRIDEX CYCLO G6™ Glaucoma Laser System, CA, USA) in adults for the treatment of uncontrolled glaucoma. Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
What is being tested?
MicroPulse® P3 Glaucoma Device (MP3)
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
52 participants
Where
1 siteCanada
Study dates
19 Jun 2017to 15 Feb 2020
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Patients of either sex and any race aged 18 years old and above.
  • Followed by a glaucoma subspecialist at University of Montreal Hospital Center.
  • Intraocular pressure (IOP) above target and unresponsive to maximal tolerated medical therapy with or without previous surgical intervention.
  • mild glaucoma: IOP > 18 mmHg
  • moderate glaucoma: IOP > 15 mmHg
  • advanced glaucoma: IOP > 12 mmHg
  • Considered poor candidates for additional filtering surgery or implantation of glaucoma drainage devices.

Who cannot join

  • Patients unable to give informed consent.
  • Patients with significant scleral thinning, defined as thinning of more than one clock hour noticed on scleral transillumination.
  • Ocular infection or inflammation in the study eye in the 2 months prior to enrolment.
  • Intraocular surgery in the study eye in the 2 months prior to enrolment.

Trial locations and contacts

1 site in 1 country.

Canada1 site
  • Centre Hospitalier de l'Université de Montréal (CHUM)

    Montreal, Quebec, H2X 3E4

Other trials in Canada

About this study

Official title: Treatment Outcomes of MicroPulse Trans-scleral Cyclophotocoagulation (mTSCPC) in Uncontrolled Glaucoma at the University of Montreal Hospital Center (CHUM)

The goal of this study is to evaluate the efficacy and safety of the novel form of trans-scleral cyclophotocoagulation using micropulse diode laser and trans-pars plana treatment (Micropulse TSCPC, mTSCPC MP3, IRIDEX CYCLO G6™ Glaucoma Laser System, CA, USA) in adults for the treatment of uncontrolled glaucoma.

Read the detailed description

Cyclophotocoagulation (CPC) is a type of cycloablation using laser to treat glaucoma. It involves ciliary body destruction by targeting the ciliary epithelium and stroma, resulting in a reduction in aqueous secretion and hence intraocular pressure. This strategy is effective for all forms of glaucoma.

Traditional trans-scleral cyclophotocoagulation (TSCPC) achieve its cyclodestructive action by using continuous diode laser to target the melanin in the pigmented ciliary body epithelium. However, the continuous mode has been shown to cause significant collateral tissue damage to adjacent non-pigmented structures including the ciliary stroma and ciliary muscle. Traditional TSCPC may therefore be associated with serious complications including uveitis, visual deterioration, chronic hypotony, and others.

More recently, a micropulse delivery mode of diode laser (Micropulse TSCPC, mTSCPC) has been used to treat glaucoma by ablating the ciliary processes and reduce aqueous humor production with more selective targeting and less collateral damage. In contrast to conventional laser delivery where a continuous flow of high intensity energy is delivered, micropulse laser application delivers a series of repetitive short pulses of energy with rest periods in between pulses. Only a few studies have described the outcomes of this novel glaucoma therapy, showing mTSCPC to have comparable efficacy with fewer side effects when compared with traditional continuous wave mode diode laser delivery.This improved side effect profile has the potential to make mTSCPC an earlier therapeutic option instead of reserving it exclusively for end-stage refractory eyes.

Being tested
MicroPulse® P3 Glaucoma Device (MP3)
Keywords
Cyclophotocoagulation, Micropulse TSCPC, Laser ablation, Laser therapy
Medical subject headings
Glaucoma, Glaucoma, Open-Angle, Glaucoma, Neovascular, Ocular Hypertension, Glaucoma, Angle-Closure

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • MicroPulse® P3 Glaucoma Device (MP3)Device

    Also called CYCLO G6 Glaucoma Laser System (Iridex, Mountain View, CA)

    Laser settings will be programmed as follows: power-2000mW-2500mW (average 2000mW) of 810nm infrared diode laser set on micropulse delivery mode; micropulse "on" time-0.5ms; micropulse "off" time-1.1ms; and duty cycle (proportion of each cycle during which the laser is on)-31.33 %.

    The laser probe will be applied in a continuous sliding or painting motion from 9:30 to 2:30 and from 3:30 to 8:30. The probe will be applied perpendicular to the limbus with the edge directly on the limbus at all times (fiberoptic tip at 3 mm posterior to the limbus).

    The laser will be delivered over 360° for 160-320s. Treatment duration will be adjusted based on iris color and glaucoma severity (mild glaucoma: 160s, moderate glaucoma: 240s, advanced glaucoma: 240-320s).

Study groups in NCT03187418
Study groupRoleWhat they receive
Micropulse trans-scleral CPCExperimentalA treatment session of micropulse trans-scleral cyclophotocoagulation in the affected eye, using the MicroPulse® P3 Glaucoma Device (MP3) powered by the CYCLO G6™ Glaucoma Laser System (Iridex, Mountain View, CA, USA).
Receives: Device: MicroPulse® P3 Glaucoma Device (MP3)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Intraocular Pressure (IOP)

    In millimeters of mercury (mmHg), measured with the Goldmann applanation tonometer

    Measured: 18 months

Secondary outcomes (12)
  1. Intraocular Pressure (IOP)

    In millimeters of mercury (mmHg), measured with the Goldmann applanation tonometer

    Measured: 1 week, 1 month, 3 months, 6 months, 12 months

  2. Number of Participants With Repeat Treatments

    Number of participants needing a repeat laser treatment during the study

    Measured: 18 months

  3. Number of Intraocular Pressure Lowering Medications

    Number of drops and oral medications used by the patient compared to baseline

    Measured: 1 week, 1 month, 3 months, 6 months, 12 months, 18 months

  4. Corrected Distance Visual Acuity (CDVA)

    Number of lines reduction or improvement from baseline on Snellen acuity chart at 6 meters

    Measured: 1 week, 1 month, 3 months, 6 months, 12 months, 18 months

  5. Cup-to-disc Ratio (CDR)

    Progression of CDR compared to baseline, assessed by an ophthalmologist on dilated fundus examination

    Measured: 18 months

  6. Visual Field Index (VFI)

    Determined by Humphrey automated perimetry Sita 24-2 visual field testing

    Measured: 18 months

  7. Mean Deviation (MD)

    Determined by Humphrey automated perimetry Sita 24-2 visual field testing

    Measured: 18 months

  8. Pattern Standard Deviation (PSD)

    Determined by Humphrey automated perimetry Sita 24-2 visual field testing

    Measured: 18 months

  9. Average Retinal Nerve Fiber Layer (RNFL) Thickness

    In micrometer, determined by optical coherence tomography (OCT)

    Measured: 18 months

  10. Average Ganglion Cell Layer (GCL) Thickness

    In micrometer, determined by optical coherence tomography (OCT)

    Measured: 18 months

  11. Cup-to-disc Ratio (CDR) Assessed by Optical Coherence Tomography (OCT)

    Progression of vertical CDR compared to baseline, assessed by optical coherence tomography (OCT) parameters

    Measured: 18 months

  12. Pain Level During Laser Treatment

    Using a verbal analog scale for pain level (none = no subjective feeling of pain, mild = pain easily tolerable, moderate = pain tolerable with difficulty, severe = pain intolerable)

    Measured: 1 day

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted15 Jun 2017
  2. Study start19 Jun 2017
  3. Primary completion15 Feb 2020
  4. Study completion15 Feb 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Model description
Prospective, interventional and monocentric study based in a university hospital setting
Masking
None (open label)
Enrolment
52 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03187418
Sponsor's protocol ID
CE16.351
Status last verified
Aug 2020
First submitted
12 Jun 2017
Last updated
8 Oct 2021
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
No

Publications

  • Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006 Mar;90(3):262-7. doi: 10.1136/bjo.2005.081224.

    PubMed 16488940
  • Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014 Nov;121(11):2081-90. doi: 10.1016/j.ophtha.2014.05.013. Epub 2014 Jun 26.

    PubMed 24974815
  • Nguyen QH. Primary surgical management refractory glaucoma: tubes as initial surgery. Curr Opin Ophthalmol. 2009 Mar;20(2):122-5. doi: 10.1097/ICU.0b013e32831da828.

    PubMed 19240544
  • Schlote T, Derse M, Rassmann K, Nicaeus T, Dietz K, Thiel HJ. Efficacy and safety of contact transscleral diode laser cyclophotocoagulation for advanced glaucoma. J Glaucoma. 2001 Aug;10(4):294-301. doi: 10.1097/00061198-200108000-00009.

    PubMed 11558814
  • Agarwal HC, Gupta V, Sihota R. Evaluation of contact versus non-contact diode laser cyclophotocoagulation for refractory glaucomas using similar energy settings. Clin Exp Ophthalmol. 2004 Feb;32(1):33-8. doi: 10.1046/j.1442-9071.2004.00754.x.

    PubMed 14746588
  • Schlote T, Derse M, Zierhut M. Transscleral diode laser cyclophotocoagulation for the treatment of refractory glaucoma secondary to inflammatory eye diseases. Br J Ophthalmol. 2000 Sep;84(9):999-1003. doi: 10.1136/bjo.84.9.999.

    PubMed 10966953
  • Egbert PR, Fiadoyor S, Budenz DL, Dadzie P, Byrd S. Diode laser transscleral cyclophotocoagulation as a primary surgical treatment for primary open-angle glaucoma. Arch Ophthalmol. 2001 Mar;119(3):345-50. doi: 10.1001/archopht.119.3.345.

    PubMed 11231767
  • Leszczynski R, Gierek-Lapinska A, Forminska - Kapuscik M. Transscleral cyclophotocoagulation in the treatment of secondary glaucoma. Med Sci Monit. 2004 Sep;10(9):CR542-8. Epub 2004 Aug 20.

    PubMed 15328489
  • Rotchford AP, Jayasawal R, Madhusudhan S, Ho S, King AJ, Vernon SA. Transscleral diode laser cycloablation in patients with good vision. Br J Ophthalmol. 2010 Sep;94(9):1180-3. doi: 10.1136/bjo.2008.145565. Epub 2010 Jun 24.

    PubMed 20576775
  • Pantcheva MB, Kahook MY, Schuman JS, Rubin MW, Noecker RJ. Comparison of acute structural and histopathological changes of the porcine ciliary processes after endoscopic cyclophotocoagulation and transscleral cyclophotocoagulation. Clin Exp Ophthalmol. 2007 Apr;35(3):270-4. doi: 10.1111/j.1442-9071.2006.01415.x.

    PubMed 17430515
  • Tan AM, Chockalingam M, Aquino MC, Lim ZI, See JL, Chew PT. Micropulse transscleral diode laser cyclophotocoagulation in the treatment of refractory glaucoma. Clin Exp Ophthalmol. 2010 Apr;38(3):266-72. doi: 10.1111/j.1442-9071.2010.02238.x.

    PubMed 20447122
  • Aquino MC, Barton K, Tan AM, Sng C, Li X, Loon SC, Chew PT. Micropulse versus continuous wave transscleral diode cyclophotocoagulation in refractory glaucoma: a randomized exploratory study. Clin Exp Ophthalmol. 2015 Jan-Feb;43(1):40-6. doi: 10.1111/ceo.12360. Epub 2014 Jun 21.

    PubMed 24811050
  • Bloom PA, Tsai JC, Sharma K, Miller MH, Rice NS, Hitchings RA, Khaw PT. "Cyclodiode". Trans-scleral diode laser cyclophotocoagulation in the treatment of advanced refractory glaucoma. Ophthalmology. 1997 Sep;104(9):1508-19; discussion 1519-20. doi: 10.1016/s0161-6420(97)30109-2.

    PubMed 9307649
  • Kosoko O, Gaasterland DE, Pollack IP, Enger CL. Long-term outcome of initial ciliary ablation with contact diode laser transscleral cyclophotocoagulation for severe glaucoma. The Diode Laser Ciliary Ablation Study Group. Ophthalmology. 1996 Aug;103(8):1294-302. doi: 10.1016/s0161-6420(96)30508-3.

    PubMed 8764801
  • Mistlberger A, Liebmann JM, Tschiderer H, Ritch R, Ruckhofer J, Grabner G. Diode laser transscleral cyclophotocoagulation for refractory glaucoma. J Glaucoma. 2001 Aug;10(4):288-93. doi: 10.1097/00061198-200108000-00008.

    PubMed 11558813

Questions about this trial

What is this clinical trial studying?

A study testing MicroPulse® P3 Glaucoma Device (MP3) in people with Glaucoma and Glaucoma, Open-Angle, run by Centre hospitalier de l'Université de Montréal (CHUM) at 1 site in Canada.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 8 Oct 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 8 Oct 2021). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Intraocular Pressure (IOP) (time frame: 18 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03187418, which also lists 29 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 Oct 2021.

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