Ahmed Valve Implantation Coated With Poly Lactic -Co-glycolic Acid (PLGA) Saturated With Mitomycin-C in the Management of Adult Onset Glaucoma in Sturge Weber Syndrome

Overview

Sturge weber's syndrome is an oculcutaneous syndrome, ocular manifestations may include heamangioma in the eye lids, choroidal heamangioma, or glaucoma, the glaucoma may present at infancy and may be due to resistance to aqueous outflow through trabecular meshwork(1), it may develop later and this is due to episcleral venous raised pressure.(2-3) Glaucoma associated with Sturge weber syndrome is difficult to be treated medically with high risk of complications when treated with bleb -based surgeries. Suprachoroidal hemorrhage or detachment is a challenging complication which must be encountered. The usage of Ahmed valve in the management of glaucoma associated with Sturge weber syndrome is a bleb based procedure carries the risks of over filtration or encapsulation and decreased filtration with failure to control glaucoma. The use of Ahmed valve in the management of pediatric glaucoma associated with Sturge weber syndrome has better results as recorded by Nassiri et al. Ahmed valve implantation can have some drawbacks such as pupillary irregularity, lens opacification, or encapsulation.(4-7) Glaucoma drainage devices such as Ahmed valve, Molteno or Braeveldt valve can be used when other methods of treatment fail, they provide alternative pathway to the aqueous to be collected in a plate positioned under the conjunctiva, (8-10) Encapsulation is a major problem occurs around the end plate due to fibrous reaction and so the drainage of the aqueous is decreased , Epatein (11) attributed that to fibro vascular proliferation in the episcleral tissue .the fibrous reaction is multifactorial , it may be due to the size of the end plate, the biomaterial, design or the shape of the plate. The use of drainage devices with advanced drug delivery system can improve the success of drainage device. A double-layered porous coating for Ahmed glaucoma valves based on biodegradable poly(lactic-co-glycolic acid) (PLGA) was described by Ponnusamy et al. [12] to produce continuous release of antifibrotic agents [mitomycin C (MMC) and/or 5-fluorouracil (5-FU)] to the subconjunctival space. This release continue for about one month with decreasing fibrosis, the nanofiltration membrane could entrap the proteins passing out from the anterior chamber leading to minimal increase in aqueous resistance.(12-13)

Study Type

• Study Type: Interventional
• Study Design
  • Allocation: Randomized
  • Intervention Model: Parallel Assignment
  • Primary Purpose: Treatment
  • Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
• Study Primary Completion Date: December 15, 2022

Detailed Description

All participants will be evaluated regarding the following: Visual acuity (VA) will be measured before and after surgery. Visual field (VF) will be assessed. Optical coherence topography (OCT) Ahmed valve coated with PLGA nanoparticles saturated with Mitomycin-C 2mg/ml. Follow up will continue for one year regarding intraocular pressure IOP, VA , VF, OCT and occurrence of complications such as erosion, extrusion, infection, encapsulation and fibrosis around the stent. Data will be collected and analyzed.

Interventions

• Procedure: Ahmed Valve
  • Ahmed valve implantation coated with poly lactic -co-glycolic acid (PLGA) saturated with Mitomycin-C in the management of adult onset glaucoma in Sturge Weber syndrome

Arms, Groups and Cohorts

• Experimental: Ahmed valve coated with PLGA is implanted in secondary glaucoma in Sturge Weber syndrome
  • Ahmed valve coated with PLGA is implanted in secondary glaucoma in Sturge Weber syndrome
• Active Comparator: Ahmed valve implanted in secondary glaucoma in Sturge Weber syndrome
  • Ahmed valve will be implanted alone with no PLGA

Clinical Trial Outcome Measures

Primary Measures

• IOP in mmg
  • Time Frame: one year
  • efficacy of Ahmed valve implantation coated with PLGA sturated with MMC
• Incidence of complications
  • Time Frame: one year
  • to assess complications regarding the flap , erosions to the conjunctiva , extrusion , endothelial toxicity.

Participating in This Clinical Trial

Inclusion Criteria

• Patients suffered from adult onset Sturge Weber syndrome and subjected to Ahmed valve implantation. Exclusion Criteria:

• other ocular pathology; choroidal heamangioma, cataract, exudative retinal detachment. Patients under 18 years old

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

• Lead Sponsor
  • Sohag University
• Provider of Information About this Clinical Study
  • Principal Investigator: Hany Mahmoud, principal investigator – Sohag University
• Overall Official(s)
  • Hany Mahmoud, MD, Principal Investigator, Sohag University
• Overall Contact(s)
  • Hany Mahmoud, MD, 01024368111, drhanymahmoud@gmail.com