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Review
. 2018 Jan-Apr;12(1):19-28.
doi: 10.5005/jp-journals-10028-1239. Epub 2018 Mar 1.

Improving Glaucoma Surgical Outcomes with Adjunct Tools

Louise J Lu  1 , Laura Hall  2 , Ji Liu  2
Affiliations
Review

Improving Glaucoma Surgical Outcomes with Adjunct Tools

Louise J Lu et al. J Curr Glaucoma Pract. 2018 Jan-Apr.

Abstract

Conventional glaucoma surgeries, such as trabeculectomy and glaucoma drainage device (GDD) surgery, have been enhanced by surgeons to improve outcome and decrease complications. Over the last two decades, adjuncts, such as collagen matrix implants, fibrin adhesives, and amniotic membrane transplantation (AMT) have been found to be effective in modulating fibrosis and scarring during the wound-healing process, reducing postoperative inflammation, and repairing bleb leakage or conjunctival erosion. The use of these tools provides several advantages when used in trabeculectomy, GDD surgery, and surface reconstruction associated with glaucoma surgery complications. Their use will be discussed in this review. How to cite this article: Lu LJ, Hall L, Liu J. Improving Glaucoma Surgical Outcomes with Adjunct Tools. J Curr Glaucoma Pract 2018;12(1):19-28.

Keywords: Adjunct tools; Amniotic membrane; Collagen matrix implant; Fibrin adhesive; Fibrin glue; Glaucoma; Innovations; Ologen; Surgery; Trabeculectomy..

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Conflict of interest statement

Source of support: Nil Conflict of interest: All authors certify that they have no affili -ations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript

Figures

Figs 1A and B:
Figs 1A and B:
Gross appearance and electron microscopy (EM) of Ologen™ biodegradable collagen matrix implant. (A) Ologen™ disk of 6 mm in diameter × 2 mm in thickness. (B) EM photo showing type I atelocollagen biodegradable scaffold with three-dimensional porous structure. Pore diameters are between 10 and 300 μm. (Photo Credit: Aeon Astron Inc.)
Figs 2A and B:
Figs 2A and B:
Ologen implantation for trabeculectomy: (A) Schematic diagram; and (B) surgical photo of Ologen placement showing that the implant is positioned on top of the scleral flap and under the conjunctiva to exert counterpressure on the scleral flap. (Photo Credit: Aeon Astron Inc.)
Figs 3A to F:
Figs 3A to F:
Application of the fibrin glue in the glaucoma drainage implant surgery. After the GDI was secured onto the sclera, both the surgical field and patch graft were carefully dried. Fibrinogen and thrombin were applied to the sclera and the patch graft separately (A). The patch graft was then flipped over to the scleral bed to cover the tube (B). After the patch graft was positioned and secured, fibrinogen was applied to the top of the patch graft (C), followed by thrombin (D). The conjunctiva was then approximated by using forceps. Any excessive glue was removed by a surgical sponge (E). The wound was well closed without any suture (F).
Figs 4A and B:
Figs 4A and B:
Use of double-layer amniotic membranes for tube exposure repair with inadequate conjunctival tissue. The first layer of the amniotic membrane is placed above the patch graft with the epithelial side up (A). The edge of the amniotic membrane is tucked under the conjunctiva and can be secured by either sutures or fibrin glue. Then the second layer of the amniotic membrane is placed above the first layer of the amniotic membrane and surrounding conjunctiva, and secured with interrupted sutures (B).
See this image and copyright information in PMC

References

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