Trabeculectomy with Ologen versus Mitomycin C in Juvenile Open-Angle Glaucoma: A 1-Year Study

Abstract

Background: We assessed bleb morphology and the intraocular pressure (IOP)-lowering effect of trabeculectomy with ologen compared to mitomycin C (MMC) in juvenile open-angle glaucoma (JOAG). Methods: This is a prospective interventional comparative study conducted on 40 eyes (20 patients) with medically uncontrolled JOAG, randomly operating one eye for trabeculectomy with ologen (group A: 20 eyes) and the other with MMC (group B: 20 eyes). IOP measurement, SITA standard perimetry, and spectral domain optical coherence tomography (OCT) for retinal nerve fiber layer (RNFL) thickness were all done pre- and postoperatively. Postoperative blebs were assessed clinically using the Moorfields bleb grading system (MBGS) and anterior segment OCT (AS-OCT). All patients were examined for up to 1 year postoperatively. Results: The mean postoperative IOP was statistically significantly lower than the mean preoperative IOP at each follow-up in each group. At 1 year, the mean postoperative IOP was significantly lower in group A. According to the MBGS, blebs with an ologen implant showed significantly better scoring than those with MMC. AS-OCT showed that ologen-induced blebs had significantly more fluid-filled spaces, cleavage planes, and less fibrosis. Conclusion: Ologen resulted in a lower long-term postoperative IOP, a better bleb morphology, and fewer complications. Our results suggest that ologen may be a useful alternative to MMC in JOAG.

Phacotrabeculectomy using collagen matrix implant (Ologen®) versus mitomycin C: a prospective randomized controlled trial

“…These results are different to findings obtained by El‐Sayyad et al. () who demonstrated with AS‐OCT that OLO totally degraded in 100% of the eyes at 6 months. However, the investigators in this study assessed effects of OLO implant in juvenile glaucoma eyes which exhibit exaggerated healing reaction.…”

Comparison between Ologen implant and Mitomycin C in trabeculectomy: A Systematic Review and Meta-Analysis

“…In this meta-analysis, one study was about juvenile open-angle glaucoma (JOAG), the results showed that Ologen resulted in a lower long-term postoperative IOP, a better bleb morphology, and fewer complications [29] . Another was about congenital glaucoma showed that Ologen had equally effective results as MMC, and Ologen implantation is safe and has low incidences of complications [28] .…”

“…Most studies were excluded because they didn't compare the effect of Ologen implant and MMC or they were not prospective studies. After assessing the full text of the potentially 30 relevant articles, 15 RCTs were enligible for our inclusion criteria and finally to be included in this meta-analysis [22,[25][26][27][28][29][30][31][34][35][36][37][38][39][40] . The exclusion reasons were as follow: one was from the same patient group, and one compared the outcomes of trabeculectomy with or without an Ologen implant, seven were not comparative studies, five compared phacotrabeculectomy with Ologen implant and MMC, one was about secondary glaucomas trabeculectomy with following failed trabeculectomy with MMC.…”

“…The benefit of the Ologen implant can be observed in some studies, they showed that the success rate using trabculectomy with the Ologen implant maybe higher than that achieved by trabculectomy with MMC [22][23][24][25][26][27][28][29] , but not in the others [30,31] . These contradictory statements prevent us reaching a consensus.…”

Outcome of trabeculectomy with Ologen versus Mitomycin C: A comparative prospective study in Bangladesh

“…3,9 However, two recently reported clinical trials of collagen matrix and MMC for trabeculectomy in patients with primary open angle glaucoma (POAG) found no difference in the success rate between the two anti-fibrotic agents after 12 months of follow-up. 10,11…”