Diabetic Macular Edema (DME)
Conditions
Keywords
dexamethasone implant, vascular endothelial growth factor, Corticosteroids, combination therapy, biomarker, best corrected visual acuity
Brief summary
The goal of this clinical trial is to learn if the efficacy of dexamethasone implant combined with anti-VEGF superior to anti-VEGF monotherapy in the treatment of DME in Chinese patients. The main questions it aims to answer are: 1. Whether combination therapy improves the best corrected visual acuity at 6 months and 12 months? 2. Does combination therapy improve retinal anatomy better than monotherapy at each time point? Researchers will compare the combination therapy to the monotherapy to see if dexamethasone implant combined with anti-VEGF will leads to better results. Participants will: 1. be randomly assigned to one of two groups with equal probability to receive the combination of intravitreal anti-VEGF and dexamethasone implant injections or intravitreal anti-VEGF injections. 2. During the first 3 months, patients in both groups will receive monthly injections of anti-VEGF. In the double protocol group, the first dexamethasone implant injection will be administered simultaneously with the first loading dose of anti-VEGF injections. Between 4 and 12 months, patients will receive intravitreal anti-VEGF injections as needed/pro-re-nata (PRN). 3. Patients will have regular follow-up. Routine examination includes Central retinal thickness (CRT), intraocular pressure (IOP), slit lamp examination, best corrected visual acuity (BCVA) and OCT.
Interventions
COMBINATION_PRODUCTThe combination of intravitreal anti-VEGF and dexamethasone implants injections.
Early combination of intravitreal dexamethasone implant and anti-VEGF injection for the treatment of DME.
Sponsors
Ningbo Eye Hospital
Jiaxing Hospital of T.C.M
Second Affiliated Hospital, School of Medicine, Zhejiang University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Type 1/type 2 diabetes mellitus with good glycaemic control and glycated haemoglobin ≤ 10.0%; DR stage II-III; * DME with involvement of the central concavity and resulting in the patient's vision loss; * Central retinal thickness (CRT) ≥250 μm; * No refractive interval clouding and pupillary constriction affecting fundus examination; * No Pan-Retinal Photocoagulation treatment within 3 months before enrolment; * No macular laser treatment in the past or during the follow-up period; * Good patient cooperation and compliance.
Exclusion criteria
* other macular lesions such as macular preexisting membranes, macular schisis, or other causes of macular oedema such as uveitis and central retinal vein occlusion; * Co-existence of diabetic optic neuropathy; * Previous intraocular injection therapy such as anti-VEGF drugs or glucocorticoid drugs in the target eye; * History of vitreoretinal surgery in the target eye; * A history of uncontrolled stable glaucoma or hypertension, hormonal hypertension in the target eye; * Aphakic eyes with posterior lens capsule rupture with an anterior chamber IOL (ACIOL), iris or transscleral fixed intraocular IOLs, and patients with posterior lens capsule rupture; * Pregnant or breastfeeding patients, uncontrolled hypertension within 3 months, cerebrovascular accident or myocardial infarction, uncontrolled diabetes mellitus, or other reasons for not being able to co-operate with the relevant examination; * Lost visits and data loss.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Average change in best corrected visual acuity (BCVA) of each group from baseline to the end of month 6. | 6 month. | BCVA was measured using the log Mar visual acuity chart or the ETDRS visual acuity chart. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Average change in best corrected visual acuity (BCVA) of each group from baseline to month 3, 12. | 3 month and 12 month | BCVA was measured using the log Mar visual acuity chart or the ETDRS visual acuity chart. |
| Average change in central retinal thickness (CRT) of each group from baseline to month 3, 6,12. | 3, 6 and 12 month | Central retinal thickness (CRT) is a measurement of the macula from the internal limiting membrane to the RPE and can be quantified by OCT scans |
| The proportion of eyes with a 5-letter /10-letter improvement from baseline of BCVA at month 6 and 12. | 6 month and 12 month | BCVA was measured using the log Mar visual acuity chart or the ETDRS visual acuity chart. |
Countries
China
Outcome results
None listed