Purpose: To compare the outcomes of trabeculectomy with 5-fluorouracil (5-FU) versus Ologen™ implant in patients with primary open-angle glaucoma. Methods: A retrospective chart review was performed of patients with primary open-angle glaucoma who underwent trabeculectomy using either Ologen or 5-FU over 12 consecutive months. The patients had moderate-to-advanced primary open-angle glaucoma and uncontrolled intraocular pressure (IOP) on maximally tolerated medical treatment. Fornix-based trabeculectomy was performed on all patients by the same surgeon. The outcomes that were recorded and analyzed included the IOP level and number of glaucoma medications before and after surgery as well as the complications. All patients were followed for at least 3 months. Results: A total of 58 eyes (of 47 patients) were included in this study. The eyes were divided into 2 groups: the 5-FU group (n = 30, 51.7%) and the Ologen group (n = 28, 48.3%). The demographics and preoperative clinical features were not significantly different between the 2 groups. Repeated-measures analysis showed a significant decrease in IOP after trabeculectomy in both groups, with a marked decrease at day 1 after surgery. The amount of relative change at postoperative day 1 was significantly higher in the Ologen group (62.1 vs. 45.2%; p = 0.025). After this, there were no significant changes over time in IOP measurements in either group. In all the eyes, there was a significant drop in the number of antiglaucoma medications used after the surgery (p < 0.005), i.e. from 4.0 to 1.4 and from 4.3 to 1.0 in the 5-FU and Ologen groups, respectively, with no significant differences between groups (p = 0.303). Complications were few and minor in both groups. Bleb revision was needed in 2 eyes in the 5-FU group and in 4 eyes in the Ologen group. Conclusion: The efficacy and safety of trabeculectomy with 5-FU was similar to that with Ologen. Further studies with a larger number of patients and longer follow-up periods are needed.

Keywords:
Trabeculectomy, Ologen, 5-Fluorouracil, Collagen, Glaucoma
1.
Quigley HA, Buhrmann RR, West SK, Isseme I, Scudder M, Oliva MS: Long term results of glaucoma surgery among participants in an east African population survey. Br J Ophthalmol 2000;84:860-864.
2.
Cairns JE: Trabeculectomy. Preliminary report of a new method. Am J Ophthalmol 1968;66:673-679.
3.
Skuta GL, Parrish RK II: Wound healing in glaucoma filtering surgery. Surv Ophthalmol 1987;32:149-170.
4.
Liebmann JM, Ritch R: 5-Fluorouracil in glaucoma filtration surgery. Ophthalmol Clin North Am 1988;1:125-131
5.
Singh K, Mehta K, Shaikh NM, Tsai JC, Moster MR, Budenz DL, et al: Trabeculectomy with intraoperative mitomycin C versus 5-fluorouracil. Prospective randomized clinical trial. Ophthalmology 2000;107:2305-2309.
6.
Singh K, Egbert PR, Byrd S, Budenz DL, Williams AS, Decker JH, et al: Trabeculectomy with intraoperative 5-fluorouracil vs mitomycin C. Am J Ophthalmol 1997;123:48-53.
7.
Papaconstantinou D, Georgalas I, Karmiris E, Diagourtas A, Koutsandrea C, Ladas I, Apostolopoulos M, Georgopoulos G: Trabeculectomy with OloGen vs. trabeculectomy for the treatment of glaucoma: a pilot study. Acta Ophthalmol 2010;88:80-85.
8.
Sarkisian SR: A replacement for antimetabolites. Glaucoma Today 2010;8:22-24.
9.
Rao K, Ahmed I, Blake DA, Ayyala RS: New devices in glaucoma surgery. Exp Rev Ophthalmol 2009;4:491-504.
10.
Lockwood A, Brocchini S, Khaw PT: New developments in the pharmacological modulation of wound healing after glaucoma filtration surgery. Curr Opin Pharmacol 2013;13:65-71.
11.
Zelefsky JR, Hsu WC, Ritch R: Biodegradable collagen matrix implant for trabeculectomy. Exp Rev Ophthalmol 2008;3:613-617.
12.
Senthil S, Rao HL, Babu JG, Mandal AK, Garudadri CS: Comparison of outcomes of trabeculectomy with mitomycin C vs. ologen implant in primary glaucoma. Indian J Ophthalmol 2013;61:338-342.
13.
Marey HM, Mandour SS, Ellakwa AF: Subscleral trabeculectomy with mitomycin-C versus ologen for treatment of glaucoma. J Ocul Pharmacol Ther 2013;29:330-334.
14.
Mitra A: Comparison of the outcomes, complications and management of complications of trabeculectomy with ologen implant versus trabeculectomy with MMC. Glaucoma-II Free Papers, 70th AIOC Proceedings, Cochin, 2012, p 330.
15.
Maheshwari D: Comparative study of MMC augmented trabeculectomy vs. Ologen implant in open angle glaucoma. Glaucoma-II Free Papers, 70th AIOC Proceedings, Cochin, 2012, p 363.
16.
Cillino S, Di Pace F, Cillino G, Casuccio A: Biodegradable collagen matrix implant vs. mitomycin-C as an adjuvant in trabeculectomy: a 24-month, randomized clinical trial. Eye (Lond) 2011;25:1598--1606.
17.
Nilforushan N, Yadegari M, Hodjat P: Comparison of the success rate of trabeculectomy with OculusGen versus trabeculectomy with mitomycin C. Iran J Ophthalmol 2011;23:3-12.
18.
He M, Wang W, Zhang X, Huang W: Ologen implant versus mitomycin C for trabeculectomy: a systematic review and meta-analysis. PLoS One 2014;9:e85782.
19.
Papaconstantinou D, Georgalas I, Karmiris E, Diagourtas A, Koutsandrea C, et al: Trabeculectomy with OloGen versus trabeculectomy for the treatment of glaucoma: a pilot study. Acta Ophthalmol 2010;88:80-85.
20.
Rosentreter A, Schild AM, Jordan JF, Krieglstein GK, Dietlein TS: A prospective randomised trial of trabeculectomy using mitomycin C vs an ologen implant in open angle glaucoma. Eye (Lond) 2010;24:1449-1457.
21.
Petter-Puchner AH, Fortelny RH, Walder N, Mittermayr R, Ohlinger W, van Griensven M, et al: Adverse effects associated with the use of porcine cross-linked collagen implants in an experimental model of incisional hernia repair. J Surg Res 2008;145:105-110.
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2017
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