J Korean Ophthalmol Soc.  2018 Jan;59(1):50-59. 10.3341/jkos.2018.59.1.50.

Comparison of Effects and Complications between Conventional Trabeculectomy and Trabeculectomy with a Collagen Matrix Insertion

• Park KS
• Kim KN
• Lee SB
• Kim JY
• Kim CS

• KMID: 2401678
• DOI: http://doi.org/10.3341/jkos.2018.59.1.50

Abstract

PURPOSE
To compare the surgical outcomes between trabeculectomy with a collagen matrix (Ologen®) insertion and conventional trabeculectomy.
METHODS
An ophthalmic examination, including tonometry and a slit lamp examination, was performed 1 week, 2 weeks, 1 month, 2 months, 4 months, 6 months, and 12 months postoperatively in glaucoma patients who underwent a trabeculectomy using Ologen® (experimental group) or a conventional trabeculectomy (control group). Clinical features including success rate and complications were compared between the two groups.
RESULTS
In 21 eyes of the experimental group and 42 eyes of the control group, the success rates were 76% and 69%, respectively (p = 0.554). Needling with subconjunctival 5-fluorouracil injection or laser suture lysis of the scleral flap was required in three eyes (14.3%) in the experimental group and 18 eyes (42.9%) in the control group (p = 0.023). The types of complications differed, although the total number of complications did not differ between the two groups (23.8% vs. 19.0%, respectively; p = 0.745). The most common complication in the experimental group was an encapsulated bleb, which occurred in three eyes (14.3%), whereas an avascular bleb occurred in three eyes (7.1%) in the control group.
CONCLUSIONS
The success rate of trabeculectomy with Ologen® was comparable to that of conventional trabeculectomy. However, postoperative interventions were less commonly required after trabeculectomy with Ologen®, and the complications differed between the groups. When choosing the surgical method and examining the postoperative condition, these differences should be considered.

Keyword

Collagen matrix; Glaucoma; Trabeculectomy

MeSH Terms

Blister
Collagen*
Fluorouracil
Glaucoma
Humans
Manometry
Methods
Slit Lamp
Sutures
Trabeculectomy*
Collagen
Fluorouracil

Figure

• 

  Figure 1. Trabeculectomy of the Ologen® insertion group. (A) After a half thickness scleral flap was sutured in place. (B) Ologen® was simply positioned on the scleral flap without an anchoring suture. (C) A conjunctival suture was performed. The yellow dotted line is the boundary of the inserted Ologen®.

• 

  Figure 2. Postoperative mean intraocular pressure (IOP; with standard error bars) of the trabeculectomy with Ologen® insertion group and the conventional trabeculectomy group. The IOPs were measured at 1 week, 2 weeks, 1 month, 2 months, 4 months, 6 months, and 12 months. Although the IOP in the conventional trabeculectomy group was higher than that in the trabeculectomy with Ologen® insertion group at all of the postoperative time points, the p-value for difference was only significant at postoperative 2 weeks, 4 months, and 6 months (Mann-Whitney U test, * p < 0.05).

• 

  Figure 3. The number of mean intraocular pressure (IOP)-lowering medications (with standard error bars) for the trabeculectomy with Ologen® insertion and conventional trabeculectomy groups. The postoperative time points were at 1 week, 2 weeks, 1 month, 2 months, 4 months, 6 months, and 12 months. There was no significant difference between the two groups at any postoperative time point (Mann-Whitney U test, p > 0.05).

• 

  Figure 4. Anterior segment photographs of a 65-year-old male who had trabeculectomy with Ologen® insertion on left eye (A-D, a-d) and conventional trabeculectomy on right eye (E-G, g) due to primary open-angle glaucoma. The dotted yellow curved line is the posterior boundary of the Ologen®. (A, a) At postoperative 1 month, there was mild conjunctival hyperemia and a posterior, diffusely elevated bleb. The intraocular pressure (IOP) was 9 mmHg. (B, b) At postoperative 2 months, an encapsulated bleb without posterior bleb elevation was observed, with an IOP of 30 mmHg. Needling with subconjunctival 5-fluorouracil injection was performed. (C, c) One week after needling, conjunctival hyperemia and a posterior highly elevated bleb were observed. The IOP was 9 mmHg. (D, d) At postoperative 10 months, some conjunctival hyperemia and a posterior, mildly elevated bleb were observed. The IOP was 17 mmHg. (E) At postoperative 3 months, the IOP was 10 mmHg. (F) At postoperative 6 months, the IOP was 16 mmHg. (G, g) At postoperative 12 months, the IOP was 12 mmHg. The right eye showed avascular bleb.

• 

  Figure 5. Anterior segment photograghs of a 67-year-old male who had trabeculectomy with Ologen® insertion on right eye (A-C, b, c) and conventional trabeculectomy on left eye (D-F, e, f). The dotted yellow line is the anterior boundary of the Ologen®. (A) At postoperative 2 months, the intraocular pressure (IOP) was 10 mmHg. (B, b) At postoperative 6 months, the IOP was 12 mmHg. (C, c) At postoperative 14 months, the IOP was 10 mmHg. An avascular lesion of the bleb was localized anterior to the Ologen®. A diffuse bleb, which was not avascular, was observed posterior to the avascular lesion. (D) At postoperative 3 months, the IOP was 13 mmHg. (E, e) At postoperative 7 months, the IOP was 11 mmHg. (F, f) At postoperative 15 months, the IOP was 13 mmHg. A wide diffuse avascular bleb was observed.

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