J Korean Ophthalmol Soc.  2010 Jun;51(6):912-918. 10.3341/jkos.2010.51.6.912.

Trabeculectomy With Biodegradable Collagen Material: A Report of Two Cases

• Hong S
• Lee JR
• Choi JY
• Choi J
• Kim YD

• KMID: 2213631
• DOI: http://doi.org/10.3341/jkos.2010.51.6.912

Abstract

PURPOSE
To report two cases of trabeculectomy with biodegradable collagen material conducted on two post-vitrectomy patients.
CASE SUMMARY
The first patient was a 43-year-old woman with uncontrolled increased intraocular pressure (IOP) after pars plana vitrectomy with scleral buckling for diabetic retinopathy and vitreous hemorrhage. Another patient, a 28-year-old woman with aphakia, also had uncontrolled increased IOP after pars plana vitrectomy with encircling scleral buckling for retinal detachment. For both of these patients, we performed trabeculectomy using mitomycin C and recently developed biodegradable collagen matrix. In the first case, the IOP was increased three months after the surgery, for which needling was done. After needling, the IOP was well controlled in the range of 16 to 19 mmHg up to eight months postoperatively with stilling anti-glaucomatous eyedrops (Cosopt(R), Xalatan(R)). In the second case, IOPwas increased one week after the surgery, but it was well controlled between 14 to 21 mmHg up to nine months postoperatively with anti-glaucomatous eye drops (Combigan(R)).
CONCLUSIONS
Biodegradable collagen matrix can possibly reduce the surgical failure of trabeculectomy and it is especially suitable for high risk patients when combined with anti-metabolic agents like MMC.

Keyword

Adjuvant therapy; Biodegradable; Collagen; Trabeculectomy; Wound healing

MeSH Terms

Adult
Aphakia
Collagen
Diabetic Retinopathy
Female
Humans
Intraocular Pressure
Mitomycin
Ophthalmic Solutions
Retinal Detachment
Scleral Buckling
Trabeculectomy
Vitrectomy
Vitreous Hemorrhage
Wound Healing
Collagen
Mitomycin
Ophthalmic Solutions

Figure

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  Figure 1. Humphery 24-2 SITA perimetry of Case 1. It shows only temporal island is saved.

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  Figure 2. Trabeculectomy with mitomycin C (MMC) using biodegradable material of Case 1. (A) Scleral flap formation. (B) MMC soaking under scleral flap. (C) Iridectomy. (D) Positioning of biodegradable collagen material. (E) Conjunctival suture. (F) Viscoelastic injection to reform anterior chamber.

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  Figure 3. Slit lamp photograph of Case 1. (A) Highly elevated bleb is observed 1 day postoperatively. (B) Well elevated bleb is observed 8 months postoperatively.

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  Figure 4. Each patient’s intraocular pressure changes (Arrow: postoperative 1 day of Case 2, due to hypotony, anterior chamber was reformed with BSS solution and additional scleral suture and collagen implantation also done. Arrow head: postoperative 3 months of Case 1, needling of bleb was done). d=day; w=week; m=month.

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  Figure 5. Initial perimetry (Humphrey 24-2, central 10-2 SITA) of Case 2. It shows only central island is saved.

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  Figure 6. This is slit lamp photograph of Case 2. (A) Well elevated bleb photographed 6 months postoperatively. (B) Well elevated bleb photographed 9 months postoperatively.

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  Figure 7. Biodegradable matrix structure (A). Microstructure (B) composed of collagen-glycosaminoglycan scaffold matrix and pore diameters are from 10 to 300 μm.

Reference

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