First Author: C.Bordeianu ROMANIA
Co Author(s):
Purpose:
Ologen is a biodegradable collagen implant intended to deceive the natural healing mechanisms which may lead to failure after glaucoma surgery. In order to obtain more rapid information on its efficiency in trabeculectomy, I did not try it in virgin cases: in such cases the success rate outpaces 90% at one year without any help and the early differences would be slight. One will have to wait for the late (4-5 years) controls to obtain significant differences. To avoid this, Ive selected only cases with scarred conjunctiva, in which failure may appear weeks-months after surgery, even when fibrogenesis inhibitors were associated. In a previous study on 18 similar cases, the complete+qualified success rate after trabeculectomy + 5FU dropped from 89,89% at 3 months, to 72.22% at 6 months and to 55.56% at 1 year. Facing such high failure risk rate, in this study Ive associated 5FU and Ologen. In this manner I hoped to obtain quicker significant results about Ologen efficiency without imposing an unnecessary risk for the patients.
Setting:
Emergency Hospital Ploiesti, ROMANIA
Methods:
22 cases with advanced glaucoma after 1-3 failed surgeries, 9 men and 13 women, 3889 years: 12 primary (7 trabecular block Gs, 5 mixed, initially pupilary block Gs) and 10 secondary Gs (8 angular neovascular, 2 aphakic). Follow up period: 18-36 months. Surgical steps: " L" shape limbal approach, traction suture on conjunctiva to prevent its retraction, subconjunctival scar ablation, trapezoidal 5/3.5 mm scleral flap, 5FU for 5-15 minutes according to the scarring process intensity, no wash, 2/1 mm trabeculectomy, peripheral iridectomy, one permanent suture in the middle of the sclaral flap and 2 Khaw releasable sutures on flap lateral sides, 3 U" sutures to close the limbal segment of the conjunctival wound, Ologen insertion through the meridional segment of the conjunctival wound, closure of this segment. Releasable suture ablation: after 10-14 days.
The suggested procedure avoids early hypotonia, when the aqueous becomes plasmoid, rich in fibrin precursors: the contact with the enzymes released from the surgically damaged cells will produce fibrin deposits. If too intense, this process may outpace Ologen scar modulation possibilities, resulting in failure. The suggested procedure allows the control of early hypertonia, too, via step by step suture release.
Results:
0m; 22; (38±4.4); 4.54%(2), 77.27%(3), 18.18%(4) //
6m; 22; (14±1.2); 21mmHg; C=86.36%; q=9.08%(1), 4.54%(2) //
18m; 22; (16±1.8); C=77.27%; q=22.72%(2) //
36m; 19; (17±2.3); C=63.15%; q=13.62%(1), 4.54%(2), 9.08%(3), one failure.
These sets of data present: under 0m the preoperative situation [lapse of time in months (m), number of cases, mean IOP ± SD, preoperative treatment intensity with 2, 3 or 4 medications], while under 6m, 18m and 36m the postoperative situation [lapse of time, number of cases, mean IOP ± SD, success criterion, complete success rate " C" , qualified success rate " q" (between parentheses the number of medications)]
Conclusions:
1. In case of iterative surgery on scarred conjunctiva, the association Ologen + 5FU produces satisfactory results. The success key consists in the association of fix and releasable sutures, which may control both early postoperative hypotonia and hypertonia. 2. The suggested manner of pressure result report after glaucoma surgery offers all necessary information for statistical interpretation in a reduced typographic space: to put in words what it was transmitted in 4 lines above would take 32 lines of 78 letters and spaces per line. 3. In any language in which the abstract be printed, its message, transmitted by generally accepted symbols, would reach its intended audience. The authors will be certain that the essence of their work would penetrate in spite of any economic, linguistic or political barriers. FINANCIAL DISCLOSURE?: No
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