Corneal TransplantationNCT05870566
Pretreatment to Promote Graft Survival After Subsequent High-risk Corneal Transplantation [CrossCornealVision]
A study testing Corneal Crosslinking in people with Corneal Transplantation, run by Claus Cursiefen at 7 sites in Germany.
Trial summary
The trial evaluates the effect of corneal crosslinking as pre-treatment before corneal transplantation. The goal is to improve graft survival by reducing pathological vessels through pre-treatment. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Corneal Transplantation
- What is being tested?
- Corneal Crosslinking
- Type of treatment
- Medical device
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 110 participants
- Where
- 7 sitesGermany
- Study dates
- 20 Nov 2023to 30 Sep 2028
- Phase
- Interventional
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
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Medical condition or disease to be investigated:
- Pathologically prevascularized cornea with need for corneal transplantation
- Further inclusion criteria:
- Written informed consent by subject and/or witness prior to any study-related procedures
- Adult male and female subjects ≥ 18 years old
- ≥ 2 corneal quadrants covered by pathological corneal neovascularization
Show all 10Show fewer
- Absence of other clinical contraindications to any part or product of the treatment plan
- A cooperative attitude to follow up the study procedures
- In case of bilateral disease only one eye will be included
- Steroid responders with adequate control regiment or local/systemic therapy can be included
Who cannot join
- < 2 corneal quadrants covered by pathological neovascularization
- Corneal stromal thickness below 400 μm (except in the central 8 mm zone which will be replaced later by a new corneal transplant with new endothelium); peripheral stromal thinning below 400 μm in weakened recipient areas is acceptable for CXL if not affecting more than 50% of the corneal circumference (allowing for later endothelial repopulation)
- Active or suspected intraocular inflammation
- Active corneal ulceration
- Compromised eyelid mobility and/or symblepharon
- Allergy, sensitivity or intolerance to riboflavin or UV
Show all 20Show fewer
- Contraindications, other than steroid response to the local or systemic antibiotics and/or corticosteroids (other than steroid response) foreseen by the protocol
- Contraindications to the surgical protocol
- Clinically significant or unstable concurrent disease or other medical condition affecting grafting procedure
- Rheumatic diseases treated with systemic immunosuppressive medication
- Subjects unlikely to comply with the study protocol or unable to understand the nature and scope of the study or the possible benefits or unwanted effects of the study procedures and treatments
- Participation in another clinical trial where an investigational drug was received less than 4 weeks prior to screening visit
- Positive for human immunodeficiency virus (HIV)
- Known abuse of alcohol, drugs, or medicinal products
- Evidence of any other medical conditions (such as psychiatric illness, physical examination, or laboratory findings) that may interfere with the planned treatment, affect the subject's compliance, or place the subject at high risk of complications related to the treatment
- Employees of the sponsor, or employees or relatives of the investigator.
- Pregnant women and nursing mothers as corneal transplantation in standard care is performed under general anaesthesia
- Persons held in an institution by legal or official order
- Dysregulated glaucoma with IOP > 25 mmHg at baseline despite local therapy
- (Protocol V040 Page 43)
Trial locations and contacts
7 sites in 1 country. Contact the study team or a site near you to ask about taking part.
7 sites in 1 country
Germany7 sites, 7 recruiting
- Recruiting
Charité - Universitätsmedizin Berlin, Klinik für Augenheilkunde
Berlin, 13353
Tina Dietrich-Ntoukas, PD Dr. med., 004930450654419, tina.dietrich-ntoukas@charite.de
Anna-Karina Maier-Wenzel, PD Dr. med., 0049 30 450 654 419, anna-karina.maier@charite.de
- Recruiting
University Hospital of Cologne, Centre for Ophthalmology
Cologne, North Rhine-Westphalia, 50937
Claus Cursiefen, Professor, 00492214780, marie.seifert@uk-koeln.de
Deniz Hos, PD Dr. med, 004922147898896, deniz.hos@uk-koeln.de
- Recruiting
Universitätsklinikum Düsseldorf, Klinik für Augenheilkunde
Düsseldorf, North Rhine-Westphalia, 40225
Gerd Geerling, Univ.-Prof. Dr. med, 004902118116051, geerling@med.uni-duesseldorf.de
Friedrich Anton Steindor, Dr. med, 004902118116051, FriedrichAnton.Steindor@med.uni-duesseldorf.de
- Recruiting
Universitätsklinikum Freiburg, Klinik für Augenheilkunde
Freiburg im Breisgau, 79106
Daniel Böhringer, Prof. Dr. med., 0049761 270-40235, Daniel.Boehringer@uniklinik-freiburg.de
Paola Kammrath Betancor, Dr. med., 0049761 270-40235, paola.kammrath.betancor@uniklinik-freiburg.de
- Recruiting
Universitätsklinikum des Saarlandes, Klinik für Augenheilkunde
Homburg, Saarland, 66424
Berthold Seitz, Prof. Dr., 0049 6841 16-22387, berthold.seitz@uks.eu
Elias Flockerzi, Dr. med., 0049 6841 16-22387, elias.flockerzi@uks.eu
- Recruiting
Augenklinik des Klinikums der Universität München
München, Bavaria, 80336
Nikolaus Luft, PD Dr. med. univ. Dr. scient., 0089 4400 53146, nikolaus.luft@med.uni-muenchen.de
- Recruiting
Klinik und Poliklinik für Augenheilkunde - Universitätsmedizin Rostock
Rostock, 18057
Marcus Walckling, Dr. med., 0049381 494 8501, marcus.walckling@med.uni-rosto
Thomas A. Fuchsluger, Univ.-Prof. Dr. med. Dr. rer., 0049381 494 8501, sekretariat.uak@med.uni-rostock.de
About this study
Official title: UV Light-mediated Corneal Crosslinking as (Lymph)Angioregressive Pretreatment to Promote Graft Survival After Subsequent High-risk Corneal Transplantation [CrossCornealVision]
The trial evaluates the effect of corneal crosslinking as pre-treatment before corneal transplantation. The goal is to improve graft survival by reducing pathological vessels through pre-treatment.
Read the detailed description
Multicenter, two armed, controlled, open randomised parallel-group study to evaluate the effect of corneal crosslinking as pre-treatment vs. no pre-treatment ahead of full-thickness penetrating corneal transplantation.
After screening of inclusion and exclusion criteria, eligible subjects will be included after obtaining informed consent. Randomisation will be performed at a 5:4 ratio. (Protocol V04_0 Page 37) At the baseline assessment, a slit lamp examination and photo documentation as well as LaserFlareCellMeter (if available), corneal tomography, and Slit lamp Adapted Optical Coherence Tomography (SL-OCT) measurements will be performed. In addition, visual acuity and a vision-related quality of life will be assessed. Concomitant medication will be documented. Macula OCT will be performed if deemed necessary. In the intervention arm, the study intervention (CXL) will then be administered to reduce CoNV 10-8 weeks prior to corneal transplantation. Two weeks after CXL a control will be performed including AE documentation, slit lamp examination, SL-OCT, corneal tomography, visual acuity and photo documentation. The study intervention will be repeated once if insufficient (less than 50%) reduction of CoNV should be observed (4 weeks prior to corneal transplantation at the latest). All subjects in the intervention arm will then undergo for corneal transplantation. In the control arm, subjects will be directly scheduled for corneal transplantation. Corneal transplantation will be performed as standard full-thickness penetrating procedure, and the graft (6.5 - 8.25 mm 7.75 mm in diameter) will be secured with 16-24 interrupted single or double running 10-0 nylon single sutures (decision by the surgeon). Postoperatively, follow-up assessments will be performed at 3, 6, 12, 18, and 24 months for all subjects (postoperative visits at these time points are standard of care). A slit lamp examination, concomitant medication, AE and photo documentation as well as LaserFlareCellMeter (if available), corneal tomography, SL-OCT, and corneal endothelial cell count measurements will be performed. In addition, visual acuity and a vision-related quality of life will be assessed. Macula OCT will be performed if deemed necessary. If a subject has any complaints, he or she can contact the responsible trial site at any time.
After consultation with the investigator, additional visits can be scheduled. (Protocol V04_0 Page 50)
- Conditions
- Corneal Transplantation
- Being tested
- Corneal Crosslinking
- Keywords
- Cornea, Transplantation, Prevascularized Corneas, Corneal crosslinking with UV light irradiation
- Medical subject headings
- Corneal Diseases
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Corneal CrosslinkingDevice
Riboflavin isotonic, 0,1 % Vitamin B2, with Dextran 20,0%, for epi-off procedure or Riboflavin isotonic 0,1% (Vitamin B2), 1,1% HPMC without Dextran for epi-off) 0.1% riboflavin-5-phosphate and 20% dextran T-500) will be applied to the cornea after epithelial debridement every 2 min for 10 minutes before irradiation and every 2 minutes during the course of a 10 minute exposure to 365 nm UV-A with an irradiance rate of 9 mW/cm2. This dose, mode and scheme of the intervention follows the internationally recognized "accelerated CXL protocol" (Elbaz et al. 2014). The data existing shows equivalent outcome regarding efficacy and safety compared to the standard protocol. To avoid any damage to the limbal stem cells, the limbus will not be irradiated during the procedure, as a CXL device (with maximal diameter of 11 mm) will be used. Furthermore, the limbal area will additionally be protected by a custom-cut LSC protection shield. (Protocol V04_0 Page 45-46)
| Study group | Role | What they receive |
|---|---|---|
| Corneal Crosslinking (CXL) | Experimental | In the intervention group, the study intervention (CXL) will be administered to stabilize therecipient cornea (which remains in place after penetrating keratoplasty) and to reduce CoNV 8 to 10 weeks prior to corneal transplantation. The study intervention will be repeated once (after 4 weeks prior to transplantation at the latest at the earliest) if insufficient (less than 50%) reduction of CoNV should be observed (to be decided by the respective surgeon). (Protocol V04_0 Page 45) Corneal transplantation will be performed as standard full-thickness penetrating procedure, and the graft (6.5 to 8.25 in diameter) will be secured with 16-24 interrupted single or 2 double running 10-0 nylon sutures (decision by the surgeon). In case of residual CoNV in the intervention group, visible vessels will may be thermally occluded by fine needle diathermy to avoid intraoperative bleeding and reduce complications (to be decided by the respective surgeon at start of surgery). (Protocol V04_0 Page 46) Receives: Device: Corneal Crosslinking |
| control group | No intervention | In the control group subjects will be directly scheduled for corneal transplantation without previous CXL. A sham CXL procedure will not be performed. Corneal transplantation will be performed as standard full-thickness penetrating procedure, and the graft (6.5 to 8.25 in diameter) will be secured with 16-24 interrupted single or 2 double running 10-0 nylon sutures (decision by the surgeon). In case of residual CoNV in the intervention group, visible vessels will may be thermally occluded by fine needle diathermy to avoid intraoperative bleeding and reduce complications (to be decided by the respective surgeon at start of surgery). In the control group, no fine needle diathermy will be performed, as this procedure combined with corneal transplantation in previously non-crosslinked eyes might lead to fistulas and thereby to potential intraocular infections. (Protocol V04_0 Page 46) |
What is being measured
The primary outcome is the main question the study is designed to answer.
First episode of endothelial graft rejection
Endothelial graft rejection episode is defined by at least 2 of the following criteria: new endothelial precipitates, new anterior chamber cells/flare, new focal or diffuse edema of the graft. All signs will be analyzed by slit lamp examination, on standardized digital slit lamp pictures, by LaserFlareCellMeter (if available), SL-OCT and corneal tomography. (Protocol V04_0 Page 48)
Measured: within 24 months after transplantation
Secondary outcomes (10)
Regression of CoNV
Assessed by morphometrical analysis of the corneal area covered by CoNV prior to and 2-4 weeks after each CXL, prior to transplantation and at 3, 6, 12, 18 and 24 months using digital standardized slit lamp images and an independent reading center (CORIC). Note: the corneal area covered by CoNV will also be measured in control patients (not receiving angioregressive CXL) at all visits to determine the natural course of CoNV. (Protocol V04_0 Page 48)
Measured: prior to and 2-4 weeks after each CXL, prior to transplantation and at 3, 6, 12, 18 and 24 months
Regression of CoNV
Number of CXL procedures needed for >50% regression of CoNV
Measured: before transplantation
Recurrence of CoNV
After CXL and after transplantation
Measured: after CXL and 3, 6, 12, 18 and 24 months after transplantation
Overall functional graft survival rate
Functional survival of graft will be assessed at every follow-up visit after transplantation clinically and using digital slit lamp pictures, SL-OCT and corneal tomography (for graft thickness) as well as endothelial cell counts
Measured: 3, 6, 12, 18 and 24 months after transplantation
Absence of rejection-related graft failure
Rejection-related graft failure assessed at every follow-up visit after transplantation and defined according to the respective criteria for graft rejection and associated graft failure
Measured: 3, 6, 12, 18 and 24 months after transplantation
Best corrected visual acuity (BCVA)
Best corrected visual acuity (BCVA) in the study eye and BCVA or spectacle corrected visual acuity in the partner eye: assessed at the following time-points: prior to CXL, at control visit after CXL, prior to transplantation and after 3, 6, 12, 18, and 24 months using ETDRS charts (logMAR transformed).
Measured: Prior to CXL, prior to transplantation and after 3, 6, 12, 18, and 24 months
Vision-related quality of life
Overall composite score measured using the NEI-VFQ25 at the following time-points
Measured: Prior to CXL, prior to transplantation and after 3, 6, 12, 18, and 24 months
Active infectious keratitis or corneal ulceration
Clinical assessment by slit lamp examination
Measured: every study visit
Graft dehiscence
Graft dehiscence with leakage of aqueous humor from the graft/host interface, assessed by slit lamp examination
Measured: 3, 6, 12, 18 and 24 months after transplantation
Delayed epithelial wound healing
assessed by slit lamp examination
Measured: 3, 6, 12, 18 and 24 months after transplantation
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted23 May 2023
- Study start20 Nov 2023
- Primary completion30 Sep 2027 (estimated)
- Study completion30 Sep 2028 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Corneal TransplantationStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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
- Randomised
- Intervention model
- Parallel groups
- Model description
- Prospective, multicenter, open randomized parallel-group trial
- Masking
- None (open label)
- Enrolment
- 110 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Claus Cursiefen
- Sponsor type
- University, hospital or other
- Collaborators
- Uniklinik Köln, Zentrum für Klinische Studien, Uniklinik Köln, Institut für Medizinische Statistik und Bioinformatik, German Federal Ministry of Education and Research
- Responsible party
- Sponsor-investigator, Claus Cursiefen, University of Cologne
- Investigators
- Claus Cursiefen, Prof. Dr., Principal investigator, University Hospital of Cologne, Centre for Ophthalmology
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05870566
- Sponsor's protocol ID
- Uni-Koeln-5045
- Other IDs
- 01KG2127
- Status last verified
- Oct 2024
- First submitted
- 3 May 2023
- Last updated
- 21 Oct 2024
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
Publications
Wiedemann J, Hos D, Limburg E, Zettelmeyer U, Schiller P, Franklin J, Bachmann B, Bohringer D, Dietrich-Ntoukas T, Fuchsluger TA, Geerling G, Lang SJ, Mayer WJ, Priglinger S, Reinhard T, Seitz B, Cursiefen C. UV light-mediated corneal crosslinking as (lymph)angioregressive pretreatment to promote graft survival after subsequent high-risk corneal transplantation (CrossCornealVision): protocol for a multicenter, randomized controlled trial. Trials. 2024 Mar 6;25(1):169. doi: 10.1186/s13063-024-08011-1.
PubMed 38448965