Same-Site Deep Sclerectomy Re-Operation with Subconjunctival and Subscleral Collagen Matrix (Ologen™) and Minimal use of Mitomycin C

Abstract

Purpose: This study aimed to evaluate the safety and efficacy of same-site Deep Sclerectomy (DS) re-operation with subconjunctival and subscleral collagen matrix (Ologen™) and minimal use of mitomycin C in cases of late failure blebs. Methods: A prospective evaluation of consecutive patients on which same-site DS was performed with subconjunctival and subscleral collagen matrix (Ologen™) and minimal use of mitomycin C; all performed at a single university institution. Intraocular pressure (IOP), number of glaucoma medications, postoperative interventions, postoperative complications and surgical success were registered at 24 hours, 1, 6 and 12 months after the surgery. Results: Twenty-five eyes of 25 patients were included in this study. Time from first DS was 55.08 ± 28.16 months. Mean preoperative IOP was 20.88 ± 6.06 mmHg and it was reduced to 16.64 ± 4.02 mmHg, at 12 months after re-operation (p 0,007). At this final visit, requirements for topical medications dropped from a mean of 2.2 ± 1.0 to 0.72 ± 1.0 per patient and no medications were required in 60% of patients. Success was 36 % in criteria A (IOP ≤15mmHg), 72% in criteria B (IOP ≤18 mmHg) and 80 % in criteria C (IOP ≤15 mmHg), 12 months after the second surgery. Conclusion: The same-site DS re-operation with subconjunctival and subscleral collagen matrix (Ologen®) and minimal use of mitomycin C is a safe and adequate technique for the reduction of IOP, especially when targeted IOP is not lower than 15mmHg.

Same-site trabeculectomy with mitomycin and Ologen™ following failed non-penetrating deep sclerectomy

“…9,13 Similar to our study, Díaz-Aljaro demonstrated a significant IOP and medication use reduction in 25 patients who underwent ssDS. 13 Mean IOP reduction was greater with same-site TRAB compared to ssDS (20.31% vs 37.9% reduction); however, mean preoperative IOP was also greater in the current study (24.90 vs 20.88 mmHg). Concerning mean medication use reduction, same-site TRAB outcomes were superior (80.36% vs. 67.27% reduction) but preoperative medication use was also greater (2.8 vs 2.2 medications).…”

“…[9][10][11]13 Surgical reopening of the failed blebs could be advantageous because conjunctiva can be preserved for future surgeries, although operating in a previously used surgical field may be challenging due to excessive scarring and bleeding. 9,13 Similar to our study, Díaz-Aljaro demonstrated a significant IOP and medication use reduction in 25 patients who underwent ssDS. 13 Mean IOP reduction was greater with same-site TRAB compared to ssDS (20.31% vs 37.9% reduction); however, mean preoperative IOP was also greater in the current study (24.90 vs 20.88 mmHg).…”

“…Although a heterogeneous sample is a known potential source of confusion that may limit the conclusions, we find that it is common in other published studies on this topic. 9–11,13,14 A possible explanation is that reintervention after a failed filtering surgery is not such a frequent procedure and gathering a considerable sample would be difficult if excluding these patients. It is also noticeable that, when the influence of these factors has been assessed, prior cataract extraction or the number of previous glaucoma surgeries have not shown a significant effect on the survival curve of the surgical revision after a failed filtering surgery.…”

“…10,12 Similar procedures have been described after TRAB failure. [9][10][11]13 Surgical reopening of the failed blebs could be advantageous because conjunctiva can be preserved for future surgeries, although operating in a previously used surgical field may be challenging due to excessive scarring and bleeding. 9,13 Similar to our study, Díaz-Aljaro demonstrated a significant IOP and medication use reduction in 25 patients who underwent ssDS.…”

“…Díaz-Aljaro reported the same-site deep sclerectomy (ssDS), which restores aqueous humor filtration while sparing conjunctiva that may be required for subsequent procedures. 13 In ssDS, a conjunctival flap is dissected and mitomycin C (MMC) 0.02% is applied for 1 min. Then, the NPDS scleral flap is re-dissected and an Ologen™ matrix (Aeon Astron Europe BV.…”