Clinical trial NCT02665884: Diurnal Fluctuations of Intraocular Pressure in EX-Press Valve Blebs in Glaucoma Patients
Study type: OBSERVATIONAL
Overall status: UNKNOWN
Conditions: GLAUCOMA
Lead sponsor: Hillel Yaffe Medical Center
Sponsor class: OTHER_GOV
First posted: 2016-01-28
Enrollment: 40
Sex: ALL
Minimum age (years): 30
Maximum age (years): 80
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: The study will include 20 open-angle glaucoma (OAG) patients underwent Ex-Press filtration surgery, and 20 OAG patients treated with medications alone.

Brief summary: Diurnal fluctuations of intraocular pressure in EX-Press Valve Blebs in Glaucoma Patients

Intraocular pressure (IOP) reduction is the mainstay of glaucoma management. (1) Open-angle glaucoma (OAG) is generally managed by decreasing the intraocular pressure (IOP) to a level that the physician believes will prevent further glaucomatous damage. However, in a significant proportion of patients, the visual fields continue to deteriorate in spite of office pressures within the range of normal values (8). It has been suggested that the progressive damage in some cases could be caused by peaks of IOP or diurnal IOP variability not detected by tonometry during office hours. It is possible that certain drugs or surgical interventions are more effective than others in dampening these fluctuations. The purpose of our study is to compare the diurnal IOP fluctuations in glaucoma patients treated with medications or Ex-press filtration surgery.

Detailed description: Diurnal fluctuations of intraocular pressure in EX-Press Valve Blebs in Glaucoma Patients

Department of Ophthalmology, Hillel-Yaffe Medical Center, affiliated with the Bruce Rappaport School of Medicine, The Technion, Haifa, Israel

Introduction:

Intraocular pressure (IOP) reduction is the mainstay of glaucoma management. (1) Medication alone is sometimes not sufficient to reduce excessively high IOP, and pharmaceutical intolerance may develop or damage can occur to the optic nerve, warranting surgical intervention. (2) The filtering bleb is considered to be the cornerstone of IOP control after glaucoma filtration surgery drainage device implantation. (3) It enables the flow of the aqueous humor from the anterior chamber to the subconjunctiva, episclera, sclera and choroid, thereby lowering the IOP. (4-6) Filtration and drainage devices, such as the EX-Press device (Alcon Laboratories, Fort Worth, Texas, USA), offer a surgical alternative to glaucoma medical therapy. (7) Open-angle glaucoma (OAG) is generally managed by decreasing the intraocular pressure (IOP) to a level that the physician believes will prevent further glaucomatous damage. However, in a significant proportion of patients, the visual fields continue to deteriorate in spite of office pressures within the range of normal values (8). It has been suggested that the progressive damage in some cases could be caused by peaks of IOP or diurnal IOP variability not detected by tonometry during office hours. (9, 10) In another study, Asrani et al. (11) showed that IOP fluctuations are an independent risk factor in patients with glaucoma and as such may need to be treated specifically. It is possible that certain drugs or surgical interventions are more effective than others in dampening these fluctuations. The purpose of our study is to compare the diurnal IOP fluctuations in glaucoma patients treated with medications or Ex-press filtration surgery.

Materials and Methods The study will include 20 open-angle glaucoma (OAG) patients underwent Ex-Press filtration surgery, and 20 OAG patients treated with medications alone. All patients will have 12 IOP measurements with 2 hours interval, starting at 10 AM until 10 AM of the following morning.

ICARE® PRO tonometer (Icare Finland Oy, Espoo, Finland) will be used for the measurement of IOP. The rebound motion of its light weighted probe will be recorded during contact of the probe with the cornea. (12, 13) The rate of deceleration of the probe is a function of IOP. The ICARE® PRO has a built-in inclination sensor that allows downward measurement of the eye in the supine position as well as in the normal upright sitting position. ICARE® PRO allows for measurement of IOP in the seated and supine positions. During IOP recording, patients will be supine or upright, and the tip of the probe will be applied perpendicular to the cornea. Two markers engraved on the piston of the probe indicated its ideal positioning. The reliability of the measurement is displayed on the ICARE® PRO tonometer screen and guided our measurements.

Fluctuations in IOP will be compared between the Ex-press filtration surgery eye and the fellow (intra-group comparison). Inter-group comparison of IOP fluctuation will be performed between the Ex-press filtration surgery eye and medically treated eye of different patients.

Eligibility criteria: Inclusion Criteria: .

* Glaucoma patients that underwent EX-PRESS surgery

Exclusion Criteria:

* Angle closure glaucoma
* Neovascular glaucoma
* High refractive error

Primary outcomes:
measure: Comparison of diurnal fluctuations of intraocular pressure
timeFrame: One year
Secondary outcomes:
Other outcomes:
Locations:
city: Hadera
country: Israel
facility: Hillel Yaffe Medical Center
Study officials:
References:
citation: The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration.The AGIS Investigators. Am J Ophthalmol. 2000 Oct;130(4):429-40. doi: 10.1016/s0002-9394(00)00538-9.
citation: Watson PG. When to operate on open angle glaucoma. Eye (Lond). 1987;1 ( Pt 1):51-4. doi: 10.1038/eye.1987.8.
citation: Levene RZ. Glaucoma filtering surgery: factors that determine pressure control. Ophthalmic Surg. 1984 Jun;15(6):475-83.
citation: Picht G, Grehn F. Classification of filtering blebs in trabeculectomy: biomicroscopy and functionality. Curr Opin Ophthalmol. 1998 Apr;9(2):2-8. doi: 10.1097/00055735-199804000-00002.
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citation: Netland PA, Sarkisian SR Jr, Moster MR, Ahmed II, Condon G, Salim S, Sherwood MB, Siegfried CJ. Randomized, prospective, comparative trial of EX-PRESS glaucoma filtration device versus trabeculectomy (XVT study). Am J Ophthalmol. 2014 Feb;157(2):433-440.e3. doi: 10.1016/j.ajo.2013.09.014. Epub 2013 Nov 7.
citation: Kidd MN, O'Connor M. Progression of field loss after trabeculectomy: a five-year follow-up. Br J Ophthalmol. 1985 Nov;69(11):827-31. doi: 10.1136/bjo.69.11.827.
citation: DRANCE SM. DIURNAL VARIATION OF INTRAOCULAR PRESSURE IN TREATED GLAUCOMA. SIGNIFICANCE IN PATIENTS WITH CHRONIC SIMPLE GLAUCOMA. Arch Ophthalmol. 1963 Sep;70:302-11. doi: 10.1001/archopht.1963.00960050304004. No abstract available.
citation: Zeimer RC, Wilensky JT, Gieser DK, Viana MA. Association between intraocular pressure peaks and progression of visual field loss. Ophthalmology. 1991 Jan;98(1):64-9. doi: 10.1016/s0161-6420(91)32340-6.
citation: Asrani S, Zeimer R, Wilensky J, Gieser D, Vitale S, Lindenmuth K. Large diurnal fluctuations in intraocular pressure are an independent risk factor in patients with glaucoma. J Glaucoma. 2000 Apr;9(2):134-42. doi: 10.1097/00061198-200004000-00002.
citation: Iliev ME, Goldblum D, Katsoulis K, Amstutz C, Frueh B. Comparison of rebound tonometry with Goldmann applanation tonometry and correlation with central corneal thickness. Br J Ophthalmol. 2006 Jul;90(7):833-5. doi: 10.1136/bjo.2005.089870. Epub 2006 May 3.
citation: Martinez-de-la-Casa JM, Garcia-Feijoo J, Castillo A, Garcia-Sanchez J. Reproducibility and clinical evaluation of rebound tonometry. Invest Ophthalmol Vis Sci. 2005 Dec;46(12):4578-80. doi: 10.1167/iovs.05-0586.