Long-term outcomes of trabeculectomy with ologen implant versus combined viscotrabeculotomy-synechiolysis in uncontrolled uveitic glaucoma.

Abstract

To compare trabeculectomy with Ologen implant(Trab-Ologen) to combined viscotrabeculotomy-synechiolysis(VTS) in uncontrolled uveitic glaucoma (UG). A retrospective chart review of 47 patients subjected to VTS(24 eyes) or Trab-ologen(23 eyes) at Mansoura Ophthalmic Center between 2010 and 2016. The patients were evaluated on day 1, week 1, months 1, 3, 6, 12, 18, 24, 30, 36, 42, and 48. The mean ± standard deviation age of patients in the Trab-ologen and VST groups were 38.29 ± 12.5 and 38.91 ± 11.8years (p = 0.86), respectively. Juvenile Idiopathic arthritis (controlled on methotrexate) was the most common associated systemic disease (3 patients in each group). The mean ± standard deviation of the intraocular pressure (IOP) and IOP-lowering medications preoperatively and at the end of follow up in the Trab-ologen and VST groups were 33.1 ± 2.6mmHg, 33.2 ± 2.6mmHg (p = 0.91), 3.4 ± 0.5, 3.4 ± 0.5 (0.90) and 15.4 ± 1.2mmHg, 13.0 ± 0.9mmHg (p < 0.001), 0.6 ± 1.1, 0.7 ± 1.2 (p = 0.72), respectively. IOP control was better in the Trab-ologen group till the 30th month when it becomes better in the VST group till the end of follow-up. The most notable complication was a minimal self-limiting hyphema in the VST group. Success rates at the end of follow-up in the Trab-ologen and VST groups were 83% and 78%, respectively. Trabeculectomy with ologen implant and visco-trabeculotomy-synechiolysis were equally effective in lowering IOP in uncontrolled UG. There was no statistically significant difference in the success rates between the 2 procedures.