A Randomized Clinical Trial of Ex Vivo Corneal Cross-Linking of Donor Keratoplasty Tissue for Keratoconus Used for Keratoplasty in Keratoconus Patients

Keratoconus Clinical Trial

— EVOKE  

Official title:

A Randomized Clinical Trial of Ex Vivo Corneal Cross-Linking of Donor Keratoplasty Tissue for Keratoconus

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT04584125
• Other study ID #: 2020P002132
• Status: Not yet recruiting
• Phase: N/A
• Start date: December 1, 2023
• Est. completion date: November 30, 2028

Study information

• Verified date: January 2023
• Source: Massachusetts Eye and Ear Infirmary
• Contact: Joseph B Ciolino, MD
• Phone: (617) 573-3938
• Email: Joseph_Ciolino[@]MEEI.HARVARD.EDU
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This randomized clinical trial will assess corneal astigmatism and visual outcomes in participants who have undergone corneal transplantation for keratoconus with ex vivo cross-linked donor corneal tissue versus participants who have undergone corneal transplantation for keratoconus with non-cross-linked donor corneas. Crosslinking is a procedure that stabilizes the biomechanical properties of the cornea; as a result, the cornea stiffens. It has been shown that this procedure stabilizes the cornea of patients with keratoconus or corneal ectasias. The FDA currently approves crosslinking for patients with progressive keratoconus and corneal ectasia following refractive surgery. Ex vivo crosslinking of donor corneal tissue for patients with keratoconus undergoing PK or DALK could stabilize the cornea and reduce the risk of high astigmatism and improve vision in patient with keratoconus.

Description:

The 15 clinical sites are expected to recruit cumulatively 216 cases over 18 months. Eligibility is assessed during a routine examination by an investigator. Informed consent will be obtained prior to collecting any information that is not part of usual care. Patients who meet all inclusion criteria and none of the exclusion criteria will be given the opportunity to participate in the study. Participants will be randomly assigned to the treatment group (cross-linked corneal tissue) or control group (non-cross-linked corneal tissue that has been exposed to riboflavin, but no ultraviolet light).

The investigator will request a cadaveric cornea from the study's central eye bank CorneaGen, which will prepare the cadaveric cornea. Participants will receive the cross-linked donor tissue or control donor tissue during surgery. Clinical sites, including surgeons, and participants will be masked to treatment assignment.

Participants will be followed up post-operatively by the site investigators as per the standard of care. This will include visits at 1 Day, 1 Week, 1 Month, 6 Months, 1 Year, 1.5 Years, 2 Years, and 2.5 Years post-surgery. Some participants may need to be seen more regularly for routine care. The investigators will monitor for systemic and ocular adverse events at all follow-up visits.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 216
• Est. completion date: November 30, 2028
• Est. primary completion date: May 1, 2028
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 50 Years

Eligibility

Inclusion Criteria:

• Willing and able to provide written informed consent.

• Willing and able to comply with study assessments for the full duration of the study.

• Age =18 years but =50 years

• History of keratoconus (without a previous transplant) requiring keratoplasty

• Willing to commit to not having further cross-linking, corneal relaxing incisions, intacs, or corneal laser vision correction during the course of the study

Exclusion Criteria:

• Age < 18 years >50

• Inability to provide written informed consent and comply with study assessments for the full duration of the study

• Participation in another simultaneous interventional medical investigation or trial

Systemic

• History of Stevens-Johnson syndrome or ocular pemphigoid

• Signs of current infection, including fever and current treatment with antibiotics

• Pregnancy (positive pregnancy test) or lactating

• Pre-menopausal sexually active women not using adequate contraception (Reliable intrauterine devices, hormonal contraception or a spermicide in combination with a barrier method)

Recipient Eye

• Corneal or ocular surface infection within 30 days prior to study entry

• History of previous cross-linking

• History of previous corneal transplant

• Non-healing epithelial defect of at least 0.5x0.5 mm in host corneal bed lasting =6 weeks preoperatively

• Ocular or periocular malignancy

• Lid abnormalities that in the opinion of the investigator could confound the study results and these include clinically significant ectropion, lagophthalmos, cicatrization, entropion, and rosacea

• Neurotrophic cornea

• Monocular

• Uncontrolled glaucoma

• Glaucoma filtering devices or trabeculectomies

Related Conditions & MeSH terms

• Keratoconus

Intervention

Drug:
• Riboflavin 5'-phosphate in 20% dextran ophthalmic solution) 0.146% with UV light
A wavelength of 365 nm ultraviolet A light will be used to direct 5.4 J/cm2 using a beam diameter of 9.5mm to treat the de-epithelialized corneal surface of a donor cornea for 30 minutes. Every 2 minutes, the UV light will be used while another drop of riboflavin is applied on top of the donor cornea.
• Riboflavin 5'-phosphate in 20% dextran ophthalmic solution) 0.146% without UV light
The corneal tissue for the control arm will be treated the same as the crosslinked tissue except that it will not be exposed to ultraviolet light. The donor cornea will be placed on an artificial anterior chamber maintainer and the epithelium will be removed mechanically. Riboflavin solution (0.1% riboflavin and 20% dextran supplied in a sterile, single-dose container) will be applied to the cornea every 2 minutes for 30 minutes.

Locations

Country	Name	City	State
United States	Massachusetts Eye and Ear Infirmary	Boston	Massachusetts

Sponsors (1)

Lead Sponsor	Collaborator
Joseph B. Ciolino, MD

Country where clinical trial is conducted

United States, 

References & Publications (26)

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* Note: There are 26 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	• Keratometric astigmatism with Pentacam Schiempflug imaging at 130 weeks post-surgery.	• Keratometric astigmatism with Pentacam Schiempflug imaging at 130 weeks post-surgery	130 weeks
Secondary	• Best spectacle corrected visual acuity (BSCVA) with ETDRS methodology at 2.5 years (130 weeks) post-surgery	• Best spectacle corrected visual acuity (BSCVA) with ETDRS methodology at 2.5 years (130 weeks) post-surgery	130 weeks
Secondary	Manifest cylinder astigmatism at 130 weeks post-surgery	Manifest cylinder astigmatism at 130 weeks post-surgerykeratometry, anterior mean keratometry, posterior mean keratometry	130 weeks
Secondary	Uncorrected visual acuity (UCVA) 130 weeks post-surgery	Uncorrected visual acuity (UCVA) 130 weeks post-surgery	130 weeks
Secondary	Low-contrast BSCVA with ETDRS methodology at 130 weeks post-surgery	Low-contrast BSCVA with ETDRS methodology at 130 weeks post-surgerypermeable contact lens.	130 weeks