Abstract
ObjectiveTo evaluate the application of the Ologen implant compared to mitomycin C (MMC) on the outcome of trabeculectomy and to examine the balance of risks and benefits.MethodsA systematic literature search (Pubmed, Embase, the Cochrane Library, and the Chinese Biomedicine Database) was performed. Randomized controlled trials comparing the Ologen implant with MMC in trabeculectomy were selected. The efficacy measures were the weighted mean differences (WMDs) for the intraocular pressure reduction (IOPR), the reduction in glaucoma medications, and the relative risks (RRs) for success rates. The tolerability measures were RRs for adverse events. The pooled effects were calculated using the random-effects model.ResultsSeven randomized controlled trials including 227 eyes were included in this meta-analysis. The WMDs of the IOPR comparing the Ologen group with the MMC group were −2.98 (95% Cl: −5.07 to −0.89) at one month, −1.41 (−3.72 to 0.91) at three months, −1.69 (−3.68 to 0.30) at six months, −1.94 (−3.88 to 0.01) at 12 months, and 0.65 (−2.17 to 0.47) at 24 months. There was no statistically significance except at one and 12 months after surgery. No significant difference in the reduction in glaucoma medications or complete and qualified success rates were found. The rates of adverse events also did not differ significantly between Ologen and MMC.ConclusionsThe Ologen implant is comparable with MMC for trabeculectomy in IOP-lowering efficacy, reduction in the number of glaucoma medications, success rates, and tolerability. However, the results should be interpreted cautiously since relevant evidence is still limited, although it is accumulating. Further large-scale, well-designed randomized controlled trials are urgently needed.
Highlights
Since it was introduced in 1968 by Cairns, trabeculectomy remains the most common surgical procedure for the treatment of glaucoma [1,2,3]
The aim of this study was to undertake a systematic review and meta-analysis to evaluate the application of the Ologen implant compared to mitomycin C (MMC) on the outcome of trabeculectomy and to examine the balance of risks and benefits
This systematic review and meta-analysis were performed according to a predetermined protocol described in the paragraph, and the standard systematic review guidelines, as outlined by the Cochrane Reviewers’ Handbook and the PRISMA (Preferred Reporting Items for Systematic Review and MetaAnalyses) statement (Table S1), were followed in all stages of the process [23,24]
Summary
Since it was introduced in 1968 by Cairns, trabeculectomy remains the most common surgical procedure for the treatment of glaucoma [1,2,3]. Wound healing and scar formation causing fibrosis and the obstruction of aqueous outflow remain the most common reason for the failure of trabeculectomy [4,5]. To resolve this problem, several agents have been used. MMC is an antitumor antibiotic isolated from Streptomycin caepitorus. It inhibits the synthesis of DNA, cellular RNA, and protein by inhibiting the synthesis of collagen by fibroblasts [6,7]
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