EuroTimes And EyeWorld News on ologen Collagen Matrix
ologen Collagen Matrix as An Alternative to MMC And The Patch Grafts in Glaucoma Surgery
The monthly magazine of ESCRS1, EuroTimes (Vol 17; 11, Nov 2012), and the official news magazine of ASCRS2, EyeWorld (Vol 17; 9, Sept 2012), cover the news on ologen Collagen Matrix implant, featuring the interviews with Dr. Sarkisian on the applications of collagen matrix implant as a promising alternative to MMC in glaucoma surgeries. The article (EuroTimes) also provides valuable insights on the trends in the discovery of collagen matrix implant applied as ophthalmic patch grafts in recent years.
Without the chemo toxic hazard of handling and applying MMC in glaucoma surgeries, “the implant inhibits scar formation by acting as a spacer and prevents the fibroblasts from laying down in organized fashion,” said Dr. Sarkisian (EuroTimes). “I now use it in 90% of my patients,” he added. Dr. Sarkisian is glaucoma fellowship director at the Dean A McGee Eye Institute and clinical associate professor at the University of Oklahoma in Oklahoma City, USA.
The exceptions, however, may include patients with thicker Tenon’s capsules, who may require MMC in filtering surgeries due to high tendencies to scarring (EuroTimes). The surgical tips provided by Dr. Sarkisian not only point to the possibility and necessity of considering patient’s risk factors, such as secondary glaucoma or a history of failed glaucoma surgery, for surgical adjustments, but also offer guidance as to how to treat ologen patients differently from those receiving MMC, in either surgical practice or study design.
“This means not using three to seven sutures in the flap and not trying the sutures too tightly. Ologen will tamponade the flap (to prevent hypotnoy) if it is placed correctly. It is also important NOT to wait three weeks before cutting the sutures,” suggested Dr. Sarkisian (EuroTimes). An early and flexible suture lysis/ release BEFORE the timing of postoperative pressure target being reached is the secret to a better controlled surgical outcome and even less chance of having to do needling.
In the issue of EuroTimes, Dr. Sarkisian also previewed a retrospective study where he uses ologen Collagen Matrix together with the ExPress glaucoma shunt (Alcon Lab). “Trabeculectomy with the ExPress glaucoma shunt and ologen found a qualified success rate of 94.4 per cent at 12 months in 36 eyes,” he said. The results of the new glaucoma drainage device surgery seemed to be better achieved with ologen Collagen Matrix where the average postoperative pressure was 12.1 mmHg at 12 months (EuroTimes).
According to a recent review article entitled “Tube Exposure Repair” on JOCGP3 by S Oana, J Vila (2012), ologen Collagen Matrix implant serves as a biodegradable, synthetic patch graft in glaucoma drainage device (GDD) surgery and revision surgery, leaving in its wake the patient’s own connective tissue in an average of 180 days. Collagen matrix implant may be a safer and more economic alternative to the traditional autologous/heterologous donor grafts in GDD and revision surgery due to its synthetic nature. Collagen matrix implant could cost even half the price of some traditional patch grafts. (Read more about ologen CM patch graft’s CPT Code information in the US.)
Positive experiences of ologen Collagen Matrix as patch grafts in GDD surgery and revision after the erosion or exposure of the GDD’s have also been gained for the Baerveldt tube shunt (Rosentreter et al 2010; 2012) and the ExPress Shunt (B Anguelov 2012; S Vold 2011; Juan A E Campaña et al 2010*4).
More evidence needs to be collected from the cases with Ahmed Valve and Molteno Implant, especially where ologen Collagen Matrix may be used to initially cover the drainage implant tube. As with the study of collagen matrix implant with Ex-Press glaucoma shunt, “clearly this needs to be confirmed in further randomized studies with longer follow up,” Dr. Sarkisian concluded (EuroTimes).
1. European Society of Cataract and Refractive Surgery
2. American Society of Cataract and Refractive Surgery
3. Journal of Current Glaucoma Practice, the official publication of ISGS (International Society of Glaucoma Surgery)
4.* Eficacia del Implante EX-PRESS en el Tratamiento del Glaucoma Cronico de Ángulo Abierto; Departament de Cirurgia, Universitat Autònoma de Barcelona; Servicio de Oftalmología del Hospital Universitario Joan XXIII de Tarragona; Sept 2010. Abstract P697 published at 2011 WGC (World Glaucoma Congress), Paris, France.