Evaluation of the efficacy and safety of injectable cross-linked hyaluronic acid compared with mitomycin C in trabeculectomy surgery

Abstract

BackgroundTrabeculectomy has been a gold standard for the treatment of glaucoma for years since its introduction to ophthalmology literature, and the outcome depends mostly on the resulting intraocular pressure (IOP). However, the most common reason for trabeculectomy failure is the development of fibrosis in the conjunctiva and episclera. Thus, glaucoma surgeons are still searching for an optimal substance for the modulation of wound-healing processes.AimThis study was conducted to evaluate the efficacy and safety of injection of cross-linked hyaluronic acid below the scleral flap and under the conjunctiva in trabeculectomy surgery compared with trabeculectomy with mitomycin C (MMC).Patients and methodsA total of 24 eyes with primary open-angle glaucoma were included in this study. Patients were divided into two groups: group 1 included 12 eyes that underwent a standardized trabeculectomy surgery supplemented by the injection of cross-linked hyaluronic acid (HealaFlow) below the scleral flap and under the conjunctiva, and group 2 included 12 eyes that underwent a standardized trabeculectomy surgery with the application of MMC. The endpoints for comparison were IOP, success rates, and postoperative complications.ResultsThe results of both groups were comparable, with no statistically significant difference between the two groups as regards IOP, success rates, and postoperative complications.ConclusionCross-linked sodium hyaluronate (HealaFlow) injectable implant is comparable to MMC for trabeculectomy in terms of IOP-lowering efficacy, success rates, early and mid-term postoperative complications, and tolerability. However, the results should be interpreted cautiously as relevant evidence is still limited, although it is accumulating. Further large-scale, long-term, and well-designed randomized controlled trials are needed.