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Lee, Woo, Min, Kee, and Yim: The Analysis of the Clinical Findings and Effects of Biodegradable Collagen Matrix in Trabeculectomy
Original Article
Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2012; 53(2): 297-305.

Published online: 15 February 2012

DOI: https://doi.org/10.3341/jkos.2012.53.2.297

The Analysis of the Clinical Findings and Effects of Biodegradable Collagen Matrix in Trabeculectomy

Sung Ju Lee, MD1, Je Moon Woo, MD, PhD1, Jung Kee Min, MD1, Chang Won Kee, MD, PhD2, Jin Ho Yim, MD1

1Department of Ophthalmology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea.

2Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea.

Address reprint requests to Jin Ho Yim, MD. Department of Ophthalmology, Ulsan University Hospital, #877 Bangeojinsunhwan-doro, Dong-gu, Ulsan 682-714, Korea. Tel: 82-52-250-7170, Fax: 82-52-250-7174, yimjinho@hanmail.net

Received 17 May 2011       Accepted 26 December 2011

Copyright © 2012 The Korean Ophthalmological Society

Abstract

Purpose

To observe the effects of biodegradable collagen matrix (OculusGen™) on filtering bleb formation and maintenance and to investigate its clinical effects and usefulness in trabeculectomy.

Methods

Ophthalmologic examinations were preformed 1 day, 2 weeks, 1 month, 2 months, 3 months, 6 months, and 12 months postoperatively in the case and control groups. The clinical findings of the filtering bleb were observed, and the clinical effects measured by mean intraocular pressure and complications were evaluated in both groups.

Results

The success rates were 76% in the case group and 88% in the control group, and there were no significant differences between the case and control groups. In the case group, postoperative conjunctival injection persisted for more than 1 month with increasing severity, while ultrasound biomicroscopy revealed increased echogenicity of the subconjuctival and tenon tissue with no definite space-occupying effect.

Conclusions

Trabeculectomy utilizing collagen matrix showed similar clinical results compared to the current traditional trabeculectomy; slit-lamp and ultrasound biomicroscopy findings did not reveal any advantageous changes to filtering bleb function.

Keywords: Biodegradable collagen matrix, Glaucoma, Intraocular pressure, Trabeculectomy

Figures and Tables

Figure 1
Collagen implant was inserted after sclera flap was performed and before closing the conjunctiva. The procedure was performed from (A) to (F). The collagen implant was positioned just superior to the sclera flap and under the conjunctiva.
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Figure 2
Graph of the serial postoperative IOP in group I and II. Each point was measured 1 day, 2 weeks, 1 month, 2 months, 3 months, 6 months, and 12 months postoperatively. IOP was higher in group I from 2 weeks to 3 months postoperatively. Encapsulation was observed in this period and was related with elevated IOP. p-value was not significant (p-value >0.05) in each postoperative period by independent t-test using Bonferroni correction. (Group I: patients received filtering surgery with collagen matrix. Group II: patients received filtering surgery without using collagen matrix.)
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Figure 3
Both eyes of a 70 year-old female who was diagnosed with primary open angle glaucoma. Trabeculectomy and cataract surgery with collagen matrix was done in the right eye (OD) while trabeculectomy and cataract surgery without collagen matrix and use of 5-FU in the left eye (OS). Conjunctival injection increased and was observed longer in the eye with collagen matrix than with use of 5-FU.
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Figure 4
Pictures of ultrasound biomicroscopic (UBM) findings in the operated eye. (A) Radial scan, (B) Transverse scan, (C) Radial scan. The patient received trabeculectomy with collagen matrix and mitomycin C 2 months ago (A, B). A highly reflective line was observed (arrow head) above the collagen matrix (arrow). However, picture C was the UBM finding of a 36 year-old male who was diagnosed with secondary glaucoma. He received conventional trabeculectomy with mitomycin C 2 months ago. This picture did not show abnormally high reflectivity in the intra-bleb structure.
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Figure 5
Bleb height of a 55 year-old female who was diagnosed with chronic angle closure glaucoma. She received trabeculectomy and cataract surgery with collagen matrix. The bleb height was not big enough right after surgery and started to decrease.
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Table 1
Baseline characteristics of patients in group I and II
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Values are mean ± SD unless otherwise indicated.

*Patients received filtering surgery with collagen matrix; †Patients received filtering surgery without collagen matrix; ‡p-value by independent t-test.

Table 2
Surgical outcomes in group I and II
jkos-53-297-i002

Values are mean ± SD or number (%).

*Patients received filtering surgery with collagen matrix; †Patients received filtering surgery without collagen matrix; ‡p-value are independent t-test; §Value is the mean intraocular pressure at last follow-up; ∥p-value from Fischer exact test.

Table 3
Effectiveness of collagen matrix as a bleb reservoir after trabeculectomy
jkos-53-297-i003

Values are mean ± SD.

*Each value was measured at the highest point of collagen matrix within the bleb using ultrasound biomicroscopy; †Height reduction was calculated by the following method; (collagen matrix height at 2 weeks - collagen matrix height at each follow-up) / collagen matrix height at 2 weeks × 100.

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