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Yu J, Dai X, Chen X, Gao X, Pan W. Use of double short tandem scleral tunnels for repairing eroded ahmed glaucoma valve tubes. BMC Ophthalmol 2024; 24:435. [PMID: 39367384 PMCID: PMC11451231 DOI: 10.1186/s12886-024-03694-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 09/23/2024] [Indexed: 10/06/2024] Open
Abstract
PURPOSE To evaluate the effectiveness and safety of a method for repairing an eroded Ahmed glaucoma valve (AGV) tube using two short scleral tunnels made in tandem with a 22G needle instead of covering the eroded tube with another scleral graft. METHODS From May 12, 2015, to July 27, 2019, we retrospectively reviewed eight patients at Ningbo Aier Eye Hospital who developed AGV tube erosion secondary to necrosis of their overlying conjunctiva and scleral grafts. This defect was repaired in all the patients using the double short tandem scleral tunnel technique, which involved the creation of double short tandem scleral tunnels made by a 22G needle. Two parallel-to-limbus scleral incisions were made 3 mm and 6 mm from the limbus first, then a curved 22G needle was inserted between the two scleral cuts to make one scleral tunnel, the other scleral tunnel was completed during the first surgery, inserted the tube into the two tunnels. The mean length of time between the AGV placement and the first erosion was 12.25 ± 6.36 months (3-24 months). The mean age of the patients was 65.50 ± 11.70 years (49-78 years). RESULTS The surgical outcome was assessed in terms of the tectonic integrity of the conjunctiva over the follow-up period (12 months). There was no AGV tube erosion, scleral thinning, or ocular infection after a mean of 41.25 ± 26.54 months of follow-up in all eight patients. CONCLUSION AGV tube erosion following shunt surgery can be successfully managed using the improved double short tandem scleral tunnel technique.
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Affiliation(s)
- Jun Yu
- Dept of Ophthalmology, Zhejiang Yiwu Aier Eye Hospital, Jinhua, 322000, China
| | - Xiangjun Dai
- Dept of Ophthalmology, Zhejiang Yiwu Aier Eye Hospital, Jinhua, 322000, China
| | - Xiaohua Chen
- Dept of Ophthalmology, Zhejiang Yiwu Aier Eye Hospital, Jinhua, 322000, China
| | - Xiaoming Gao
- Dept of Ophthalmology, Zhejiang Ningbo Aier Eye Hospital, Ningbo, 315100, China.
| | - Weihua Pan
- Dept of Ophthalmology, Zhejiang Hangzhou Aier Eye Hospital, Hagzhou, 311200, China.
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Rojo-Arnao M, Martinez-de-la-Casa JM, Albis-Donado O, Yañez-Castro G, Maroto-Cejudo R, Téllez J, Menoyo-Calatayud R. Preserflo TM MicroShunt implantation combined with Ologen TM in primary and secondary glaucoma patients in a clinical setting. Indian J Ophthalmol 2024; 72:417-426. [PMID: 38153975 PMCID: PMC11001232 DOI: 10.4103/ijo.ijo_1502_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/24/2023] [Accepted: 10/18/2023] [Indexed: 12/30/2023] Open
Abstract
PURPOSE This study aims to assess the effectiveness and safety of combining the Preserflo™ MicroShunt implant (MicroShunt) with a simultaneous Ologen™ implant in patients with glaucoma. METHODS We conducted a retrospective study on consecutive patients with medically uncontrolled glaucoma who underwent MicroShunt + Ologen implantation as a standalone procedure or in combination with phacoemulsification (combined procedure). Success was defined as achieving an intraocular pressure (IOP) of 6-15 mmHg at 18 months post surgery, with a preoperative IOP reduction of at least 20%, and without (complete success) or with (qualified success) the need for antiglaucoma medications. The primary endpoint was the success rate. RESULTS Forty-eight eyes from 47 patients were included, with 28 eyes (58.3%) undergoing the standalone procedure and 20 eyes (41.7%) undergoing the combined procedure. Overall, there was a significant reduction in preoperative IOP from 19.7 ± 5.8 mmHg to 11.4 ± 2.6 mmHg at 18 months ( P < 0.0001). In the standalone procedure group, preoperative IOP decreased from 21.5 ± 5.2 mmHg to 11.7 ± 2.5 mmHg ( P < 0.0001), and in the combined procedure group, preoperative IOP decreased from 17.1 ± 5.8 mmHg to 10.9 ± 2.7 mmHg ( P = 0.0002), with no significant difference between the two groups regarding final IOP. The mean number of antiglaucoma medications significantly decreased from 3.2 ± 1.1 to 0.3 ± 0.7 in the overall study population ( P < 0.0001). At 18 months, 40 eyes (83.3%) were classified as successful. Regarding safety, out of the total number of eyes, two (4.2%) experienced choroidal detachment without visual impairment, two (4.2%) had transient hyphema, one (2.1%) showed reactivation of a corneal herpetic ulcer, one (2.1%) had diplopia, and one (2.1%) exhibited a shallow anterior chamber during the first week. CONCLUSION The combination of Ologen™ and Preserflo™ MicroShunt, either alone or in conjunction with phacoemulsification, demonstrated a favorable profile in terms of IOP reduction and safety.
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Affiliation(s)
| | - José María Martinez-de-la-Casa
- Department of Ophthalmology and ORL, Faculty of Medicine, Ophthalmology Unit, Hospital Clinico San-Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clinico San-Carlos (IdISSC), Madrid, Spain
- Department of Immunology, Ophthalmology and ORL, School of Medicine, Instituto de Investigaciones Oftalmologicas Ramon Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
| | - Oscar Albis-Donado
- Glaucoma Specialist, Private Practice, Visual Sense, Mexico City, Mexico
| | | | | | - Jesús Téllez
- Department of Ophthalmology, Hospital de la Santa Creu i de Sant Pau, Autonoma University of Barcelona, Barcelona, Spain
- Departament of Ophthalmology, Grupo Admiravisión, Barcelona, Spain
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Ang BCH, Lim SY, Betzler BK, Wong HJ, Stewart MW, Dorairaj S. Recent Advancements in Glaucoma Surgery-A Review. Bioengineering (Basel) 2023; 10:1096. [PMID: 37760198 PMCID: PMC10525614 DOI: 10.3390/bioengineering10091096] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/10/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Surgery has long been an important treatment for limiting optic nerve damage and minimising visual loss in patients with glaucoma. Numerous improvements, modifications, and innovations in glaucoma surgery over recent decades have improved surgical safety, and have led to earlier and more frequent surgical intervention in glaucoma patients at risk of vision loss. This review summarises the latest advancements in trabeculectomy surgery, glaucoma drainage device (GDD) implantation, and minimally invasive glaucoma surgery (MIGS). A comprehensive search of MEDLINE, EMBASE, and CENTRAL databases, alongside subsequent hand searches-limited to the past 10 years for trabeculectomy and GDDs, and the past 5 years for MIGS-yielded 2283 results, 58 of which were included in the final review (8 trabeculectomy, 27 GDD, and 23 MIGS). Advancements in trabeculectomy are described in terms of adjunctive incisions, Tenon's layer management, and novel suturing techniques. Advancements in GDD implantation pertain to modifications of surgical techniques and devices, novel methods to deal with postoperative complications and surgical failure, and the invention of new GDDs. Finally, the popularity of MIGS has recently promoted modifications to current surgical techniques and the development of novel MIGS devices.
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Affiliation(s)
- Bryan Chin Hou Ang
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Woodlands Health Campus, Singapore 737628, Singapore
| | - Sheng Yang Lim
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Bjorn Kaijun Betzler
- Department of Surgery, Tan Tock Seng Hospital, National Healthcare Group, Singapore 308433, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Hon Jen Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Michael W. Stewart
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL 32224, USA; (M.W.S.)
| | - Syril Dorairaj
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL 32224, USA; (M.W.S.)
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Suzuki Junior ER, Maestrini HA, Ruppert ADP, Seixas RCS, Belfort AF, de Miranda Santos HD, Basile Neto A, Balbino M, Lopes da Silva MJ. A Retrospective Comparison of Ahmed Glaucoma Valve Implants with or without Ologen Collagen Matrix. Clin Ophthalmol 2023; 17:15-23. [PMID: 36627928 PMCID: PMC9826637 DOI: 10.2147/opth.s396330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023] Open
Abstract
Purpose To study the effects of Ologen collagen matrix on the outcomes of the Ahmed glaucoma valve implant. Study Design Retrospective case-control multicenter study, conducted at four centers, comparing the 6-month outcomes of Ahmed valve implants with or without Ologen. Participants The study included 125 eyes in a 4:1 pairing (25 patients with Ologen matched to 100 patients without Ologen). Intervention Ologen was placed over the Ahmed plate in the study group. Success was defined as an intraocular pressure (IOP) ≤ 21 mmHg either with no medication (complete success) or regardless of medications (qualified success). Other outcomes included IOP variation, eye drop use, and surgical complications. Results Overall, the IOP decreased from 30.72 ± 9.08 to 16.14 ± 4.79 mmHg (p=0.0001). Of the 125 eyes, 26 achieved complete success and 94 achieved qualified success. There was no difference in complete success between the groups (p=0.12); however, there was a difference in qualified success (p=0.01), with better results in the no-Ologen group (80% vs 56%). There were no differences in the decrease in medications (p=0.06), as well as the incidence of complications (p=0.69). Although the need for postoperative surgical reintervention was higher in the no-Ologen group (13% vs 4%), the difference was not significant (p=0.2). Conclusion The reductions in IOP and number of medications were similar in both groups after 6 months, with similar complication rates. The qualified success rate was lower in the Ologen group, but further studies are needed to clarify the role of Ologen in Ahmed valve implants.
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Affiliation(s)
| | | | | | | | - Ana Flávia Belfort
- Department of Ophthalmology, Clínica de Olhos da Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brazil
| | | | - Alberto Basile Neto
- Department of Ophthalmology, Complexo Hospitalar Padre Bento de Guarulhos, Guarulhos, SP, Brazil
| | - Marcos Balbino
- Department of Emergency Medicine, Centro Universitário São Camilo, São Paulo, SP, Brazil,Correspondence: Marcos Balbino, Department of Emergency Medicine, Centro Universitário São Camilo, Cipriano Barata, 1869 – ap. 93. Ipiranga, São Paulo, 04205001, Brazil, Tel +5511-983462354, Email
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Park J, Shin JW, Sung KR. Comparison of surgical outcomes with and without Ologen collagen matrix augmentation during XEN gel stent implantation. BMC Ophthalmol 2022; 22:426. [PMID: 36348387 PMCID: PMC9641924 DOI: 10.1186/s12886-022-02668-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background To compare the surgical outcomes and postoperative complications with and without Ologen collagen matrix augmentation during XEN gel stent implantation. Methods We retrospectively analyzed patients who underwent XEN gel stent implantation with an ab externo technique. The amount of intraocular pressure (IOP) reduction, percentage of postoperative complications and additional management, and surgical success defined as IOP reduction greater than 20% compared with the preoperative IOP measurement were compared between Ologen-augmented and non-augmented groups. Groups of patients who underwent XEN gel stent implantation alone and combined with phacoemulsification were analyzed separately. Results A total 103 eyes of 103 participants were included. Of those, 72 eyes underwent standalone XEN gel stent implantation: 42 eyes with Ologen augmentation (Oloxen group) and 30 eyes without Ologen augmentation (Xen group). Thirty-one eyes underwent XEN gel stent implantation with phacoemulsification: 19 eyes with Ologen augmentation (Phaco-Oloxen group) and 12 eyes without Ologen augmentation (PhacoXen group). The surgical success rate at six months postoperatively was not different between the Oloxen and Xen groups (56.4% vs 43.3%, P > 0.05) or between the Phaco-Oloxen group and PhacoXen group (57.9% vs 41.7%, P > 0.05). The prevalence of postoperative hypotony, 5-fluorouracil injections, use of anti-glaucoma medications, bleb needling, and additional glaucoma surgeries was not different between the Oloxen and Xen groups or between the Phaco-Oloxen and PhacoXen groups when assessed six months postoperatively. Conclusions All groups showed significant IOP reduction after XEN gel stent implantation, but there was no significant difference between the Ologen collagen matrix augmented and non-augmented groups in surgical outcomes.
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Jacobson A, Bohnsack BL. Ologen augmentation of Ahmed valves in pediatric glaucomas. J AAPOS 2022; 26:122.e1-122.e6. [PMID: 35550861 DOI: 10.1016/j.jaapos.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/17/2022] [Accepted: 02/17/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND We previously showed that Ologen increased success and survival rates of Ahmed glaucoma devices in a small number of children. The current study analyzed the same surgical technique in an expanded cohort. METHODS Retrospective interventional case series of children who underwent Ologen augmentation of Ahmed glaucoma device (OAGD) from 2018 to 2021 with ≥6 months' postoperative follow-up. Complete success was defined as intraocular pressure (IOP) of 5-20 mm Hg without glaucoma medications or additional IOP-lowering surgeries. Complete or qualified success was defined as above, except that IOP control was maintained with or without glaucoma medications. RESULTS A total of 26 eyes of 18 patients underwent OAGD at a median age of 2.0 years. Diagnoses included primary congenital glaucoma (5 eyes) and glaucoma secondary to nonacquired ocular anomalies (9 eyes), nonacquired systemic anomalies (8 eyes), and acquired conditions (4 eyes). Seventeen eyes had ≥1 prior eye surgery (average, 1.6 ± 0.9 surgeries per eye). Preoperative IOP was 29.4 ± 9.9 mm Hg on an average of 2.7 ± 1.0 glaucoma medications. At final follow-up (1.3 ± 1.0 years; median 1.0), IOP (13.4 ± 4.7 mm Hg) and number of glaucoma medications (0.3 ± 0.7, median 0) were significantly decreased (P < 0.0001). Complete success was achieved in 77% of eyes (20/26); Kaplan Meier analysis showed 1- and 3-year survival rates of 82% (95% CI, 59-93) and 60% (95% CI, 25-83), respectively. Complete or qualified success was achieved in 100% of eyes (26/26) at final follow-up. There were no visually devastating complications. CONCLUSIONS OAGD showed a high rate of success defined by decreased IOP and medication dependency in our study cohort of pediatric glaucoma patients.
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Affiliation(s)
- Adam Jacobson
- Department of Ophthalmology and Visual Sciences, University of Michigan
| | - Brenda L Bohnsack
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago; Department of Ophthalmology, Northwestern University Feinberg School of Medicine.
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Kim YH, Kim KE, Kim C, Ahn JH. Utility of Collagen Matrix Insertion during Ahmed Valve Implantation with Adjunctive Mitomycin-C: Outcomes at One-year. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.10.1388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: To compare the surgical outcomes of adjunctive mitomycin-C (MMC) Ahmed valve implantation with and without collagen matrix insertion.Methods: We retrospectively reviewed 108 eyes of 108 patients who underwent Ahmed valve implant surgery with adjunctive MMC. Collagen matrix insertion/Ahmed valve implant surgery (CM-AGV) was performed on 55 eyes, while conventional Ahmed valve implant surgery (AGV) was performed on 53 eyes. We defined surgical failure as an intraocular pressure (IOP) > 18 mmHg or <5 mmHg on two or more consecutive visits, regardless of medication status.Results: After surgery, the IOP and number of topical medications required fell significantly (compared with the preoperative period) in both groups (both p < 0.001); these findings did not significantly differ between groups. The cumulative surgical success rates at 1 year did not significantly differ between groups (78.2% vs. 79.2%, p = 0.54). The only risk factor significantly associated with surgical failure was a postoperative hypertensive phase. Anterior chamber (compared with sulcus) tube placement was significantly associated with visual acuity loss at 1 year postoperatively, but this did not significantly differ between groups.Conclusions: At the 1-year follow-up after Ahmed implant surgery with adjunctive MMC, the success rates of surgery with and without collagen matrix insertion were similar.
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Hong WG, Kim JY, Lee SJ, Jeong SW. Efficacy of biodegradable collagen matrix (Ologen ® CM) in augmenting the success rate of Ahmed glaucoma valve implantation in canine glaucoma. Vet Ophthalmol 2021; 24:391-399. [PMID: 34240540 DOI: 10.1111/vop.12919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 06/07/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To prospectively assess the efficacy of a biodegradable collagen matrix (ologen) in dogs with uncontrolled glaucoma receiving an Ahmed glaucoma valve (AGV) implant. ANIMAL STUDIED Five client-owned dogs with glaucoma (five eyes). PROCEDURES Five eyes treated for uncontrolled glaucoma underwent AGV implantation with ologen. Ologen was placed on the AGV plate and tube with a scleral flap. Complete ophthalmological examinations were performed preoperatively and at 1 and 3 days, 1 and 2 weeks, and 1, 2, 3, and 6 months postoperatively. Surgical outcomes were assessed based on the intraocular pressure (IOP), vision, frequency of anti-glaucoma eye drops, and bleb morphology; complications, if any, were recorded. The number of dogs with an IOP <20 mmHg with or without topical medications were tabulated and compared to those with an IOP ≥20 mmHg or those requiring surgery to maintain the IOP at <20 mmHg. RESULTS The IOP significantly decreased from 47.00 ± 5.09 mmHg preoperatively to 17.00 ± 0.71 mmHg 6 months postoperatively (p = .008). IOP was controlled (<20 mmHg) in 5/5 dogs at 6 months postoperatively. Brief periods of elevated IOP (IOP ≥ 20 mmHg, IOP spike) occurred in one eye (case 5) at 1 month (35 mmHg) and 2 months (33 mmHg) postoperatively. The anti-glaucoma eye drop frequency decreased from 3.2 ± 0.44 preoperatively to 1.6 ± 0.90 at 6 months postoperatively (p = .007). CONCLUSIONS To our knowledge, this is the first study to assess the potential safety of AGV implantation with ologen for canine glaucoma. This method effectively controlled the IOP, without any adverse effects.
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Affiliation(s)
- Won-Gyun Hong
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, Seoul, Korea
| | - Joon-Young Kim
- Department of Veterinary Ophthalmology, College of Veterinary Medicine, Konkuk University, Seoul, Korea
| | - Suk-Jun Lee
- Division of Business Administration, College of Business, Kwangwoon University, Seoul, Korea
| | - Soon-Wuk Jeong
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, Seoul, Korea
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Jacobson A, Rojas C, Bohnsack BL. Ologen augmentation of Ahmed glaucoma drainage devices in pediatric glaucomas. BMC Ophthalmol 2021; 21:72. [PMID: 33546636 PMCID: PMC7863366 DOI: 10.1186/s12886-021-01827-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 01/20/2021] [Indexed: 12/18/2022] Open
Abstract
Background Limited data exists on the effectiveness of the collagen matrix, Ologen, on increasing Ahmed glaucoma valve (AGV) success in childhood glaucomas. Methods Ocular examination and surgical details of pediatric patients who underwent AGV placement ± Ologen augmentation between 2012 and 2020. Complete success was defined as intraocular pressure (IOP) between 5 and 20 mmHg without glaucoma medications and additional IOP-lowering surgeries. Qualified success was defined as above, except IOP control maintained with or without glaucoma medications. Results Twenty-two eyes of 16 patients underwent AGV placement of which 6 eyes had Ologen-augmentation (OAGV) and 16 eyes had conventional surgery (CAGV). Average age was 6.4 ± 5.1 years with 4.2 ± 2.5 follow-up years. There was no difference in age, number of previous surgeries, and preoperative IOP and glaucoma medications. At final follow-up, success rate was 100% (5 eyes complete, 6 eyes qualified) in the OAGV group compared to 31% (0 eyes complete, 5 eyes qualified) in the CAGV group. One and two-year survival rates were 100% for OAGV compared to 62 and 38% for CAGV. Postoperative IOP was significantly lower at 1-month and final follow-up (p = 0.02) as was the number of glaucoma medications at 3, 6, 12-months and final follow-up (p < 0.05) in the OAGV group. Conclusions Ologen-augmentation increased the success and survival rates of AGVs in childhood glaucomas. Further, Ologen mitigated the hypertensive phase and decreased medication dependency. Longer follow-up with a greater number of eyes is required to fully evaluate the effectiveness of OAGV. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-01827-4.
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Affiliation(s)
- Adam Jacobson
- Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA
| | - Carin Rojas
- Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA
| | - Brenda L Bohnsack
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 70, Chicago, IL, 60611, USA. .,Department of Ophthalmology, Northwestern University Feinberg School of Medicine, 645 N. Michigan Ave, Chicago, IL, 60611, USA.
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Harizman N, Du J, Tania Tai TY. A Prospective Randomized Trial of Ahmed Glaucoma Drainage Device Implantation with or without Ologen Collagen Matrix. Ophthalmol Glaucoma 2020; 4:421-426. [PMID: 33338679 DOI: 10.1016/j.ogla.2020.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 12/05/2020] [Accepted: 12/09/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of this study is to evaluate the effectiveness of Ologen collagen matrix (OCM; Aeon Astron Corporation) in the prevention of the postoperative hypertensive phase and on long-term intraocular pressure (IOP) control after Ahmed glaucoma valve (AGV; New World Medical) implantation. DESIGN This is a prospective, randomized, controlled study of 26 patients treated at a tertiary care center, with 13 eyes assigned to each treatment arm. PARTICIPANTS Consecutive patients with refractory glaucoma requiring AGV implantation were enrolled. Refractory glaucoma was defined as IOP >21 mmHg on maximum tolerated glaucoma medications or progressive visual field and optic nerve head changes despite maximal tolerated medical therapy. METHODS In Ologen eyes, a round 12 × 1-mm OCM segment was placed flush over the AGV-FP7 plate immediately before conjunctival closure. Control eyes received conventional AGV surgery without OCM implantation. MAIN OUTCOME MEASURES The primary outcomes were postoperative IOP and requirement of pressure-lowering medications. On the basis of these measures, the rates of complete and qualified success over the course of follow-up were calculated. Complete success was defined as IOP ≤21 mmHg without antihypertensive medications. Qualified success was defined as IOP ≤21 mmHg with or without medications. Frequency of hypertensive phase was also determined. RESULTS Patients receiving Ologen-augmented AGV surgery exhibited significantly lower IOPs compared with control subjects at the 1-, 2-, and 3-month time points (P < 0.04). Maximum mean IOP postoperatively was 25.2 ± 7.4 for control eyes and 16.8 ± 8.9 for Ologen eyes, peaking at month 2 for both groups and stabilizing by month 6. No differences in average number of pressure-lowering medications were detected between groups. There were no statistically significant differences in complete or qualified success rates at 6 and 12 months. The frequency of hypertensive phase was 61.5% in control eyes and 38.5% in OCM-implanted eyes. CONCLUSIONS Ologen collagen matrix-augmented AGV surgery may provide better IOP control in the intermediate postoperative period and blunt the hypertensive phase compared with AGV implantation alone.
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Affiliation(s)
- Noga Harizman
- New York Eye and Ear Infirmary of Mount Sinai, New York, New York; Columbia University Irving Medical Center, Department of Ophthalmology, New York, New York
| | - Jeanette Du
- New York Eye and Ear Infirmary of Mount Sinai, New York, New York.
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