Fuchs' Endothelial Dystrophy
Conditions
Keywords
Fuchs' endothelial corneal dystrophy, Descemet membrane endothelial keratoplasty, Incomplete graft attachment, Endothelial corneal graft detachment, Rebubbling (repeat injection of air or gas in the anterior chamber), Supine positioning, Postoperative posture, Anterior segment optical coherence tomography, Neural network, Machine learning, Randomized controlled trial
Brief summary
This randomized controlled trial evaluates the efficacy and safety of postoperative supine head positioning on graft attachment after Descemet membrane endothelial keratoplasty in patients with Fuchs' endothelial corneal dystrophy (FECD).
Detailed description
In Descemet membrane endothelial keratoplasty (DMEK), an air or gas bubble is inserted in the anterior chamber of the eye to keep the ultrathin endothelial corneal graft attached to the patients own cornea. Supine positioning is thought to improve attachment by using the tamponade effect of the bubble. At present, it is unclear how long supine positioning is required. Positioning regimens vary between one hour to over one week. In this trial, the investigators will assess if prolonged supine positioning for 5 days improves graft attachment and long-term outcomes compared to supine positioning for 1 day.
Interventions
BEHAVIORALSupine positioning: 5 days
Supine positioning for 5 days after DMEK
BEHAVIORALSupine positioning: 1 days
Supine positioning for 1 days after DMEK
Sponsors
University Eye Hospital, Freiburg
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Masking description
Participants, care providers, surgeons, and investigators will be masked until the first postoperative day after DMEK. Investigators will open the opaque envelope with the study assignment together with the participant and inform care providers on the positioning regimen for the next 4 days. The primary outcome will be assessed by a masked investigator using a trained and validated neural network for image segmentation.
Intervention model description
Stratification will be performed according to the surgical procedure (DMEK alone or DMEK combined cataract surgery). Within each strata, participants will be randomized in a 1:1 ratio to 5 days (intervention) and 1 day (control) postoperative supine positioning.
Eligibility
Sex/Gender
ALL
Age
18 Years to 100 Years
Healthy volunteers
No
Inclusion criteria
* Diagnosis of advanced Fuchs' endothelial corneal dystrophy (FECD) * Indication for corneal endothelial transplantation (Descemet Membrane Endothelial Keratoplasty - DMEK)
Exclusion criteria
* Other corneal diseases (i.e. corneal scars, corneal dystrophies except FECD, corneal inflammation / infection) * Regular use of drugs potentially affecting the cornea (i.e. amiodarone, chloroquine, triptan, isotretinoin, use of contact lenses in past four weeks, anesthetic eye drops) * Diabetes mellitus with endorgan complications) * Lack of fixation during corneal tomography * Bedridden
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Graft attachment | At two weeks after DMEK | Area of graft detachment, quantified from a trained and validated neural network for image segmentation of anterior segment optical coherence tomography |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Safety of supine positioning | At two weeks and 3 months after DMEK | Adverse events (AE) and serious AEs (SAE) |
| Subjective visual function | At 3, 12, and 24 months after DMEK | Subjective visual function on a scale from 0 (worse vision) to 10 (best vision) with higher scores meaning better subjective visual function |
| Visual acuity | At 3, 12, and 24 months after DMEK | Best-corrected visual acuity to determine visual acuity in letters |
| Disability glare | At 3, 12, and 24 months after DMEK | Straylight meter measurement to determine forward scatter in logs straylight parameter |
| Rebubbling | At two weeks and 3 months after DMEK | Number of eyes with secondary injection of air after DMEK |
| Graft health | At 12, and 24 months after DMEK | Slit-lamp exam to identify signs of graft rejection |
| Patient-reported visual disability | At 3, 12, and 24 months after DMEK | The Visual Acuity Factor and Glare Factor of the Visual Function and Corneal Health Status (V-FUCHS) instrument. The instrument's scores are Rasch-analysis based scores expressed in logits. Participants with more difficulty have higher or more positive V-FUCHS scores. |
| Corneal edema | At 2 weeks and at 3, 12, and 24 months after DMEK | Tomography to determine corneal edema in µm |
| Corneal backscatter | At 3, 12, and 24 months after DMEK | Tomography to determine corneal backscatter in scatter units (SU) |
| Graft health: endothelial cell density | At 3, 12, and 24 months after DMEK | Specular microscopy to determine endothelial cell density |
Countries
Germany
Outcome results
None listed