Collagen Matrix Implant (Ologen)TM in Glaucoma Surgeries; Precautions for a Better Control of Intraocular Pressure

Background: Collagen matrix implant (CM) is used in glaucoma surgery to regulate healing under the conjunctiva.

Purpose: To highlight the precautions that should be taken for a better intraocular pressure (IOP) control with CM in different glaucoma surgeries during and after the operation.

Methods: Thirty five cases of glaucoma were treated surgically with adjunctive OlogenTM.

a) Fifteen subscleral trabeculectomies (SST): for adult Primary Open Angle Glaucoma (POAG).

b) Five SST's for Primary Congenital Glaucoma (PCG).

c) Fifteen Phaco-trabeculectomies for advanced POAG with cataract. One was converted to extracapsular cataract extraction with SST because of a subluxated (270 degree) cataractous lens with advanced glaucoma.

The number of 10/0 nylon stitches to close the scleral flap, the method of closure of the fornix based conjunctival flap and injection of Na hyaluronate at the end of the surgery were evaluated. Postoperatively: Anterior chamber(AC) depth, the need for ocular massage, any additional medications or further surgical intervention were assessed.

Results: Better IOP control was obtained with slightly shallow AC postoperatively and tight conjunctival closure. Ocular massage may be needed as well as medications for cases which experienced tight closures of the scleral flap. Three SST´s and four phaco-trabeculectomies needed supplemental medications after surgeries. Failure in one SST (PCG) and two phacotrabeculectomies was due to presence of additional risk factors in the patients. The rest of cases went successfully with IOP < 21 mm Hg without medications.

Conclusion: CM is a successful adjunct to glaucoma surgeries, intraoperative and postoperative precautions should be taken to maintain proper aqueous drainage and functioning blebs to improve the degree of success.