Collagenoplasty in ophthalmology

Abstract

Background: Glaucoma surgical procedures are the most common cause of ocular hypotony, which can occur as a result of bleb leak or overfiltration, use of glaucoma drainage implants, or iatrogenic cyclodialysis cleft. This rare complication may be asymptomatic or lead to visual loss. Glaucoma tube erosion occurs as a late postoperative complication in 2% to 5% of eyes after glaucoma drainage device implantation. Tube exposure can lead to serious complications such as hypotony, ocular inflammation, and endophthalmitis. Therefore, the aim of  our study was to evaluate the efficacy and complications of treatment method with collagen implants according to standard surgical technique in glaucoma surgery and in ophthalmic trauma surgery.

Collagen implants combine all benefits that synthetic polimers and tissue transplants have, and devoid of negative aspects as toxicity and carcinogenicity; immunotropic and allergic activity.

Collagen implants have great potential for the treatment of damaged  tissues,  have hemostatic effect, are able to form complexes with various pharmacological agents and it can be used as a mechanical barrier  to prevent post-surgical  adhesions.

Aim: Evaluation of collagen Salvecoll use in ophthalmic surgery.

Material and methods: We used collagen Salvecoll soaked with 5FU in glaucoma surgery to prevent postoperative hypotony and bleb scarring. Salvecoll was used for antiglaucomatous surgeries such as: trabeculectomy 24, non-penetrating sclerectomy 26, implantation of mini shunt 16 (Express shunt), implantation of Ahmed valve to prevent stripping of silicone tube – tube was covered by pericard+salvecoll, sizes 6×6 mm 25; cystic bleb surgery 3; bleb fistula surgery 1.

Pericard and Collagen Salvecoll was also used for trauma surgery such as: penetrating injury of sclera 17, perforation of cornea after corneal ulcer 3. 

Observation period was from 2^nd day to 24 months.

Results: Postoperative condition in glaucoma patients was same to that after operation without salvecoll. There was performed impressive, wide filtration bleb. Postoperative hypotony was in more fewer cases. The range of postoperative IOP was from 10 to 14, 95 patients.

In cases of ocular trauma, healing process went well. The range of postoperative IOP ranged from 10 to 25. In cases of corneal perforation the eye was saved, in several cases we got vision about 0.3.

We have operated 115 patient, 115 eyes: 95 glaucoma, 17 trauma, 3 perforation of cornea.

Conclusions: using of collagen implants and pericard biorepar in ophthalmic surgery increases the efficiency of ocular surgery. Impressive, wide filtration blebs were performed and less postoperative scarring in glaucoma surgery. Additional hermetization of penetrating ocular trauma supports getting better scarring without growing additional proliferative tissues into the eye.