title: Ex-PRESS outcomes using mitomycin-C, Ologen alone, Ologen with 5-fluorouracil.
abstract: To compare the complication rate and effectiveness of mitomycin C (MMC), Ologen alone, and Ologen with 5-fluorouracil (5-FU) as adjunctives with Ex-PRESS mini shunt for medically uncontrolled glaucoma. Retrospective comparative study of 59 Ex-PRESS mini shunt trabeculectomy operations coupled with Ologen implantation alone, transient MMC application or Ologen implantation with 5-FU as adjunctive treatment. Eight eyes (7 patients) received Ologen alone, 37 eyes (34 patients) received MMC, and 14 eyes (14 patients) received Ologen with 5-FU as adjunctive therapy. Baseline characteristics, adjunctive used during operation, along with outcomes including intraocular pressure (IOP), number of anti-hypertensive drops, visual acuity, and complications were documented and compared. The primary outcome was IOP at 12 months. Variables were compared with r × c Fisher tests. The Ologen only group had a significantly higher IOP at 12 months (20.5 ± 10.23 mmHg) compared with Ologen combined with 5-FU (12.2 ± 1.47 mmHg) or MMC (13.8 ± 4.37 mmHg) (p = 0.015, linear mixed model). The Ologen only cohort also had a higher re-operation rate (p = 0.01, Fisher's Exact Test) and higher rate of bleb leak (p = 0.02, Fisher's Exact Test). Visual acuity was similar among all three groups. 5-FU with Ologen is as effective as MMC in maintaining IOP following Ex-PRESS shunt surgery at 1 year. However, Ologen alone may not be as effective as the other two adjunctive agents.
authors.affiliation: Department of Ophthalmology, University of California San Francisco, 10 Koret Way, San Francisco, CA, 94143, USA.
authors.forename: Shivali A
authors.initials: SA
authors.lastname: Menda
authors.forename: Eugene A
authors.initials: EA
authors.lastname: Lowry
authors.forename: Travis C
authors.initials: TC
authors.lastname: Porco
authors.forename: Robert L
authors.initials: RL
authors.lastname: Stamper
authors.forename: Michel R
authors.initials: MR
authors.lastname: Rubin
authors.forename: Ying
authors.initials: Y
authors.lastname: Han
mesh_terms: D000368:Aged; D000477:Alkylating Agents / Q000008:administration & dosage*; D000873:Anthracenes; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D003094:Collagen / Q000008:administration & dosage*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D005901:Glaucoma / Q000503:physiopathology / Q000628:therapy*; D020327:Glaucoma Drainage Implants; D006025:Glycosaminoglycans / Q000008:administration & dosage*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D012189:Retrospective Studies; D014130:Trabeculectomy / Q000379:methods*; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000477:Alkylating Agents; C546739:AnOV compound; D000873:Anthracenes; D000959:Antihypertensive Agents; D006025:Glycosaminoglycans; D007166:Immunosuppressive Agents; C058506:collagen-glycosaminoglycan copolymer; D016685:Mitomycin; D003094:Collagen; D005472:Fluorouracil