Trabeculectomy with ologen in secondary glaucomas following failed trabeculectomy with MMC: Comparative study

Abstract

Purpose We aimed to assess the IOP-lowering effect of trabeculectomy with ologen in refractory secondary glaucoma following failed trabeculectomy with mitomycin C (MMC), and to compare its surgical outcome between open angle (SOAG) and angle closure (SACG) cases.MethodsThis is a prospective interventional comparative study conducted on 40 eyes (40 patients) with medically uncontrolled secondary glaucoma. Patients were divided into group A: 18 eyes (18 patients) with SOAG, and group B: 22 eyes (22 patients) with SACG. All patients underwent trabeculectomy with insertion of ologen implant. Intraocular pressure (IOP) measurement, SITA standard perimetry (Central 24-2), spectral domain optical coherence tomography (OCT) for retinal nerve fiber layer (RNFL) thickness, and anterior segment OCT for bleb morphology, were all done pre- and postoperatively. Primary outcome measures were comparing preoperative to postoperative measurements and also comparing these measurements between SOAG and SACG. All patients were examined up to 1 year.ResultsWhen preoperative IOP was compared with postoperative IOP, in each group, there was a statistically significant difference (P<0.001). IOP percentage difference was statistically insignificantly different between both groups except at 1 month. According to Moorfields bleb grading system; postoperative bleb was better than the bleb of the previously failed trabeculectomy (P<0.001), and there was a significant difference between group A and B regarding bleb area. Total success rate was 100%; in group A, complete success was 100%, while in group B it was 72.7% (P=0.016).ConclusionOur results suggest that Ologen may be a useful alternative to MMC in repeat trabeculectomy.