Safety and Effectiveness of the PXL Platinum 330 System With Riboflavin Solution for Previously Untreated Corneal Ulcers

Sponsor

Peschke GmbH (Industry)

Overall Status

Recruiting

CT.gov ID

NCT05255107

Collaborator

(none)

468

Enrollment

Locations

Arms

15.3

Anticipated Duration (Months)

58.5

Patients Per Site

3.8

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

This study is being conducted to evaluate the safety and effectiveness of using the PXL Platinum 330 System with riboflavin solution for performing corneal collagen crosslinking (CXL) for the treatment of previously untreated corneal ulcers. The PXL Platinum 330 System is a combination product consisting of an ultraviolet A (UV-A) 365 nm wavelength light source (PXL Platinum 330 Illumination System) and riboflavin (Riboflavin 0.23% PESCHKE-L Solution) administered in conjunction with the UV-A light as a photosensitizer. The PXL Platinum 330 System is intended to induce corneal collagen CXL to improve the biomechanical properties of the cornea by strengthening the corneal tissue in the anterior stroma. Corneal collagen CXL is performed by pretreating the cornea with riboflavin ophthalmic solution beginning 40 min before UV-A light exposure to saturate the corneal tissue with the riboflavin photosensitizer. The cornea is then irradiated with UV-A light (365 nm) at an irradiance of 18 mW/cm2 (5 seconds on, 5 seconds off) for 10 min. Exposure of the cornea to this UV-A light regimen after topical administration of riboflavin ophthalmic solution has been shown to induce CXL of the corneal collagen fibrils, with a resultant increase in tensile strength and diameter of the collagen fibrils. Clinically, CXL has been shown to stabilize the corneal curvature in eyes with progressive keratoconus, with no significant change in the refractive index of the cornea. Numerous reports and a few clinical trials have also shown benefit in aiding resolution of infective corneal ulcers.

Condition or Disease	Intervention/Treatment	Phase
Keratitis Corneal Ulcer	Combination Product: Standard of Care Therapy + CXL + Riboflavin 0.23% L Solution Other: Standard of Care Therapy + Sham CXL + Artificial Tears	Phase 2/Phase 3

Detailed Description

This is a prospective, 2-arm parallel-group, single-masked, randomized multicenter study to determine the safety and effectiveness of the PXL Platinum 330 System for performing CXL in eyes with previously untreated corneal ulcers. Subjects with documented infectious corneal ulcers that have not been treated (treatment na ve) will be evaluated initially for suitability as candidates for CXL. Subjects who are candidates for CXL will be asked to participate in this study and will undergo the required screening procedures to determine study eligibility. Informed consent will be obtained from each subject before performance of any required study procedures that are not part of the investigator's routine examination. After completing screening procedures, the diagnosis for each eligible eye will be confirmed. Subjects will be randomized to 1 of 2 groups, both including standard of care (SOC) treatment:

SOC: Moxifloxacin 0.5% eyedrop therapy every 1 hour (q1h) while awake; to be tapered at treating physician's discretion
CXL + SOC: Moxifloxacin 0.5% eyedrop therapy + CXL

Eyes undergoing CXL will have topical anesthetic administered and then have topical riboflavin instilled onto the cornea every 2 min (or longer as needed to assure adequate corneal penetration), after which the cornea will be exposed to UV-A pulsed light 18 mW/cm2 for 10 min. Riboflavin instillation will continue every 2 min during CXL. The CXL procedures will be performed on an outpatient basis using the PXL Platinum 330 System (UV-A light source and riboflavin solution). All use of the PXL Platinum 330 System will be in accordance with this protocol and the general instructions provided by the manufacturer (PESCHKE) in the PXL Platinum 330 Illumination System Operator's Manual. All subjects will be evaluated at Screening/Baseline, Day 0 (Randomization/Treatment), Day 1, Day 3 ( 1 day), Week 1 ( 2 days), Week 2 ( 2 days), and Week 4 ( 3 days) after treatment. Efficacy monitoring throughout the study will include observations at appropriate times for re-epithelialization, size of infection, and corneal culture results. Safety monitoring throughout the study will include observations at appropriate times for pain, IOP, BSCVA, corneal scar size, AEs, clinically significant findings on ophthalmic examination, dilated fundus examination, and slit lamp examination. After treatment, subjects will be followed at the treating physician's discretion.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

468 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Intervention Model Description:

Simple block randomization will be used to assign subjects in a 1:1 ratio to 2 treatment arms. Subjects will be randomized consecutively (not stratified by site) to ensure balance between the treatment arms at any point in the study.Simple block randomization will be used to assign subjects in a 1:1 ratio to 2 treatment arms. Subjects will be randomized consecutively (not stratified by site) to ensure balance between the treatment arms at any point in the study.

Masking:

Single (Participant)

Primary Purpose:

Treatment

Official Title:

Safety and Effectiveness of the PXL Platinum 330 System With Riboflavin Solution for Previously Untreated Corneal Ulcers

Actual Study Start Date :

Mar 14, 2022

Anticipated Primary Completion Date :

Apr 24, 2023

Anticipated Study Completion Date :

Jun 24, 2023

Arms and Interventions

Arm	Intervention/Treatment
Sham Comparator: Standard of Care Therapy + Sham CXL + Artificial Tears Standard-of-care treatment and Sham CXL and administration of artificial tears.	Other: Standard of Care Therapy + Sham CXL + Artificial Tears Standard Of Care: Moxifloxacin 0.5% eyedrop therapy every 1 hour (q1h) while awake; to be tapered at treating physician's discretion. Following SOC, for subjects randomized to the Sham comparator group, artificial tears (1 drop every 2 min for 40 min) will be administered. After instillation of artificial tears, the eye will be aligned under the PXL Platinum 330 light. The instrument will be kept off and the subject will be kept under the device for 10 min, during which time instillation of artificial tears will be performed (1 drop every 2 min) to maintain corneal hydration. The operator will keep track of sham exposure time independently to confirm the actual duration.
Experimental: Standard of Care Therapy + CXL + Riboflavin 0.23% L Solution The PXL Platinum 330 Illumination System is a portable electronic medical device. The device's light emitting diode (LED) is used to deliver a metered dose of UV-A light to a targeted treatment area for illuminating the cornea during corneal collagen CXL. PESCHKE-L Solution is a riboflavin 5'-phosphate 0.23% ophthalmic solution that functions as a photosensitizer and is indicated for use with the PXL Platinum 330 Illumination System. Designed to be used when there is epithelial disruption as can occur with a corneal ulcer or wound. It does not contain benzalkonium chloride. It is intended to achieve rapid absorption.	Combination Product: Standard of Care Therapy + CXL + Riboflavin 0.23% L Solution Standard Of Care: Moxifloxacin 0.5% eyedrop therapy every 1 hour (q1h) while awake; to be tapered at treating physician's discretion. Following SOC, for subjects randomized to the experimental arm, riboflavin will be administered (1 drop every 2 min for 40 min with PESCHKE-L solution [0.23%], or longer as needed to assure adequate corneal penetration). Then the eye will be aligned under the PXL Platinum 330 light (the treatment plane will be at the correct working distance from the PXL Platinum 330 beam aperture when the border of the projected beam is in sharp focus). The correct aperture setting (3 to 12 mm) will be selected for the size of the eye and area needing to be treated (2 mm larger than the maximal ulcer diameter), and the eye will be irradiated at 18 mW/cm2, with pulsed mode (5 seconds on, 5 seconds off) for 10 min, during which time instillation of riboflavin will continue (1 drop every 2 min).

Arm

Intervention/Treatment

Sham Comparator: Standard of Care Therapy + Sham CXL + Artificial Tears

Standard-of-care treatment and Sham CXL and administration of artificial tears.

Other: Standard of Care Therapy + Sham CXL + Artificial Tears

Standard Of Care: Moxifloxacin 0.5% eyedrop therapy every 1 hour (q1h) while awake; to be tapered at treating physician's discretion. Following SOC, for subjects randomized to the Sham comparator group, artificial tears (1 drop every 2 min for 40 min) will be administered. After instillation of artificial tears, the eye will be aligned under the PXL Platinum 330 light. The instrument will be kept off and the subject will be kept under the device for 10 min, during which time instillation of artificial tears will be performed (1 drop every 2 min) to maintain corneal hydration. The operator will keep track of sham exposure time independently to confirm the actual duration.

Experimental: Standard of Care Therapy + CXL + Riboflavin 0.23% L Solution

The PXL Platinum 330 Illumination System is a portable electronic medical device. The device's light emitting diode (LED) is used to deliver a metered dose of UV-A light to a targeted treatment area for illuminating the cornea during corneal collagen CXL. PESCHKE-L Solution is a riboflavin 5'-phosphate 0.23% ophthalmic solution that functions as a photosensitizer and is indicated for use with the PXL Platinum 330 Illumination System. Designed to be used when there is epithelial disruption as can occur with a corneal ulcer or wound. It does not contain benzalkonium chloride. It is intended to achieve rapid absorption.

Combination Product: Standard of Care Therapy + CXL + Riboflavin 0.23% L Solution

Standard Of Care: Moxifloxacin 0.5% eyedrop therapy every 1 hour (q1h) while awake; to be tapered at treating physician's discretion. Following SOC, for subjects randomized to the experimental arm, riboflavin will be administered (1 drop every 2 min for 40 min with PESCHKE-L solution [0.23%], or longer as needed to assure adequate corneal penetration). Then the eye will be aligned under the PXL Platinum 330 light (the treatment plane will be at the correct working distance from the PXL Platinum 330 beam aperture when the border of the projected beam is in sharp focus). The correct aperture setting (3 to 12 mm) will be selected for the size of the eye and area needing to be treated (2 mm larger than the maximal ulcer diameter), and the eye will be irradiated at 18 mW/cm2, with pulsed mode (5 seconds on, 5 seconds off) for 10 min, during which time instillation of riboflavin will continue (1 drop every 2 min).

Outcome Measures

Primary Outcome Measures

To evaluate the safety and effectiveness of corneal collagen CXL for treating previously untreated corneal ulcers [Week 2 (#+/- 2 study days).]
Primary Outcome Measure: The composite primary endpoint outcome would be the proportion of patients in the treated group, compared to the control group, who achieve all three of the following components: complete re-epithelialization at week 2, defined as absence of corneal fluorescein staining noted with the blue light of the slit lamp by the investigator. no expansion of infiltrate from baseline to week 2. The size of the infiltrate will be reviewed by the investigator using the slit lamp exam and compared to baseline measures to assess expansion of the infiltrate. a negative corneal culture at week 2 Each of the components of this composite endpoints is a binary outcome (yes or no), and are NOT measured as units of measure.

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Subjects who have one or both eyes that meet the following criteria will be considered candidates for this study:

18 years of age or older
Ulcers outside the central 5 mm optical zone of the cornea that have not been treated with ophthalmic antibiotic eyedrops (eg, quinolone,polymyxin/trimethoprim, erythromycin, vancomycin, tobramycin, cefazolin, or other ophthalmic antimicrobials) in the preceding 30 days
Consent to a corneal culture for suspected bacterial keratitis (defined as a corneal epithelial defect of any size with an infiltration of the underlying stroma 1-5 mmin maximal diameter)
Signed written informed consent
Willingness and ability to comply with schedule for follow-up visits
Minimum corneal thickness >300 μm

Exclusion Criteria:

All subjects meeting any of the following criteria will be excluded from this study:

Presence of a perforated corneal ulcer
Presence of a corneal ulcer that had produced a descemetocele
Presence of a corneal ulcer deeper than 50% depth or 275 μm in the cornea
Any active ocular infection other than the corneal ulcer to be treated
Suspicion of amoebic or viral keratitis requiring treatment with topical anti-amoebic or topical antiviral ophthalmic medications
Previous ocular condition (other than refractive error) in the eye(s) to be treated that may predispose the eye(s) for future complications. This may include history of or active corneal disease (eg, herpes simplex, herpes zoster keratitis, recurrent erosion syndrome, acanthamoeba, etc.)
Uncontrolled systemic disease, especially a collagen-vascular or rheumatologic condition that could be contributing to the corneal condition
Pregnancy (or plan to become pregnant) or lactation during the course of the study
A known sensitivity to study medications
Presence of nystagmus or any other condition that would prevent a steady gaze during the CXL treatment or other diagnostic tests

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Bay Area Eye Institute	Tampa	Florida	United States	33613
2	Price Vision Group	Indianapolis	Indiana	United States	46260
3	The cornea & Laser Eye Institute-NJ	Teaneck	New Jersey	United States	07666
4	Prisma Health Opthalmology	Columbia	South Carolina	United States	29203
5	Woolfson Eye	Chattanooga	Tennessee	United States	37421
6	Houston Eye Associates	Houston	Texas	United States	77008
7	San Antonio Eye Center	Lackland Air Force Base	Texas	United States	78236
8	Milwaukee Eye Surgeons	Milwaukee	Wisconsin	United States	53203

Sponsors and Collaborators

Peschke GmbH

Investigators

Study Director: Yvette Viscuso, Peschke GmbH
Principal Investigator: Bala Ambati, Pacific Clear Vision Institute

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.

Responsible Party:

Peschke GmbH

ClinicalTrials.gov Identifier:

NCT05255107

Other Study ID Numbers:

PXL-330-02B

First Posted:

Feb 24, 2022

Last Update Posted:

Jul 18, 2022

Last Verified:

Jul 1, 2022

Individual Participant Data (IPD) Sharing Statement:

Plan to Share IPD:

Studies a U.S. FDA-regulated Drug Product:

Yes

Studies a U.S. FDA-regulated Device Product:

Yes

Additional relevant MeSH terms:

Study Results

No Results Posted as of Jul 18, 2022