Trabeculectomy with subconjunctival collagen implant in Indi
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The use of antimetabolites, such as mitomycin-C (MMC) and 5-fluorouracil (5-FU), has significantly enhanced trabeculectomy success rates by preventing episcleral fibrosis and scarring of bleb. However, the use of these relatively toxic agents is fraught with the risk of corneal toxicity, wound leak, overfiltration, and hypotony during the immediate postoperative period.

The present study, published in the Indian Journal of Ophthalmology, reports long-term safety and efficacy of trabeculectomy with collagen implant in Indian population.

The researchers included all cases of trabeculectomy with Ologen® Collagen Matrix implant performed over a 7-year period at a tertiary referral institute were reviewed. A total of 30 eyes of 28 patients were included in the study with two patients undergoing bilateral trabeculectomy. Outcomes measured included intraocular pressure (IOP) control, number of antiglaucoma medications used, bleb morphology, and complications/reoperations.

The results showed that Trabeculectomy resulted in reduction in IOP from 36.46 to 11.65 mm Hg in the immediate postoperative period (day 1), a 68% decrease to 15.18 mm Hg at 84 months (58% decrease). The mean IOP reduction decreased over time from 63% in the first year to 55% after 5 years of follow-up. Fourteen eyes attained a follow-up of 5 years and eight eyes a follow-up of ≥7 years.

No sight-threatening complication such as hypotony, bleb leak, and bleb-related endophthalmitis was observed in our series, and only intervention required was 5-fluorouracil needling in one case.

The authors concluded that Ologen-augmented trabeculectomy is effective in controlling IOP over a long-term follow up from minimal 3 to maximal 7 years. No untoward events jeopardizing bleb safety were noted at any time. This modality is a viable alternative for patients with contraindications to use of antimetabolites.

Read in detail about the study here: