Biodegradable Collagen Implants in Trabeculectomy

The Use of Ologen Implant in Childhood Glaucoma Surgeries: A Review

PURPOSE

This study assesses the effectiveness and safety of using Ologen implants (Aeon Astron Europe BV, Leiden, The Netherlands) as an adjunctive therapy in childhood glaucoma surgeries.

METHODS

We systematically reviewed the existing literature across various electronic databases to examine the effectiveness and safety of Ologen implants in childhood glaucoma surgeries.

RESULTS

Our analysis encompassed 14 studies on the use of Ologen implants in childhood glaucoma. Among these, seven were prospective, five were retrospective, and two did not specify their study design. Success rates varied depending on the type of surgery and the included childhood glaucoma subtype. The success rates for Ologen implants-augmented surgeries were as follows: 33.3-70% for trabeculectomy, 50-81% for combined trabeculotomy-trabeculectomy procedure, 33%-87% for glaucoma drainage device, and 60% in deep sclerectomy.

CONCLUSION

Ologen implant has a potential role in mitigating postoperative fibrosis and enhancing success rates in various childhood glaucoma surgeries. However, the existing literature is limited. Future comparative prospective studies with larger cohorts are needed.

Development of Vitroceramic Coatings and Analysis of Their Suitability for Biomedical Applications

Within the field of tissue engineering, thin films have been studied to improve implant fixation of metallic or ceramic materials in bone, connective tissue, oral mucosa or skin. In this context, to enhance their suitability as implantable devices, titanium-based substrates received a superficial vitroceramic coating by means of laser ablation. Further, this study describes the details of fabrication and corresponding tests in order to demonstrate the bioactivity and biocompatibility of the newly engineered surfaces. Thus, the metallic supports were covered with a complex material composed of SiO2, P2O5, CaO, MgO, ZnO and CaF2, in the form of thin layers via a physical deposition techniques, namely pulsed laser deposition. The resulting products were characterized by X-ray diffraction, Fourier-transform infrared spectroscopy, scanning and transmission electron microscopy coupled with energy dispersive X-ray spectroscopy, selected area electron diffraction, and electron energy loss spectroscopy. It was found that a higher substrate temperature and a lower working pressure lead to the highest quality film. Finally, the samples biocompatibility was assessed and they were found to be bioactive after simulated body fluid soaking and biocompatible through the MTT cell viability test.

Improving Glaucoma Surgical Outcomes with Adjunct Tools

Conventional glaucoma surgeries, such as trabeculectomy and glaucoma drainage device (GDD) surgery, have been enhanced by surgeons to improve outcome and decrease complications. Over the last two decades, adjuncts, such as collagen matrix implants, fibrin adhesives, and amniotic membrane transplantation (AMT) have been found to be effective in modulating fibrosis and scarring during the wound-healing process, reducing postoperative inflammation, and repairing bleb leakage or conjunctival erosion. The use of these tools provides several advantages when used in trabeculectomy, GDD surgery, and surface reconstruction associated with glaucoma surgery complications. Their use will be discussed in this review. How to cite this article: Lu LJ, Hall L, Liu J. Improving Glaucoma Surgical Outcomes with Adjunct Tools. J Curr Glaucoma Pract 2018;12(1):19-28.

Comparison between Ologen implant and different concentrations of Mitomycin C as an adjuvant to trabeculectomy surgery

CONTEXT:

Trabeculectomy is the most common surgical procedure for treatment of glaucoma. To improve success rates, adjuvants were utilized as Mitomycin C (MMC) and Ologen implant.

AIMS:

This study aims to establish efficacy and safety of Ologen implant versus MMC in trabeculectomy.

SETTING AND DESIGN:

A prospective, comparative clinical study was conducted at the Department of Ophthalmology, Assiut University, between December 2014 and April 2016.

SUBJECTS AND METHODS:

Patients with primary open-angle glaucoma (OAG), primary narrow-angle glaucoma and secondary OAG were assigned equally to trabeculectomy with Ologen, 0.4 mg/mL or 0.2 mg/mL MMC. The study outcome measures were reduction in intra-ocular pressure (IOP), success rates, survival analysis, and rate of complications.

STATISTICAL ANALYSIS USED:

SPSS software Version 17.0 (SPSS, Inc., IL, USA) was utilized.

RESULTS:

Thirty eyes were included in the study. Mean baseline IOP in Ologen, MMC 0.4 and MMC 0.2 groups were 27.43 ± 2.97, 28.4 ± 3.24, and 27.56 ± 2.69 mmHg, respectively. At week 24 follow-up, mean IOP in Ologen, MMC 0.4 and MMC 0.2 groups were 18.55 ± 3.18, 16.2 ± 3.22, and 16.93 ± 3.04 mmHg, respectively. No significant inter-group difference was noticed at any visits. Complete success was achieved in 10%, 40%, and 30%, whereas incomplete success in 70%, 50%, and 60%, respectively in Ologen, MMC 0.4 and MMC 0.2 groups. No treatment group difference was reported by Kaplan–Meier analysis. Shallow anterior chamber occurred more in Ologen and MMC 0.4 groups. A single case of serous choroidal effusion had occurred in MMC 0.4 group.

CONCLUSION:

Ologen implant is a promising alternative to MMC for improving the success rate of trabeculectomy.