Ignite Creation Date:
2024-05-05 @ 11:28 AM
Last Modification Date:
2024-10-26 @ 9:08 AM
Study NCT ID:
NCT00050479
Status:
COMPLETED
Last Update Posted:
2006-07-19
First Post:
2002-12-09
Brief Title:
Laser and Medical Treatment of Diabetic Macular Edema
Sponsor:
National Eye Institute NEI
Organization:
National Institutes of Health Clinical Center CC
Study Overview
Official Title:
Preliminary Multi-Center Assessment of Laser and Medical Treatment of Diabetic Macular Edema
Status:
COMPLETED
Status Verified Date:
2006-07
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
This study will compare the side effects of two laser treatments for diabetic macular edema a common condition in patients with diabetes In macular edema blood vessels in the retina a thin layer of tissue that lines the back of the eye become leaky and the retina swells The macula the center part of the retina that is responsible for fine vision may also swell causing vision loss Traditional laser treatment argon blue or green or yellow for macular swelling or edema causes scarring that can expand and possibly lead to more loss of vision Studies with a different type of laser diode may be less damaging The results of this study on side effects of the treatments will be used to design a larger study of effectiveness This study will also examine whether celecoxib Celebrex Registered Trademark an anti-arthritis drug that reduces inflammation and swelling can reduce inflammation and swelling of the retina Patients with elevated cholesterol levels will be invited to participate in a cholesterol reduction part of the study to compare normal-pace cholesterol reduction with accelerated reduction
Patients 18 years of age and older with type 1 or type 2 diabetes and macular edema that requires laser treatment may be eligible for this study Candidates will be screened with the following tests and procedures
Medical history to review past medical conditions and treatments
Physical examination to measure vital signs pulse blood pressure temperature breathing rate and examine the head and neck heart lungs abdomen arms and legs
Eye examination to assess visual acuity eye chart test and examine pupils lens retina and eye movements The pupils will be dilated with drops for this examination
Blood tests to measure cholesterol blood clotting time hemoglobin A1C a measure of diabetes control and to evaluate liver and kidney function
Eye photography to help evaluate the status of the retina and changes that may occur in the future Special photographs of the inside of the eye are taken using a camera that flashes a bright light into the eye From 2 to 20 pictures may be taken depending on the eye condition
Fluorescein angiography to evaluate the eyes blood vessels A yellow dye is injected into an arm vein and travels to the blood vessels in the eyes Pictures of the retina are taken using a camera that flashes a blue light into the eye The pictures show if any dye has leaked from the vessels into the retina indicating possible blood vessel abnormality
Participants will be randomly assigned to take celecoxib or placebo an inactive look-alike pill Participants who have elevated cholesterol levels may return for a brief visit after 1 month All patients will return for follow-up visits at 3 6 and 12 months Patients who require laser treatment will be randomly assigned to one of the two laser treatments For these procedures eye drops are put in the eye to numb the surface and a contact lens is placed on the eye during the laser beam application Several visits may be required for additional laser treatments The maximum number of treatments depends on how well the treatment is working Patients who respond well to the study medication may receive no laser treatments After the first year patients will be followed every 6 months until either the patient returns for a 3-year visit the last enrolled patient returns for the 1-year visit or the patient requests to leave the study During the follow-up visits patients response to treatment will be evaluated with repeat tests of several of the screening exams
Patients 18 years of age and older with type 1 or type 2 diabetes and macular edema that requires laser treatment may be eligible for this study Candidates will be screened with the following tests and procedures
Medical history to review past medical conditions and treatments
Physical examination to measure vital signs pulse blood pressure temperature breathing rate and examine the head and neck heart lungs abdomen arms and legs
Eye examination to assess visual acuity eye chart test and examine pupils lens retina and eye movements The pupils will be dilated with drops for this examination
Blood tests to measure cholesterol blood clotting time hemoglobin A1C a measure of diabetes control and to evaluate liver and kidney function
Eye photography to help evaluate the status of the retina and changes that may occur in the future Special photographs of the inside of the eye are taken using a camera that flashes a bright light into the eye From 2 to 20 pictures may be taken depending on the eye condition
Fluorescein angiography to evaluate the eyes blood vessels A yellow dye is injected into an arm vein and travels to the blood vessels in the eyes Pictures of the retina are taken using a camera that flashes a blue light into the eye The pictures show if any dye has leaked from the vessels into the retina indicating possible blood vessel abnormality
Participants will be randomly assigned to take celecoxib or placebo an inactive look-alike pill Participants who have elevated cholesterol levels may return for a brief visit after 1 month All patients will return for follow-up visits at 3 6 and 12 months Patients who require laser treatment will be randomly assigned to one of the two laser treatments For these procedures eye drops are put in the eye to numb the surface and a contact lens is placed on the eye during the laser beam application Several visits may be required for additional laser treatments The maximum number of treatments depends on how well the treatment is working Patients who respond well to the study medication may receive no laser treatments After the first year patients will be followed every 6 months until either the patient returns for a 3-year visit the last enrolled patient returns for the 1-year visit or the patient requests to leave the study During the follow-up visits patients response to treatment will be evaluated with repeat tests of several of the screening exams
Detailed Description:
This randomized pilot study is an important first step in planning a large multi-center clinical trial to evaluate medical and laser approaches that could improve the visual outcome for patients with diabetic retinopathy This study will provide preliminary safety data on these therapies as well as allow for assessment of the performance of ocular outcomes and study design for use in subsequent trials If there are no safety concerns the results of this pilot will be helpful in the design of a large multicenter clinical trial by providing data on estimates of expected treatment effects
Using a factorial design this study will compare 1 diode micropulse laser photocoagulation to mild ETDRS style focal photocoagulation and 2 treatment with a COX-2 inhibitor celecoxib or placebo prior to and following laser photocoagulation The primary outcomes are a visual acuity drop or increase of 15 letters or more from baseline to year 3 The secondary outcome is a significant reduction in macular edema defined as a 50 reduction in thickening as measured by Optical Coherence Tomography OCT a two step reduction in macular thickness compared to standard stereoscopic fundus photographs and a 50 reduction in the area of leakage as measured by fluorescein angiography The University of Wisconsin Fundus Photography Reading Center will grade OCT photographs and angiograms and will be masked to treatment assignment Other secondary outcomes will include the timing of the first required laser treatment changes in visual acuity throughout the study and the number of laser treatments required during the course of the study In addition all adverse events and abnormal laboratory values will be collected and tabulated Specific objectives regarding safety and efficacy follow
Safety
Is the risk of visual loss in patients with clinically significant diabetic macular edema potentially different across treatment groups
Preliminary Assessment of Potential Outcomes
Is there evidence that any treatment combinations could be effective in reducing retinal thickening
Is there evidence that celecoxib may inhibit or induce retinal thickening
What are the estimated treatment effects on vision
Is the number of laser treatments required to achieve a reduction in retinal thickening similar across treatment groups
The tertiary objective of this study will be to examine the effects of dramatically reducing low-density lipoproteins cholesterol in patients with diabetic macular edema and elevated serum lipid levels Change vision and retinal thickness will be compared across three groups 1 patients without elevated serum lipids at baseline 2 patients with elevated lipid levels at baseline and receive standard of care treatment and 3 patients with elevated lipid levels at baseline and are aggressively treated pharmacologically
Using a factorial design this study will compare 1 diode micropulse laser photocoagulation to mild ETDRS style focal photocoagulation and 2 treatment with a COX-2 inhibitor celecoxib or placebo prior to and following laser photocoagulation The primary outcomes are a visual acuity drop or increase of 15 letters or more from baseline to year 3 The secondary outcome is a significant reduction in macular edema defined as a 50 reduction in thickening as measured by Optical Coherence Tomography OCT a two step reduction in macular thickness compared to standard stereoscopic fundus photographs and a 50 reduction in the area of leakage as measured by fluorescein angiography The University of Wisconsin Fundus Photography Reading Center will grade OCT photographs and angiograms and will be masked to treatment assignment Other secondary outcomes will include the timing of the first required laser treatment changes in visual acuity throughout the study and the number of laser treatments required during the course of the study In addition all adverse events and abnormal laboratory values will be collected and tabulated Specific objectives regarding safety and efficacy follow
Safety
Is the risk of visual loss in patients with clinically significant diabetic macular edema potentially different across treatment groups
Preliminary Assessment of Potential Outcomes
Is there evidence that any treatment combinations could be effective in reducing retinal thickening
Is there evidence that celecoxib may inhibit or induce retinal thickening
What are the estimated treatment effects on vision
Is the number of laser treatments required to achieve a reduction in retinal thickening similar across treatment groups
The tertiary objective of this study will be to examine the effects of dramatically reducing low-density lipoproteins cholesterol in patients with diabetic macular edema and elevated serum lipid levels Change vision and retinal thickness will be compared across three groups 1 patients without elevated serum lipids at baseline 2 patients with elevated lipid levels at baseline and receive standard of care treatment and 3 patients with elevated lipid levels at baseline and are aggressively treated pharmacologically
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None
Secondary IDs
| Secondary ID | Type | Domain | Link |
|---|---|---|---|
| 03-EI-0065 | None | None | None |