Five Years' Outcomes of Trabeculectomy with Cross-linked Sodium Hyaluronate Gel Implantation for Chinese Glaucoma Patients

Abstract

Background:Trabeculectomy is the most efficient surgical treatment. Prevention failure of bleb cicatrix would lead to unsatisfactory postoperative intraocular pressure (IOP) controlling and unsatisfactory success rate. The aim of this study was to evaluate the 5-year outcomes of trabeculectomy with a cross-linked sodium hyaluronate gel implantation for Chinese glaucoma patients.Methods:This is a prospective, case-controlled study. Patients who were to be applied first-time trabeculectomy in the Department of Ophthalmology of Peking University Third Hospital between 2010 and 2012 were included in the study. Totally, 60 eyes were randomly assigned to the trabeculectomy group (TA group) or the trabeculectomy with cross-linked sodium hyaluronate gel implantation group (TH group). Follow-up was finished at 1 week, 1 month, 3 months, 1 year, 3 years, and 5 years after the operation. The statistical index of demographic data, IOP, bleb shape, and any complications or medications or surgical procedures were recorded and assessed by SPSS 19.0 software through independent t-test, one-way analysis of variance (ANOVA) and Pearson's Chi-square test, respectively.Results:The baseline IOP was comparable between the two groups (t= −1.00, P= 0.32) while the postoperative IOP was significantly lower in the TH group at 1, 3 and 5 years' time points (P = 0.00, P= 0.01 and P = 0.01, respectively). According to the Indiana Bleb Appearance Grading Scale, the height and extent of bleb were better in the TH group at all follow-up time points (P < 0.05), however, the comparison of bleb vascularity showed no statistical difference (P > 0.05). TA group had a higher percentage of complications (13% vs. 3%) compared to TH group; however, there was no statistical difference in the comparison of each statistical item (P > 0.05, respectively). The complete success at 5 years was higher in the TH group than that in the TA group (78% vs. 54%, P = 0.03).Conclusion:Our results suggested that implantation of cross-linked sodium hyaluronate gel with trabeculectomy was more efficient and would improve the prognosis of glaucoma patients.

Hyaluronic Acid: The Influence of Molecular Weight on Structural, Physical, Physico-Chemical, and Degradable Properties of Biopolymer

“…To obtain hydrogel from HA, the latter might be crosslinked by chemical modification. In addition to creating a three-dimensional structure, chemical modification makes it possible to achieve better physicochemical characteristics in hydrogels, thereby increasing their resistance to biodegradation [ 131 ].…”

Cross-linked hyaluronic acid viscoelastic scleral implant in trabeculectomy

“…stated that by 5 years 78% patients had postoperative IOP below 21 mmHg with sodium hyaluronate and 54% reached the goal in the group with only trabeculectomy. [ 27 ]…”

Novel Therapies for the Prevention of Fibrosis in Glaucoma Filtration Surgery

“…Ologen is a biodegradable three-dimensional collagen-glycosaminoglycan copolymer matrix implant that may also act as a physical spacer [ 56 ]. In an RCT, Ologen was shown to improve IOP control and blunt the hypertensive phase in Ahmed glaucoma valve surgery immediately after surgery but not at 6 or 12 months post-surgery [ 184 ].…”

“…In an RCT, Ologen was shown to improve IOP control and blunt the hypertensive phase in Ahmed glaucoma valve surgery immediately after surgery but not at 6 or 12 months post-surgery [ 184 ]. Although early clinical studies comparing the rates of complications and efficacy of Ologen to MMC in trabeculectomy showed mixed results, recent trials have shown the comparable or superior efficacy of Ologen [ 56 ]. When comparing Ologen and perfluoropropane in trabeculectomy, the IOP values were similar in the first 12 months of follow-up, but the Ologen group showed a more significant reduction in IOP during the last 24 months of follow-up [ 50 ].…”