Trabeculectomy With Combined Use of Subconjunctival Collagen Implant and Low-dose Mitomycin C

Dada, Tanuj; Kusumesh, Rakhi; Bali, Shveta Jindal; Sharma, Sourabh; Sobti, Amit; Arora, Vishal; Panda, Anita

doi:10.1097/ijg.0b013e3182594f5b

Cited by 38 publications

(32 citation statements)

References 13 publications

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“…In the study by Dada et al, 18 there were no sight-threatening complications; however, two eyes developed hypotony during the early postoperative course due to leaky conjunctival wound. Another case was noted to have implant exposure at 1 week.…”

Section: Discussionmentioning

confidence: 99%

“…They declared that it appears to offer encouraging short-term results for IOP control. 18 In a similar study, Min et al 19 studied surgical outcomes and wound healing reaction of a filtering bleb after trabeculectomy using MMC-soaked ologen. They found that it did not exert any synergistic effect in terms of a reduction in IOP, but it resulted in comparatively stable IOP and did not aggravate wound healing or scar formation, while encapsulated blebs were more common and developed more rapidly.…”

Section: Discussionmentioning

confidence: 99%

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Trabeculectomy with ologen in secondary glaucomas following failed trabeculectomy with MMC: comparative study

El-Saied¹,

Abdelhakim²

2016

Eye

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Trabeculectomy with ologen in secondary glaucomas following failed trabeculectomy with MMC: comparative study

El-Saied¹,

Abdelhakim²

2016

Eye

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“…implantation of a CGM with supplementary MMC in lower concentrations, should be considered so as to benefit from the advantages of both MMC (low IOP) and CGM (advanced morphology of filtering blebs). In one retrospective study the intraoperative administration of MMC (0.1 mg/ml for 1 min) in addition to CGM implantation achieved an IOP level as low as 12.54 ± 1.67 mm Hg 12 months after surgery [27]. In another noncomparative study the use of an MMC-soaked (0.2 mg/ml) OLO implant as an adjuvant in trabeculectomy showed no further synergistic effect related to IOP reduction [26].…”

Section: Discussionmentioning

confidence: 99%

Trabeculectomy Using Mitomycin C versus an Atelocollagen Implant: Clinical Results of a Randomized Trial and Histopathologic Findings

et al. 2013

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Purpose: To assess the efficacy of trabeculectomy with a biodegradable Ologen™ implant (OLO) versus mitomycin C (MMC) in patients in a prospective randomized clinical trial. Methods: In the MMC group (15 patients), trabeculectomy was performed according to standard protocols. In the OLO group (15 patients) after standard trabeculectomy, the implant was positioned on top of the scleral flap, and no MMC was applied. Results: Mean preoperative intraocular pressure (IOP) levels (OLO: 28.0 ± 9.4; MMC: 23.9 ± 5.0 mm Hg; p = 0.21) and medication score (OLO: 3.4 ± 1.6; MMC: 3.6 ± 1.5; p = 0.56) were comparable in both groups. One year after surgery, the mean IOP was 15.9 ± 4.5 mm Hg in the OLO group (p < 0.01, 43% reduction) and 11.0 ± 2.6 mm Hg in the MMC group (p < 0.01, 54% reduction). The surgical success rate 12 months after surgery was 93.3% in the MMC group and 40% in the OLO group (p = 0.01). Conclusions: With the atelocollagen-glycosaminoglycan matrix OLO it was not possible to reach the surgical success rate and pressure reduction achieved in the MMC group.

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“…1 No difference has been found in relative incidence of BRI when trabeculectomy is performed with adjuvant mitomycin or ologen implant. 2 Although bleb leaks and shallow chambers have been reported with ologen use, 3 exposure of the implant is a rare occurrence, 4 and its association with endophthalmitis has not been previously reported.…”

Section: Commentmentioning

confidence: 99%

Blebitis with scleral abscess in a case of operated trabeculectomy with mitomycin C and a subcunjunctival ologen implant

Gupta

Wadhwani

Sehgal

et al. 2014

Eye

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Sir, Blebitis with scleral abscess in a case of operated trabeculectomy with mitomycin C and a subcunjunctival ologen implantWe report a case of juvenile open-angle glaucoma who underwent mitomycin-augmented trabeculectomy with subconjunctival ologen implantation, and subsequently developed scleral abscess and endophthalmitis. Case reportA 19-year-old male presented with BCVA of 6/24 OD and 6/6 OS. His intraocular pressure was 20 mm Hg OD and 18 mm Hg OS on maximal medical therapy with a vertical cup:disc ratio of 0.9 : 1 OU. Gonioscopy showed open angles with prominent iris processes with severely depressed visual fields.Superior fornix-based trabeculectomy with adjuvant 0.01% mitomycin C (1 min) along with subconjunctival ologen implantation was done OU. Conjunctiva was secured using 7-0 Vicryl. He was prescribed topical moxifloxacin 0.5%, prednisolone 1%, and tropicamide 1% drops at discharge on day 2; following which he was lost to follow-up. Two months postoperatively, the patient presented with sudden painful visual loss in his right eye. On examination, his BCVA was perception of light only with inaccurate ray projection; he had diffuse circumcorneal congestion and fibrinous exudates in anterior chamber, an exposed ologen implant, a necrotic bleb, and a scleral abscess (Figure 1). Ultrasonography of posterior segment showed endophthalmitis along with suprachoroidal exudates. Culture of bleb exudates revealed Staphylococcal species. He was treated with intravenous ceftriaxone and vancomycin, fortified antibiotics, and cycloplegic drops along with intracameral 5% vancomycin. Because of partial reabsorption, a well defined ologen could not be appreciated to allow explantation. In consultation with a retinal specialist, intravitreal antibiotic instillation or pars plana vitrectomy was not considered in view of suprachoroidal infiltrates. Despite best efforts, patient lost light perception in that eye. CommentTrabeculectomy with combined use of low-dose mitomycin C and subconjunctival ologen implant has been found to be effective in controlling IOP. 1 No difference has been found in relative incidence of BRI when trabeculectomy is performed with adjuvant mitomycin or ologen implant. 2 Although bleb leaks and shallow chambers have been reported with ologen use, 3 exposure of the implant is a rare occurrence, 4 and its association with endophthalmitis has not been previously reported. Bleb related infections (BRI), though infrequent, are potentially vision threatening; usually present with the most likely causative organisms being Streptococcus, Staphylococcus, and H. influenzae. 5 Meticulous conjunctival closure should be done during trabeculectomy to prevent ologen exposure as it can act as a nidus of infection. Primary care eye physicians should explant ologen without delay if any exposure is seen associated with signs of blebitis. It is important to counsel patient that if they develop symptoms of BRI (diminution of vision, redness, pain, and photophobia) at any time after surgery, immediate check-up at the ...

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Trabeculectomy With Combined Use of Subconjunctival Collagen Implant and Low-dose Mitomycin C

Abstract: Trabeculectomy with implantation of an Ologen implant and use of low-dose MMC appears to offer encouraging short-term results for IOP control in eyes with primary open-angle glaucoma.

Cited by 38 publications

References 13 publications

Trabeculectomy with ologen in secondary glaucomas following failed trabeculectomy with MMC: comparative study

Trabeculectomy with ologen in secondary glaucomas following failed trabeculectomy with MMC: comparative study

Trabeculectomy Using Mitomycin C versus an Atelocollagen Implant: Clinical Results of a Randomized Trial and Histopathologic Findings

Blebitis with scleral abscess in a case of operated trabeculectomy with mitomycin C and a subcunjunctival ologen implant

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