Biodegradable Implant for Tissue Repair After Glaucoma Drainage Device Surgery

Department of Ophthalmology, Bad Tölz.
Journal of glaucoma (Impact Factor: 2.11). 01/2011; 21(2):76-8. DOI: 10.1097/IJG.0b013e3182027ab0
Source: PubMed


To report a novel technique using biodegradable material to cover exposed glaucoma tube shunts.
A case report of a single patient who underwent drainage tube shunt surgery with the Baerveldt drainage device for intractable glaucoma. Four months post operation the tube became exposed through necrosis of the overlying scleral flap and conjunctiva. The defect was repaired by fixation of the tube to the sclera, with a slice of an ologen implant as a patch, covered by the adjacent conjunctiva. The patient was followed over a period of 1 year after the surgery.
Successful, lasting closure of the conjunctival defect was achieved without any side effects or complications.
Erosion of the drainage tube after shunt surgery is a potentially serious problem. It can be successfully managed using a biodegradable implant as a patch before closing the conjunctiva.

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    ABSTRACT: Glaucoma refers to a group of eye conditions that lead to damage to the optic nerve, the nerve that carries visual information from the eye to the brain. In many cases, damage to the optic nerve is due to increased pressure in the eye, also known as intraocular pressure. Glaucoma is a disease of the optic nerve that affects approximately 60 million people globally. It is the second most common cause of blindness, leaving an estimated 7.5 million people blind. In India it affects 11 million people, of which 1.5 million are blind. Glaucoma is a disease that is often associated with elevated intraocular pressure, in which damage to the eye (optic) nerve can lead to loss of vision and even blindness. Glaucoma is the leading cause of irreversible blindness in the world. Glaucoma usually causes no symptoms early in its course, at which time it can only be diagnosed by regular eye examinations and screenings with the frequency of examination based on age and the presence of other risk factors. Intraocular pressure increases when either too much fluid is produced in the eye or the drainage or outflow channels of the eye become blocked. While anyone can get glaucoma, some people are at greater risk. The two main types of glaucoma are open-angle glaucoma, which has several variants and is a long duration condition, and angleclosure glaucoma, which may be a sudden condition or a chronic disease. Damage to the optic nerve and impairment of vision from glaucoma is irreversible. Several painless tests that determine the intraocular pressure, the status of the optic nerve and drainage angle, and visual fields are used to diagnose glaucoma. Glaucoma is usually treated with eye drops, although lasers and surgery can also be used. Most cases can be controlled well with these treatments, thereby preventing further loss of vision. Much research into the causes and treatment of glaucoma is being carried out throughout the world. Early diagnosis and treatment is the key to preserving sight in people with glaucoma.
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    ABSTRACT: Purpose: To evaluate outcomes of trabeculectomy with use of a subconjunctival biodegradable collagen implant (Ologen) combined with mitomycin C (MMC). Methods: This retrospective study included 33 eyes of 24 patients with primary open-angle glaucoma who underwent fornix-based trabeculectomy with subconjunctival Ologen implant and MMC (0.1 mg/mL×1 min) between October 2008 and April 2010. Data pertaining to the preoperative parameters and postoperative outcomes were recorded. Each patient was followed up for at least 12 months. Results: The mean age of the study participants was 53.03±7.08 years. Mean preoperative intraocular pressure (IOP) was 34.06±6.56 mm Hg, and decreased to 11.87±2.23 mm Hg, 12.27±2.05 mm Hg, and 12.54±1.67 mm Hg at 3, 6, and 12 months, respectively. Mean postoperative IOP readings at all follow-up visits were significantly lower than those at preoperative levels (P<0.001). Two eyes required ocular hypotensive medications to lower the IOP in the postoperative period. All eyes had a diffuse elevated well-formed bleb, with the implant being visible for 6 to 9 months. Two eyes had a shallow anterior chamber with hypotony during the early postoperative period due to wound leak, whereas 1 case developed implant exposure at 1-week follow-up; all these cases were managed by conjunctival resuturing. Two cases developed a Tenon cyst at 8 to 12 weeks and required needling for restoration of bleb function. Conclusions: Trabeculectomy with implantation of an Ologen implant and use of low-dose MMC appears to offer encouraging short-term results for IOP control in eyes with primary open-angle glaucoma.
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