Trabeculectomy with Ologen implant versus mitomycin C in congenital glaucoma secondary to Sturge Weber Syndrome.

AIM To compare the efficacy and safety of collagen matrix implant [Ologen (OLO) implant] versus mitomycin C (MMC) with subscleral trabeculectomy (SST) for the surgical treatment of congenital glaucoma (CG) in Sturge-Weber Syndrome (SWS). METHODS A prospective comparative randomized study of 20 eyes of 16 patients with CG associated with SWS was divided into two groups. The first group (MMC Group) included 10 eyes that were subjected to SST with MMC. The second group (OLO Group) included 10 eyes that were subjected to trabeculectomy with a collagen matrix implant (OLO implant). Postoperative evaluation included intraocular pressure (IOP) level, bleb evaluation, complications, and the need for further medication or surgical intervention. RESULTS The mean preoperative IOP was 29±3.16 mm Hg in MMC and 29.8±3.08 mm Hg in OLO eyes. Mean 12-month percentage reduction in IOP was significant in both groups (57.9% and 56.3%). At the end of the 12 postoperative follow-up month, in the MMC Group, 80% of eyes achieved the complete success, 20% of eyes had qualified success with no failed surgery in comparison to OLO Group which 70% of eyes achieved the complete success, 20% of eyes had qualified success with 10% failed surgery. In terms of complications, the MMC Group had a higher rate of complications than the OLO Group in the form of thin polycystic bleb in 6 eyes (60%), blebitis in only one eye (10%) treated with topical antibiotics, shallow anterior chamber in two eyes (20%). CONCLUSION This study proves that the use of a collagen matrix implant yields equally effective results as MMC when combined with trabeculectomy for the treatment of CG in SWS. Furthermore, OLO implantation is safe and has low incidences of complications.

[1]  R. Bowman,et al.  Trabeculectomy or Transscleral Cyclophotocoagulation as Initial Treatment of Secondary Childhood Glaucoma in Northern Tanzania , 2017, Journal of glaucoma.

[2]  Hossam T Al-Sharkawy,et al.  Safety and Efficacy of Collagen Matrix Implantation in Infantile Glaucoma , 2017, European journal of ophthalmology.

[3]  M. H. Ali,et al.  Pathophysiology, diagnosis, and management of glaucoma associated with Sturge–Weber syndrome , 2017, International Ophthalmology.

[4]  Alessandro Lambiase,et al.  Ocular manifestations of Sturge–Weber syndrome: pathogenesis, diagnosis, and management , 2016, Clinical ophthalmology.

[5]  A. Casuccio,et al.  Biodegradable collagen matrix implant versus mitomycin-C in trabeculectomy: five-year follow-up , 2016, BMC Ophthalmology.

[6]  W. El-Haig,et al.  Evaluation the adjunctive use of combined bevacizumab and mitomycinc to trabeculectomy in management of recurrent pediatric glaucoma , 2016, Eye.

[7]  T. Dietlein [Glaucoma surgery in children]. , 2015, Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft.

[8]  Tetsuya Yamamoto,et al.  Blindness following bleb-related infection in open angle glaucoma , 2014, Japanese Journal of Ophthalmology.

[9]  Xiulan Zhang,et al.  Ologen Implant versus Mitomycin C for Trabeculectomy: A Systematic Review and Meta-Analysis , 2014, PloS one.

[10]  Jung Kee Min,et al.  Surgical Outcome of Mitomycin C-soaked Collagen Matrix Implant in Trabeculectomy , 2013, Journal of glaucoma.

[11]  T. Dietlein,et al.  Secondary subconjunctival implantation of a biodegradable collagen-glycosaminoglycan matrix to treat ocular hypotony following trabeculectomy with mitomycin C , 2013, British Journal of Ophthalmology.

[12]  A. Ellakwa,et al.  Subscleral trabeculectomy with mitomycin-C versus ologen for treatment of glaucoma. , 2013, Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics.

[13]  I. Wong,et al.  Congenital Glaucoma from Sturge-Weber Syndrome: A Modified Surgical Approach , 2012, Korean Journal of Ophthalmology.

[14]  A. Casuccio,et al.  Biodegradable collagen matrix implant vs mitomycin-C as an adjuvant in trabeculectomy: a 24-month, randomized clinical trial , 2011, Eye.

[15]  A. Comi Presentation, Diagnosis, Pathophysiology, and Treatment of the Neurological Features of Sturge-Weber Syndrome , 2011, The neurologist.

[16]  G. Krieglstein,et al.  A prospective randomised trial of trabeculectomy using mitomycin C vs an ologen implant in open angle glaucoma , 2010, Eye.

[17]  I. Pascual-Castroviejo,et al.  Sturge-Weber Syndrome. Study of 55 Patients , 2008, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.

[18]  R. Ritch,et al.  Control of filtering bleb structure through tissue bioengineering: An animal model. , 2006, Investigative ophthalmology & visual science.

[19]  R. Fechtner,et al.  Antifibrotics and wound healing in glaucoma surgery. , 2003, Survey of ophthalmology.

[20]  H. D. Hoskins,et al.  Analysis of surgical and medical management of glaucoma in Sturge-Weber syndrome. , 1990, Ophthalmology.