Abstract
ABSTRACTSubconjunctival and subscleral fibrosis are the major causes of failure of filtering surgery. Antiproliferative agents have been successfully used to improve the long-term success of this surgery. Recent advancement in the field of glaucoma surgery has been the use of bioengineered, biodegradable, porous collagen-glycosaminoglycan matrix implant in the subconjunctival and/or subscleral space to modify the wound-healing process and reduce scar formation, hence improving the surgical success without the need for anti-fibrotic agents.Biodegradable, collagen implants have shown favorable results when used with deep sclerectomy. There have been variable results regarding the success of trabeculectomy when combined with these implants. These implants also decrease the dose of mitomycin C required with trabeculectomy and hence, decrease the side effect associated with these drugs.The use of the biodegradable implants in glaucoma surgery is still evolving and further studies are needed to find the appropriate surgical technique, the ideal size and site of placement and determine their long-term impact on trabeculectomy outcomes and complications.How to cite this article: Ichhpujani P, Dada T, Bhartiya S. Biodegradable Collagen Implants in Trabeculectomy. J Curr Glaucoma Pract 2015;9(1):24-27.
Highlights
Trabeculectomy, the ‘traditional’ filtration surgery, aims at reduction of intraocular pressure (IOP) in medically refractory glaucoma patients, by way of shunting aqueous humor through to the canal of Schlemm by excising part of the trabecular meshwork exposing the canal of Schlemm.[1,2]
The antimetabolites, mitomycin C (MMC) and 5-fluorouracil (5-FU) are a double edged sword. They help to modify the fibrotic response to the surgical insult,[5,6] but their use is associ ated with complications, such as hypotony, hypotony maculopathy, suprachoroidal hemorrhage, choroidal effusions, bleb leak, blebitis, bleb encapsulation, failure and endophthalmitis.[7,8]
Amniotic membrane transplantation and expanded polytetrafluoroethylene (Gore-Tex) implants have been tried as adjunctive modifications to enhance and maintain the desired effect of trabeculectomy, but not with much success.[9,10]
Summary
Trabeculectomy, the ‘traditional’ filtration surgery, aims at reduction of intraocular pressure (IOP) in medically refractory glaucoma patients, by way of shunting aqueous humor through to the canal of Schlemm by excising part of the trabecular meshwork exposing the canal of Schlemm.[1,2] This surgery has contradictory concepts: prevention of wound healing around the surgical fistula and inhibition of fibrosis of Tenon capsule to sclera on one. When used in glaucoma surgery, the use of collagenglycosaminoglycan copolymers leads to random and relatively loose reorganization of regenerating myofibro blasts, fibroblasts and the secreted extracellular collagen matrix, resulting in reduced scar formation.[14,15] These implants offer a potential alternative to antifibrosis agents as they produce more loosely organized, yet more abundant bleb tissue than a bleb created without antimetabolites. These biodegradable polymers degrade into nontoxic compounds in the body, avoiding the need for surgical removal. This chapter throws light on the available collagen implants, their surgical applications, complications and outcome
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