Retinopathy of Prematurity
Conditions
Keywords
pharmacokinetics, retinopathy of prematurity, dexamethasone
Brief summary
Background and study aims When an infant is born premature, the blood vessels in the eyes have not developed fully on the retina, and can start to grow incorrectly and result in blindness. To prevent this from happening, premature infants are often screened, and treated with laser or injections into the eye to prevent retinal detachment. A new treatment strategy with steroid eye drops have been found to prevent serious blood vessel growth. The treatment is commonly used in older children and adults to treat different inflammatory conditions, but how the drop is absorbed in premature infants and if there is any risk of side-effects is poorly investigated. The aim of this study is to document how the steroid drop is absorbed and excreted in premature infants and to study if there is a risk of any side effects. Who can participate? Premature infants born before gestational age week 30, that undergo eye-screening at Sahlgrenska University Hospital in Gothenburg and Skånes University Hospital in Malmö and Lund or at Helsingborg Hospital, in the need for steroid eye-drop treatment against pathological vessels. It is not possible to participate if the infant has received systemic steroid treatment 2 weeks prior to the eye-drop treatment, or has an ongoing ocular infection. What does the study involve? The study involves blood and saliva samples according to a specific protocol designed to be able to learn about the uptake and breakdown of the steroid in premature infants. Measurements of blood pressure, growth and a few urine samples will also be collected during the treatment period usually lasting for some weeks. At 2.5 and 5 years of age, visual acuity, refractive errors and retinal thickness measurements will be noted. What are the possible benefits and risks of participating? The infant will receive steroid eye-drops that have been noted to heavily reduce the number of infants that develop retinal changes that require injections or laser treatment. The blood samples have been reduced to an absolute minimum in volume and numbers, but will entail some extra samplings from the infant. The infant will be rigorously checked with regard to any possible side effects from the steroid treatment. Possible but unlikely side effects from the low dose in eye drops are; elevated blood pressure, retarded growth, lowered endogenous steroid production during the eye-drop treatment, increase in blood glucose, and an increase in intra-ocular pressure.
Interventions
one drop daily in each eye with retinopathy of prematurity of a predefined stage.
Sponsors
Region Skane
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
multicenter interventional phase 1 trial
Eligibility
Sex/Gender
ALL
Age
No minimum to 30 Weeks
Healthy volunteers
No
Inclusion criteria
* Infants screened for retinopathy of prematurity (ROP) at Sahlgrenska University Hospital in Gothenburg, at Skåne University Hospital in Malmö and Lund and at Helsingborg Hospital. * zone I stage 1 or 2 ROP without plus disease, posterior zone II stage 2 ROP without plus disease, or zone II stage 3 ROP without plus disease. ROP needs to be documented by digital widefield photography and classification confirmed by two ophthalmologist.
Exclusion criteria
* ocular infection * systemic steroid treatment within two weeks before the start of drop treatment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pharmacokinetics: half-life of plasma concentrations of dexamethasone during treatment with dexamethasone eye drops measured with mass spectrometry. | up to 14 weeks | Half-life of dexamethasone- t½, hours |
| Pharmacokinetics: maximum plasma concentration of dexamethasone during treatment with dexamethasone eye drops measured with mass spectrometry. | up to 14 weeks | Maximum plasma concentration- Cmax, nmol/L |
| Pharmacokinetics: saliva koncentrations of dexamethasone during treatment with dexamethasone eye drops. | up to 14 weeks | Half-life of dexamethasone- t½, hours |
| Pharmacokinetics: saliva koncentrations of dexamethasone during treatment with dexamethasone eye drops measured with mass spectrometry. | up to 14 weeks | Maximum saliva concentration- Cmax, nmol/L |
| Pharmacokinetics: time to reach maximum plasma concentration of dexamethasone during treatment with dexamethasone eye drops measured with mass spectrometry. | up to 14 weeks | tmax, hours |
| Pharmacokinetics: time to reach maximum saliva concentrations of dexamethasone during treatment with dexamethasone eye drops measured with mass spectrometry. | up to 14 weeks | tmax, hours |
| Pharmacokinetics: area under the concentration-time curve for plasma dexamethasone from time point 0 to time t of the last measured concentration above the limit of quantification time. | up to 14 weeks | AUC0-t, nmol.h/L |
| Pharmacokinetics: area under the concentration-time curve for saliva dexamethasone from time point 0 to time t of the last measured concentration above the limit of quantification time. | up to 14 weeks | AUC0-t, nmol.h/L |
| Pharmacokinetics: area under the concentration-time curve for plasma dexamethasone from time point 0 to infinity; | up to 14 weeks | AUC0-∞, nmol.h/L |
| Pharmacokinetics: area under the concentration-time curve for saliva dexamethasone from time point 0 to infinity; | up to 14 weeks | AUC0-∞, nmol.h/L |
| Pharmacokinetics: apparent total body clearance | up to 14 weeks | CL/F, L/h |
| Pharmacokinetics: apparent volume of distribution | up to 14 weeks | Vz/F, L |
| Safety: serum concentrations of endogenous corticosteroids before, during and after treatment with dexamethasone eye drops measured with mass spectrometry. | up to 14 weeks | Endogenous levels of corticosteroids, nmol/L |
| Safety: saliva concentrations of endogenous corticosteroids before, during and after treatment with dexamethasone eye drops. | up to 14 weeks | Endogenous levels of corticosteroids, nmol/L |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| To describe if dexamethasone eye drops delay the intervention for type 1 ROP in cases without regression by calculating the time from detection of type 2 ROP to type 1 ROP | Up to 14 weeks | Time from detection of type 2 ROP to type 1 ROP, days |
| To describe if dexamethasone eye drop treatment before intervention for type 1 ROP reduces the number of recurrences after the intervention. | Up to 14 weeks | recurrences after laser/anti-VEGF treatment, percentage |
| To find out if retinal morphology measured with optical coherence tomography is affected by dexamethasone eye drops at 2.5 years of age. | after 2.5 years | Retinal thickness, micrometers |
| To find out if retinal morphology measured with optical coherence tomography is affected by dexamethasone eye drops at 5 years of age. | after 5 years | Retinal thickness, micrometers |
| To find out if dexamethasone eye drops affect visual acuity at 2.5 years of age | after 2.5 years | Visual acuity according to Snellen, fraction |
| To find out if dexamethasone eye drops affect refractive errors at 2.5 years of age | after 2.5 years | Refractive power, diopters |
| To find out if dexamethasone eye drops affect visual acuity at 5 years of age | after 5 years | Visual acuity according to Snellen, fraction |
| To find out if dexamethasone eye drops affect refractive errors at 5 years of age | after 5 years | refractive power, diopters |
Countries
Sweden
Contacts
PRINCIPAL_INVESTIGATORHanna Maria Öhnell, PhD
Ophthalmology, dep. of clinical sciences Lund, Lund University, Skåne University Hospital, Sweden
PRINCIPAL_INVESTIGATORAnn Hellström, prof
Ophthalmology, inst. of neuroscience and physiology, University of Gothenburg, Sweden
Outcome results
None listed