Endophthalmitis Clinical Trial
Official title:
Comparison Between Nylon and Polyglactin Corneal Suture in Pediatric Cataract Surgery: a Randomized Controlled Clinical Trial
Pediatric cataract surgery requires the suturing of the corneal incision in order to maintain
the integrity of the eyeball and to help avoid the trauma often caused by scratching in the
postoperative period of pediatric surgeries. Traditionally, this suturing is performed using
10-0 nylon material. Because this material is non-absorbable, it must be removed under
sedation in cases of complications such as suture loosening, late suture lysis, accumulation
of secretion on the suture, corneal neovascularization, and corneal ulceration. The objetive
of this study is to compare the rate of postoperative complications and the need for suture
removal after pediatric cataract surgery in cases in which nylon (non-absorbable) sutures are
used versus cases in which polyglactin (absorbable) sutures are used.
This is a controlled, randomized, prospective, single-center study performed on patients
undergoing pediatric cataract surgery at the Clinical Hospital of the University of Campinas
(UNICAMP). The volunteers for whom cataract extraction surgery has been indicated and who
have signed the ICF (or whose ICF has been signed by a parent or guardian) will undergo
cataract surgery and the cornea will be sutured using a polyglactin 910 suture (Vicryl®
10-0). In the control group (Group B), the cornea will be sutured using nylon 10-0 sutures
(the current routine procedure). All patients will be monitored for six months and will
receive complete ophthalmological evaluations in order to determine whether they experience
any suture-related complications and whether sutures must be removed under sedation. A lower
incidence of complications and a less frequent need for suture removal under sedation are
expected in the group receiving Vicryl® sutures.
Patients who are diagnosed with cataracts and for whom surgery is indicated shall be
evaluated (as much as possible based on their ability to cooperate with the assessment) in
terms of their visual acuity and refractive error via biomicroscopy, automated keratometry
(Auto Kerato Refractometer KR 8000® Alcon), Goldmann applanation tonometry, fundoscopy, and
biometric assessment (Ocuscan RxP® Alcon or Lenstar LS900® Haag-Streit International).
Patients who choose to sign (or whose guardians choose to sign) the informed consent form
after being informed of all of the aspects of the surgery and this trial shall be randomly
divided into one of two groups that shall be approximately equal in size and stratified by
age.
- Up to 6 months of age
- From 6 to 12 months of age
- From 1 to 3 years of age
- From 3 to 6 years of age
- Older than 6 years Patients in Group A will have their surgical incisions sutured with
polyglactin 10-0 material (Vicryl®, composed of polyglactin 910, 10-0 diameter,
absorbable, a 0.62 cm, 3/8 circle needle) at the end of cataract surgery followed by the
use of 0.5% moxifloxacin and 0.1% dexamethasone eye drops before the bandage is applied.
Patients in Group B will have their surgical incisions sutured with nylon 10-0 material
(Vicryl®, composed of nylon monofilament, 10-0 diameter, absorbable, a 0.55 cm, 1/2
circle needle) at the end of cataract surgery followed by the use of 0.5% moxifloxacin
and 0.1% dexamethasone eye drops before the bandage is applied.
Cataract surgery will be performed using the standardized protocol in the Ophthalmology
department of UNICAMP by fourth-year ophthalmology residents with experience in pediatric
cataract surgery. Preoperative pupil dilation shall be performed through the use of 2.5%
phenylephrine and 1% tropicamide 3 times in five-minute increments. General anesthesia shall
be performed. Skin sterilization shall be performed using an aqueous solution of 10%
povidone-iodine. After the sterile surgical field is established and the eyelashes are
isolated, 4 eye drops containing 5% povidone-iodine shall be administered in the conjunctival
sac with subsequent irrigation using a 10% balanced salt solution. In cases of allergy to
povidone-iodine, an aqueous solution of 0.05% chlorhexidine shall be used. The main incision
(either a clear corneal incision or a scleral tunnel) will be 2.2 mm to 3.0 mm, and
aspiration will be applied using the Infiniti® or Laureate® phacoemulsifier (Alcon) with a
foldable AcrySof® intraocular lens (Alcon) and a posterior capsulotomy with an automated
vitrectomy only in cases in which it is indicated.
Neither patients nor surgeons will be masked to the study treatment. The postoperative
consultations will be held on the first, seventh, thirtieth, ninetieth, one hundred and
twentieth, and one hundred and eightieth postoperative days and will include visual acuity
assessments, refractive error assessments, keratometry , biomicroscopy, applanation
tonometry, and fundoscopy, depending on the patient's age and ability to cooperate. If a
necessary exam is not possible in a clinical setting, it will be performed under sedation in
the surgical center.
Primary outcome: frequency of complications associated with sutures in each group.
Secondary outcome: need for suture removal under sedation in each group. The following will
be defined as suture-related complications: corneal neovascularization close to the suture,
loosening of the suture, accumulation of mucus on the suture, early rupture (within 2 weeks
or less) of the suture, aqueous humor leakage through the incision (as determined by the
Seidel test), prolapse of the iris through the incision site, infectious or traumatic
keratitis, endophthalmitis and giant papillary conjunctivitis as observed in a biomicroscopy
exam using a slit lamp.
Based on the frequency of suture-related complications described in the literature and using
a two-tailed 95% confidence interval, 80% power, an exposed/unexposed radius of 1, and a null
frequency of complications in the polyglactin suture group, approximately 40 subjects are
needed for each group. UNICAMP performs an average of 75 pediatric cataract surgeries per
year. Thus, there is a perspective for patient inclusion and study completion of just over
one year.
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