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CompletedNCT02423161PIONEERUpdated Aug 20, 2024

PIONEER: Intraoperative and Perioperative OCT Study

An observational study in Retinal Detachment, Epiretinal Membrane and Macular Hole, sponsored by The Cleveland Clinic. Completed at 1 site in United States. Open to participants aged 18 Years and older, including healthy volunteers. Per ClinicalTrials.gov, last updated 2024-08-20.

Sponsored by The Cleveland Clinic · Observational

Study type
Observational
Model
Other
Time perspective
Prospective
Enrollment
750
Ages
18 Years and older
Sex
All
01

Study summary

OCT provides high-resolution information regarding the anatomic structure of the tissues of the eye in a 2-dimensional and 3-dimensional view. Much of this information is not able to be recognized by a clinician. Utilizing this information during surgery will allow for ophthalmic surgeons to better understand how surgical procedures impact the anatomic structure of the eye.

Read the detailed description

Over the last decade, optical coherence tomography (OCT) has become a critical component to the evaluation of ophthalmic disease. Similar to ultrasound, OCT uses light to reconstruct an image of the tissue of interest. In effect, OCT has become to function as a light biopsy, allowing clinicians to visualize subtle pathologic changes in the tissue, such as macular edema or subretinal fluid. The use of OCT in the clinic setting has become the standard for monitoring diseases such as macular degeneration and diabetic retinopathy. It has quickly become the most frequent ordered diagnostic test in ophthalmology.

Due to restraints in the size and structure of the imaging equipment, the use of OCT in the operating room has been limited. More recently, modifications to OCT table-top models as well as the development of hand-held OCT probes have allowed for the translation of OCT technology into the operating room. The high resolution anatomic information that is gained from OCT imaging is a natural complement to the ophthalmic surgeon. Using OCT during vitreoretinal surgery has revealed subtle changes in the microarchitecture of the retina in diseases such as retinal detachment, macular hole, and optic pit, that were not previously known. Using OCT during lamellar corneal transplant procedures, anterior segment surgeons have been able to image proper placement of the graft that was previously unattainable with a standard surgical microscopic view.

Using information gained from OCT, surgeons may be able to improve surgical decision making and improve clinical outcomes. For this study, subjects undergoing ophthalmic surgery, including vitreoretinal surgery and anterior segment surgery, would have OCT imaging performed in the perioperative period, intraoperative period, or both to document architectural changes in the ocular tissues. This information would be prospectively collected and reviewed for associations with anatomic and functional outcomes.

A microscope-mounted OCT system will be used to assess feasibility and utility of imaging during ophthalmic surgical milestones.

02

Conditions studied

  • Retinal Detachment
  • Epiretinal Membrane
  • Macular Hole
  • Fuchs Endothelial Dystrophy

Keywords

  • OCT
  • image-guided surgery
  • vitreoretinal surgery
  • corneal surgery
03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
Yes
Sampling method
Non-probability sample

Study population

The study population includes any patient requiring ophthalmic surgery

Inclusion criteria

  • The study population includes any patient requiring ophthalmic surgery

Exclusion criteria

Exclusion Criteria:

  • Children under the age of 18
  • Cognitive/Mentally impaired or unable to provide consent
  • Media opacity precluding OCT scanning
04

Study design

Observational model
Other
Time perspective
Prospective
Enrollment
750 participants (actual)
Patient registry
No
05

What researchers measure

Primary outcomes

  1. Feasibility of intraoperative OCT

    Defined as percentage of cases where OCT was successfully able to be obtained during surgery

    Time frame: 3 years

Secondary outcomes

  1. Utility of intraoperative OCT

    Defined as percentage of cases where the OCT altered surgical decision-making based on surgeon-report on questionnaire

    Time frame: 3 years

  2. Safety of intraoperative OCT

    Defined as the percentage of subjects that experience adverse events that were related to the intraoperative OCT and/or in excess of what might be expected relative to the surgery performed

    Time frame: 3 years

  3. Time requirements for intraoperative OCT

    Defined as the mean number of minutes required to completed intraoperative imaging during a surgical case

    Time frame: 3 years

06

Study locations

1 site
  • Cole Eye Institute, Cleveland Clinic
    Cleveland, Ohio 44195, United States
07

References and documents

Publications

  • Ehlers JP, Ohr MP, Kaiser PK, Srivastava SK. Novel microarchitectural dynamics in rhegmatogenous retinal detachments identified with intraoperative optical coherence tomography. Retina. 2013 Jul-Aug;33(7):1428-34. doi: 10.1097/IAE.0b013e31828396b7. PubMed 23609120 ↗
  • Ehlers JP, Xu D, Kaiser PK, Singh RP, Srivastava SK. Intrasurgical dynamics of macular hole surgery: an assessment of surgery-induced ultrastructural alterations with intraoperative optical coherence tomography. Retina. 2014 Feb;34(2):213-21. doi: 10.1097/IAE.0b013e318297daf3. PubMed 23860560 ↗
  • Ehlers JP, Itoh Y, Xu LT, Kaiser PK, Singh RP, Srivastava SK. Factors associated with persistent subfoveal fluid and complete macular hole closure in the PIONEER study. Invest Ophthalmol Vis Sci. 2014 Dec 18;56(2):1141-6. doi: 10.1167/iovs.14-15765. PubMed 25525173 ↗
  • Ehlers JP, Dupps WJ, Kaiser PK, Goshe J, Singh RP, Petkovsek D, Srivastava SK. The Prospective Intraoperative and Perioperative Ophthalmic ImagiNg with Optical CoherEncE TomogRaphy (PIONEER) Study: 2-year results. Am J Ophthalmol. 2014 Nov;158(5):999-1007. doi: 10.1016/j.ajo.2014.07.034. Epub 2014 Jul 29. PubMed 25077834 ↗
  • Juthani VV, Goshe JM, Srivastava SK, Ehlers JP. Association between transient interface fluid on intraoperative OCT and textural interface opacity after DSAEK surgery in the PIONEER study. Cornea. 2014 Sep;33(9):887-92. doi: 10.1097/ICO.0000000000000209. PubMed 25055146 ↗
  • Au J, Goshe J, Dupps WJ Jr, Srivastava SK, Ehlers JP. Intraoperative Optical Coherence Tomography for Enhanced Depth Visualization in Deep Anterior Lamellar Keratoplasty From the PIONEER Study. Cornea. 2015 Sep;34(9):1039-43. doi: 10.1097/ICO.0000000000000508. PubMed 26114817 ↗
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Registry details

Key details

Study ID
NCT02423161
Lead sponsor
The Cleveland Clinic
Collaborators
National Eye Institute (NEI)
Responsible party
Justis Ehlers (Assistant Professor of Ophthalmology, The Cleveland Clinic) — Principal investigator
First posted
Apr 22, 2015
Start date
Aug 2011
Primary completion
Aug 2014
Completion
Aug 2017
Last update
Aug 20, 2024

Study contacts

Justis P Ehlers, MD
principal investigator · Cole Eye Institute, Cleveland Clinic, OH 44195

Oversight

Data monitoring committee
No
View the source record on ClinicalTrials.gov ↗

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This study is completed, as verified in Aug 2024. You cannot join it, but the record below documents what was studied.

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