Outcomes of Trabeculectomy Augmented With Subconjunctival and Subscleral Ologen Implantation in Primary Advanced Glaucoma.
OBJECTIVE
To evaluate the efficacy and safety of trabeculectomy with combined subconjunctival and subscleral ologen implant in eyes with advanced glaucomatous optic neuropathy.


METHODS
This is a retrospective, noncomparative case series.


METHODS
Twenty seven eyes of 23 patients with advanced primary glaucoma who underwent fornix-based trabeculectomy with insertion of ologen both subsclerally and subconjunctivally along with low dose Mitomycin-C (0.1 mg/mL×1 min) were evaluated. Data recorded included a complete history, demographic profile, and ophthalmic examination including gonioscopy and visual fields. Any complications or secondary procedures performed after trabeculectomy were recorded. Complete success was defined as intraocular pressure (IOP) ≤15 mm Hg without ocular hypotensive medication and qualified success as IOP≤15 mm Hg with medications.


RESULTS
The average age of patients was 46.2±14.8 years. There were 17 males and 6 females. Of these, 7 patients were diagnosed with juvenile open-angle glaucoma, 7 patients with primary open-angle glaucoma and 9 patients with primary angle-closure glaucoma and pseudophakia. The average follow-up time was 23.3±5.6 months, with a minimum of at least 12 months. The mean preoperative IOP was 38.3±6.6 mm Hg. Postoperatively, the IOP at 3 months was 12.5±1.9 mm Hg; 6 months was 12.6±3.9 mm Hg; 12 months was 12.3±2.5 mm Hg; and 24 months was 12.5±1.6 mm Hg (n=17); (P<0.0001). Complete success was noted in 92.6% eyes, qualified success in 3.7% eyes, and failure in 3.7% eyes. The preoperative and postoperative best-corrected visual acuity in logarithm of the minimum angle of resolution was 0.3±0.2 and 0.3±0.1 (P=0.31). The average number of ocular hypotensive medications used preoperatively was 4.2±0.5 (median 4) which decreased to 0.07±0.3 (median 0), (P<0.0001) postoperatively.


CONCLUSIONS
Trabeculectomy with low dose Mitomycin-C and with implantation of ologen both subsclerally and subconjunctivally, appears to offer encouraging results in achieving a low target IOP in eyes with advanced primary adult glaucoma.
*Glaucoma Research Facility & Clinical Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences †Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
Dewang
D
Angmo
Meenakshi
M
Wadhwani
Ashish Dutt
AD
Upadhyay
Shreyas
S
Temkar
Tanuj
T
Dada
D000293:Adolescent; D000328:Adult; D000368:Aged; D003094:Collagen / Q000008:administration & dosage*; D003228:Conjunctiva; D004343:Drug Implants; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D006025:Glycosaminoglycans / Q000008:administration & dosage*; D006068:Gonioscopy; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D011108:Polymers; D012189:Retrospective Studies; D012590:Sclera; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity; D014794:Visual Fields / Q000502:physiology*; D055815:Young Adult
D004343:Drug Implants; D006025:Glycosaminoglycans; D011108:Polymers; C058506:collagen-glycosaminoglycan copolymer; D003094:Collagen