Secondary subconjunctival implantation of a biodegradable collagen-glycosaminoglycan matrix to treat ocular hypotony following trabeculectomy with mitomycin C.

Abstract

AIM:

Biodegradable collagen glycosaminoglycan matrices (CGM) have been introduced to glaucoma filtration surgery in order to prevent scarring of the filtering bleb. In this retrospective case series, we describe a new surgical concept for treating symptomatic ocular hypotony following filtration surgery with mitomycin C by a secondary subconjunctival implantation of a CGM.

METHODS:

Depending on bleb morphology, a CGM implant with a diameter of 6 or 12 mm was placed subconjunctivally on the scleral flap in 12 eyes displaying symptomatic ocular hypotony with (n=2) or without (n=10) bleb leakage. Median period between trabeculectomy and this intervention was 4.5 months (range, 1-72 months).

RESULTS:

Mean intraocular pressure significantly increased from 4.4±1.4 mm Hg to 9.9±2.8 mm Hg (p<0.0001) over a median follow-up of 6 months (range, 2-18 months). Mean visual acuity improved significantly (p=0.0012). Postoperative complications included implant re-exposure in one eye and persistent choroidal detachment requiring resurgery in another eye.

CONCLUSIONS:

Subconjunctival implantation of CGM may present an additional surgical tool in the treatment of symptomatic ocular hypotony after filtering surgery. The mechanism of action may be counter-pressure to the scleral flap and secondary wound healing around the CGM scaffold. Long-term observations are needed to fully evaluate this new surgical concept.

• Authors: T S Dietlein, A Lappas, A Rosentreter
• Journal: The British journal of ophthalmology (Br J Ophthalmol) Vol. 97 Issue 8 Pg. 985-8 (Aug 2013) ISSN: 1468-2079 [Electronic] England
• PMID: 23759438 (Publication Type: Journal Article)

Chemical References

• Alkylating Agents
• Glycosaminoglycans
• collagen-glycosaminoglycan copolymer
• Mitomycin
• Collagen

Topics

• Absorbable Implants
• Aged
• Aged, 80 and over
• Alkylating Agents (administration & dosage)
• Collagen
• Combined Modality Therapy
• Conjunctiva (surgery)
• Glycosaminoglycans
• Humans
• Intraocular Pressure (physiology)
• Middle Aged
• Mitomycin (administration & dosage)
• Ocular Hypotension (etiology, physiopathology, surgery)
• Postoperative Complications
• Prosthesis Implantation
• Retrospective Studies
• Trabeculectomy
• Visual Acuity (physiology)