Abstract
Introduction: Ologen™ is traditionally placed subconjunctivally during trabeculectomy, which limits its area of action. Subscleral implantation of Ologen has been described involving fashioning a gutter beneath the scleral flap. This, however, would not prevent fibrosis at the margins of the scleral flap. We describe a modified technique of Ologen® placement that has the potential to prevent scarring at the margins of the flap withoutthe need to fashion a gutter.
 Materials and methods: The study involved a retrospective review of patients who had undergone trabeculectomy with Ologen implantation by the wick technique between January 2015 and August 2016. Patients judged to be at high risk of trabeculectomy failure were operated with this technique.
 Results: A total of six patients with median age of 38.5 years were included in the study. The mean preoperative intraocular pressure (IOP) was 30.8 ± 7.3 mmHg, which reduced to 10.6 ± 2.2 mmHg 18 months after surgery. By 18 months postoperative, all patients had IOP in the low teens (two patients required additional topical medication). One patient had two episodes of hypotony that responded to steroids and cycloplegics. Another patient required two needlings to bring IOP under control. No other complications were noted. Ultrasound biomicroscopy done 3 months after surgery showed two pieces of Ologen in one patient.
 Conclusions: The results of our study show that this technique may be used effectively in patients at high risk of trabeculectomy failure. Further studies in a larger number of patients with diverse high-risk conditions are required before this technique is recommended for general use.
Highlights
OlogenTM is traditionally placed subconjunctivally during trabeculectomy, which limits its area of action
After placing a corneal traction suture, peritomy, and fashioning a rectangular scleral flap, mitomycin C (MMC)-soaked sponges are applied over a wide area for one minute
If the use of subscleral Ologen by the wick technique is proven to be effective, there is an opportunity to enhance the efficacy of trabeculectomy with Ologen implantation and low concentration MMC in high-risk situations
Summary
OlogenTM is traditionally placed subconjunctivally during trabeculectomy, which limits its area of action. OlogenTM (Aeon Astron, Leiden, Netherlands) is a bioengineered collagen matrix that causes fibroblasts to grow through it in a random fashion resulting in a loose scar tissue matrix It is placed subconjuctivally.[1,2,3] Subscleral Ologen implantation has been described with an aim to limit subscleral fibrosis. The remaining Ologen is placed over the scleral flap after placing the releasable sutures.[1,4] as only a small piece is placed subsclerally, the area wherein fibrosis may be limited is restricted. This may be true at the margins of the scleral flap. If the use of subscleral Ologen by the wick technique is proven to be effective, there is an opportunity to enhance the efficacy of trabeculectomy with Ologen implantation and low concentration MMC in high-risk situations
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