Outcomes of Trabeculectomy Augmented With Subconjunctival and Subscleral Ologen Implantation in Primary Advanced Glaucoma (original) (raw)
Related papers
Research Square (Research Square), 2023
To compare the effect of SST augmented with Mitomycin C (MMC) versus Ologen implant as secondary procedures for treatment of primary congenital glaucoma. Methods This is a retrospective study evaluating records of 38 eyes that had undergone SST with MMC (group M, 17 eyes) versus Ologen (Group O, 21 eyes), by authors of the study. The study primary endpoint was set at 5 to 9 months postoperatively and the secondary endpoint was the last follow-up. A successful outcome was an IOP </=18 mmHg for infants < 1 year, and </= 20 mmHg for older ones. Results Follow-up duration was 1.25 to 51 (26.79 +/-27.583) months in group M, and 0.25 to 103 (22.86+/-28.991) months in group O (p = .673). The mean preoperative IOP was 28.06+/-3.929 in group M and 26.95+/-6.095 in group O (p = .522). Reduction of IOP was signi cant in group M at all follow-up visits, but starting at the fourth postoperative month in group O. Recorded IOP in groups M and O, respectively, was 14.9+/-6.437 and 12.1+/-5.043 at the primary endpoint, and 22.35+/-8.536 and 22.52+/-10.152 (p > .05) at the secondary endpoint. A successful outcome was achieved in groups M and O, respectively, in 47.1% and 47.6% at the primary endpoint and in 47.1% and 52.4% at the secondary endpoint (p > .05). Cataract, posterior synechiae and pupillary abnormalities were insigni cantly different in both groups (p = .623). Conclusions Ologen implant was comparable to MMC, in terms of e cacy and safety. Reoperations are inadvisable prior to 4 months of Ologen implants.
Graefes Archive for Clinical and Experimental Ophthalmology, 2015
Objective To evaluate safety and efficacy of 0.1 mg/ml versus 0.2 mg/ml mitomycin-C (MMC), applied for 1 min subconjunctivally, during trabeculectomy for primary adult glaucoma in previously un-operated eyes. Materials and methods This is a randomised controlled, noninferior, clinical trial consisting of 50 consecutive POAG or CPACG patients uncontrolled on maximal hypotensive therapy, meeting all inclusion criteria. Patients were randomized into two groups and underwent a standard limbus-based trabeculectomy with MMC: Group I, 0.1 mg/ml and Group II, 0.2 mg/ml. The pre-operative and post-operative intraocular pressure (IOP), bleb morphology, and visual acuity were recorded every 6 months for 2 years. Complete success (primary outcome) was defined as IOP≤15 mmHg without any additional medications at the end of 2 years. Results The average age of patients was 62.6±9.8 years and 61.2±8.1 years in Group 1 and 2, respectively; p=0.57. The mean preoperative IOP was 22.5±1.4 mmHg and 23.3± 1.8 mmHg; p=0.10. The mean IOP at 2 years was 11.1± 1.6 mmHg and 10.8±2.8 mmHg, a mean reduction in IOP of 50.6±1.23 %, and 53.7±2.25 % in Group I and II, respectively. The complete success was 92.0 % and 91.7 % in the two groups, respectively (p=0.99), and there was one failure (Group II, post trauma). A wider bleb extent and larger areas of thin, transparent conjunctiva over the bleb were seen with the 0.2 mg/ml MMC group (p<0.001) and in PACG eyes; p<0.04. Conclusion A 1-min subconjunctival application of low dose 0.1 mg/ml MMC is non-inferior to 0.2 mg/ml and is probably a safer alternative, as thinning of the bleb is significantly less frequent in the long term.
Eye, 2010
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Nature Publishing Group. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians. Medscape, LLC designates this educational activity for a maximum of 0.5 AMA PRA Category 1 Creditst. Physicians should only claim credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test and/or complete the evaluation at www.medscapecme.com/journal/eye; (4) view/print certificate. Learning objectives Upon completion of this activity, participants will be able to: 1. Compare the efficacy, on the basis of intraocular pressure reduction, of trabeculectomy with a biodegradable ologen TM implant with trabeculectomy with mitomycin C (MMC), according to a prospective, randomized trial 2. Compare the use of antiglaucomatous medication after trabeculectomy using a biodegradable ologen TM implant with that for trabeculectomy using MMC 3. Compare bleb morphology following trabeculectomy using a biodegradable ologen TM implant with that for trabeculectomy using MMC Authors/Editors disclosure information AJ Lotery served as an advisor or consultant for Alcon; as a speaker or member of speaker's bureau for Pfizer Inc.; and has received grants for clinical research from Novartis Pharmaceuticals Corporation. André Rosentreter has disclosed no relevant financial relationships. Andrea M Schild has disclosed no relevant financial relationships. Jens F Jordan has disclosed no relevant financial relationships. Gü nter K Krieglstein has disclosed no relevant financial relationships. Thomas S Dietlein has disclosed no relevant financial relationships.
Trabeculectomy With Combined Use of Subconjunctival Collagen Implant and Low-dose Mitomycin C
Journal of Glaucoma, 2013
Purpose: To evaluate outcomes of trabeculectomy with use of a subconjunctival biodegradable collagen implant (Ologen) combined with mitomycin C (MMC). Methods: This retrospective study included 33 eyes of 24 patients with primary open-angle glaucoma who underwent fornix-based trabeculectomy with subconjunctival Ologen implant and MMC (0.1 mg/mLÂ1 min) between October 2008 and April 2010. Data pertaining to the preoperative parameters and postoperative outcomes were recorded. Each patient was followed up for at least 12 months. Results: The mean age of the study participants was 53.03 ± 7.08 years. Mean preoperative intraocular pressure (IOP) was 34.06 ± 6.56 mm Hg, and decreased to 11.87 ± 2.23 mm Hg, 12.27 ± 2.05 mm Hg, and 12.54 ± 1.67 mm Hg at 3, 6, and 12 months, respectively. Mean postoperative IOP readings at all follow-up visits were significantly lower than those at preoperative levels (P < 0.001). Two eyes required ocular hypotensive medications to lower the IOP in the postoperative period. All eyes had a diffuse elevated well-formed bleb, with the implant being visible for 6 to 9 months. Two eyes had a shallow anterior chamber with hypotony during the early postoperative period due to wound leak, whereas 1 case developed implant exposure at 1-week follow-up; all these cases were managed by conjunctival resuturing. Two cases developed a Tenon cyst at 8 to 12 weeks and required needling for restoration of bleb function. Conclusions: 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.
Success and complication rates of trabeculectomies augmented with MMC in the management of glaucoma
2010
Glaucoma unresponsive to medical treatment is managed by surgery. Augmentation with mitomycin C (MMC) is considered in patients at high risk of surgery failure. Aim: In this paper we assess and compare the success and complications of this procedure performed in the local state hospital with those of larger international centres. Methods: A retrospective study, of the surgery performed between 2003 and 2007 at St. Luke’s Hospital by one surgeon (FM), was conducted. The total number of eyes considered in this analysis was 32. Intraocular pressures and complications up to one year post-operatively were recorded. Results: The mean intraocular pressure decreased from 30mmHg pre-operatively to 18mmHg post-operatively. The mean IOP drop registered was 42%. Of the 32 eyes that underwent trabeculectomy augmented with MMC, 23 were classified as a complete success with IOP remaining below 21mmHg at 1year post-surgery. Six eyes were considered as a partial success since they had an IOP under 2...
Outcome of trabeculectomy with mitomycin C in patients with advanced glaucoma
British Journal of Ophthalmology, 2010
Background/Aims To determine the medium term intraocular pressure control and visual outcomes for patients with advanced glaucoma undergoing trabeculectomy with mitomycin C. Methods All patients with advanced glaucoma (MD-20dB or above) undergoing trabeculectomy with mitomycin C between 2000 and 2008 under the care of a single glaucoma surgeon were included. Intraocular pressure, visual acuity and visual field outcomes were assessed from data prospectively collected into a surgical outcome database. Results One hundred and three patients were eligible for inclusion. The posttrabeculectomy group mean IOP varied between 11.3 and 13.3mmHg between 1 and 7 years. At year 5, 85.2% had an IOP < 16mmHg and 96.3% had an IOP < 21mmHg. The number completing a reliable visual field exam decreased significantly year on year, however the change in mean MD for the group as a whole and for individual patients remained stable. 28 patients experienced a significant reduction in acuity defined as 2 or more lines of Snellen, although this was not due to glaucoma surgery in the majority. The only pre-operative determinant for a significant reduction in VA was the pre-operative MD (-27.00dB (n=21) compared with-24.79dB (n=63; p=0.029). 3 Conclusion Trabeculectomy is a successsful method of controlling intraocular pressure in the short to medium term in patients with advanced glaucoma.
Merits of trabeculectomy in advanced and end-stage glaucoma
International journal of health sciences
The aim of the study was to evaluate intraocular pressure (IOP) control, potential benefits, and associated complications in advanced cases of glaucoma (visual acuity of <6/60) after trabeculectomy. Although many studies of trabeculectomy in glaucoma patients have been done, very few in such advanced cases. The study was done on 60 cases of advanced primary open-angle glaucoma (POAG). Trabeculectomy was done and IOP control was assessed. Pre-operative workup included a detailed history, slit lamp biomicroscopy, Goldmann applanation tonometry, gonioscopy using Goldmann 2 mirror lens, and detailed fundus examination with the 78D lens. All the patients were to undergo optical coherence tomography and Humphrey automated perimetry. Out of 60 patients with POAG, 48 were males and 12 were females with a ratio of 4:1. Of all the 60 cases, 36 had a visual acuity of 20/200, 16 had a visual acuity of hand movements, and eight patients had a visual acuity of perception of light. The mean pre...
International Journal of Ophthalmology, 2022
• AIM: To determine the long-term postoperative outcomes of deep sclerectomy-trabeculectomy (DST) with mitomycin C (MMC) in the treatment of glaucoma. • METHODS: Patients who underwent DST with MMC between 2010 and 2017 were included in this retrospective observational study. Complete success was defined as postoperative intraocular pressure (IOP) ≤21 mm Hg or 30% reduction of IOP from baseline without any topical IOP-lowering agent, and qualified success defined as IOP≤21 mm Hg or 30% reduction of IOP from baseline with/without single topical agent. We evaluated the surgical success rates and complication rates of this procedure, as well as described the IOP profiles, best corrected visual acuity (BCVA) profiles and mean deviations (MD) of Humphrey visual field (HVF) 24-2 performance at each follow-up time point. Mixed linear regression models were constructed to determine estimated predictive values of demographic data, use of topical IOPlowering agents, baseline and postoperative IOP and optical profiles (e.g., BCVA and MD). • RESULTS: Totally 98 eyes (mean postoperative followup 67.5mo) showed mean IOP reduction at every followup interval. Both median BCVA and MD of visual fields were maintained throughout the follow-up intervals when comparing to baseline. The number of IOP-lowering medications decreased from 2.8±0.8 to 0.3±0.7 (P=0.068). Totally 84 (85.7%) eyes achieved complete success at final follow-up. Transient hyphaema and transient choroidal effusion developed in 15 eyes (15.3%) and 11 eyes (11.2%) respectively. Other complications included shallow anterior chamber in 5 eyes (5.1%), bleb leak in 4 eyes (4.1%), bleb revision in 7 eyes (7.1%), bleb needling in 9 eyes (9.2%) and repeat trabeculectomy in 1 eye (1.0%). There was no endophthalmitis, blebitis or macular oedema. There was no significant correlation between postoperative IOP control and postoperative BCVA. • CONCLUSION: DST with MMC demonstrates effective and sustained long-term outcomes in the treatment of glaucoma with no major complication.
IP innovative publication pvt. ltd, 2019
Purpose: To describe for the first time, a new approach of subconjunctival Mitomycin-C (MMC) injection at the end trabeculectomy for secondary glaucoma. Materials and Methods: This pilot study consisted of 4 eyes of 4 patients of uncontrolled secondary glaucoma. After preoperative glaucoma workup, all patients underwent standard trabeculectomy with subconjunctival MMC injection, 0.1ml (0.02mg) in superonasal quadrant at the end of surgery. Postoperative follow-up included assessment of visual acuity, intraocular pressure (IOP), bleb, anterior chamber depth and for any complications. The success criterion was IOP of ≤21 mmHg. Results: The mean pre and postoperative IOP were 43 mmHg± 16.2 and 12.00mmHg ± 1.6 respectively with a success rate of 100% during a mean follow up of 15.5 months. Blebs were mildly elevated, diffuse and less avascular. No intraoperative complications were seen. Postoperative wound leak, flat anterior chamber, hypotony, choroidal detachment or endophthalmitis were not encountered. Conclusion: This novel approach of subconjunctival MMC injection at the end of trabeculectomy was found to be safe and highly effective in secondary glaucoma without any MMC related complications.
Long-term Outcomes of Repeat vs Initial Trabeculectomy in Open-Angle Glaucoma
American Journal of Ophthalmology, 2009
To evaluate the long-term intraocular pressure (IOP) control and to identify risk factors for failure of repeat trabeculectomy with mitomycin C (MMC) in patients with open-angle glaucoma. • DESIGN: Retrospective case-control study. • METHODS: Seventy-five eyes (67 patients) that had undergone repeat trabeculectomy with MMC were matched to 75 eyes (64 patients) that had undergone initial trabeculectomy with MMC according to age, gender, race, diagnosis, preoperative IOP, number of glaucoma medications, and lens status in an institutional setting. Surgical successes were defined as: 1) IOP <18 mm Hg and > 20% reduction in IOP, 2) < 15 mm Hg IOP and > 25% reduction in IOP, and 3) < 12 mm Hg IOP and > 30% reduction in IOP from baseline, with or without glaucoma medications, and were assessed by Kaplan-Meier survival analyses. Risk factors for failure in the repeat trabeculectomy group were analyzed by the Cox proportional hazard regression model. The main outcome measures were success rate, number of medications, and visual acuity. • RESULTS: Eyes that underwent initial trabeculectomy with MMC had a statistically significantly higher cumulative surgical success rate than those that underwent repeat trabeculectomy with MMC at 3 years according to criteria B (61.3% vs 41.3%; P ؍ .022) and C (52.0% vs 32.0%; P ؍ .021). In eyes that underwent repeat trabeculectomy, younger age and requirement of laser suture lysis were significant risk factors for surgical failure. Eyes that underwent initial trabeculectomy required a statistically fewer number of medications than eyes that underwent repeat trabeculectomy (0.6 vs 1.2; P ؍ .013). • CONCLUSIONS: Repeat trabeculectomy with MMC is less successful at achieving IOP reduction in open-angle glaucoma than is initial trabeculectomy with MMC at 3 years or more.