Trabeculectomy with subconjunctival collagen implant in Indian eyes: Long-term results

Purpose: To report long-term safety and efficacy of trabeculectomy with collagen implant in Indian population. Methods: All cases of trabeculectomy with Ologen® Collagen Matrix implant performed over a 7-year period from May 2008 through April 2015 at a tertiary referral institute were reviewed. A total of 30 eyes of 28 patients were included in the study with two patients undergoing bilateral trabeculectomy. Outcomes measured included intraocular pressure (IOP) control, number of antiglaucoma medications used, bleb morphology, and complications/reoperations. Results: Trabeculectomy resulted in reduction in IOP from 36.46 to 11.65 mm Hg in the immediate postoperative period (day 1), a 68% decrease to 15.18 mm Hg at 84 months (58% decrease). The mean IOP reduction decreased over time from 63% in the first year to 55% after 5 years of follow-up. Fourteen eyes attained a follow-up of 5 years and eight eyes a follow-up of ?7 years. No sight-threatening complication such as hypotony, bleb leak, and bleb-related endophthalmitis was observed in our series, and only intervention required was 5-fluorouracil needling in one case. Conclusion: Ologen-augmented trabeculectomy is effective in controlling IOP over a long-term follow up from minimal 3 to maximal 7 years. No untoward events jeopardizing bleb safety were noted at any time. This modality is a viable alternative for patients with contraindications to use of antimetabolites.

Histopathological Evaluation of Collagen Sheet (Permacol®) after Augmentation Rhinoplasty / 대한이비인후과학회지

In Asian rhinoplasty, allograft materials are often required due to insufficient amount of autologous sources for dorsal augmentation. Nowadays, Silicon and polytetrafluoroethylene are commonly used allograft materials although these can often lead to postoperative complications such as protrusion, migration or infection of implanted graft. Permacol® is a collagen sheet which is indicated for soft tissue reinforcement or repair of the head and face area in plastic and reconstructive surgery. Its clinical safety and stability is well established with low complication rates. However, its histopathology has rarely investigated, especially in human. Thus, we reviewed histopathology of two graft-removal cases of patients who had undergone rhinoplasty using Permacol®. In conclusion, Permacol® can lead to fibrosis of imbedded tissues with or without absorption in long-term follow-up. Although Permacol® is gradually absorbed as time passes, the implanted graft can maintain its volume by replaced fibrotic connective tissues.

Quantificação da angiogênese induzida por tumor em membrana corioalantóica de embrião de galinha / Quantification of tumor-induced angiogenesis on chicken embryo chorioallantoic membrane

Angiogênese é um processo de surgimento de novos microvasos provenientes de vasos sanguíneos já existentes. O desenvolvimento tumoral e o processo de metástase são dependentes de angiogênese, pois o tumor em crescimento necessita de uma rede capilar que forneça nutrientes e oxigênio. A membrana corioalantóica de embrião de galinha (CAM) é um modelo experimental in vivo que oferece muitas vantagens, como a alta vascularização natural e alta taxa de reprodução, além de ser um modelo simples e de baixo custo. A CAM é composta por proteínas de matriz extracelular, que mimetizam o ambiente fisiológico de células cancerosas. A etapa de contagem do número total de vasos permite a determinação dos efeitos dos estímulos pró ou anti angiogênicos, portanto a padronização de um método eficaz é necessário. O presente estudo teve como objetivo geral avaliar o potencial angiogênico de células de uma linhagem de adenocarcinoma de cólon humano (HT29) e propor um método para quantificação da angiogênese induzida por células tumorais na CAM. Os embriões foram mantidos em sistema ex ovo. No oitavo dia, foram adicionados sobre a CAM, implantes de colágeno contendo células tumorais em diferentes concentrações. No décimo primeiro dia foi feito o registro fotográfico utilizando microscópio estereoscópico e foram determinados quatro scores para a quantificação e caracterização dos vasos, considerando-se se seccionavam o implante e também seu grau de ramificação. A contagem dos vasos, feita em uma área específica ao redor do implante, foi realizada após edição das imagens pelo programa Image Pro Plus. Os resultados mostraram aumento significativo do número de vasos que não seccionavam o implante para aqueles contendo 3 x 104 e 6 x 104 células. Pode-se concluir que a metodologia de contagem dos vasos, utilizando registros fotográficos e edições de imagens, é eficaz. Demonstrou-se que as células HT29 induzem a uma alteração no padrão de crescimento de novos vasos quando depositada sobre a CAM em implantes de colágeno e podem ser utilizadas como modelo experimental para se investigar o efeito de diferentes compostos sobre a angiogênese induzida por tumor.

Angiogenesis is a process of sprouting of new microvessels from existing blood vessels. The tumoral development and the metastasis process are angiogenesis dependent, because the growing tumor needs a capillaries network that provides nutrients and oxygen. The chicken chorioallantoic membrane (CAM) is an experimental in vivo model which offer many advantages, such as the high natural vascularization and high reproducibility, besides the simplicity and low cost. The CAM contains extracellular matrix proteins, which mimics the physiological cancer cell environment. The counting of the total number of vessels allows a determination of pro- and anti-angiogenic effects of different stimulus, therefore patterning an effective method is necessary. The general goal of the present study was to evaluate the angiogenic potential of a human colon adenocarcinoma cell line (HT29) and propose a method to quantify angiogenesis induced by cancer cells on the CAM. Embryos were cultivated in an ex ovo system. At the eighth day, collagen implants containing cancer cells in different concentrations were added on the top of CAM. At the eleventh day, the photographic records were made by using stereoscope microscope and were determined four scores for vessels quantification and characterization. Vessels counting were done in a specific area around the implant, and edition of the captured images were done using Image Pro Plus software. Our results showed a significant increase in vessels that do not section the implant. It was demonstrated that HT29 cells induce a change in the pattern of growth of new blood vessels when placed on CAM into collagen implants and can be used as an experimental model for investigating the effect of different compounds on tumor-induced angiogenesis.

Facelift incision and superficial musculoaponeurotic system advancement in parotidectomy: case reports / 대한악안면성형재건외과학회지

Surgical procedures for parotidectomy had been developed to gain adequate approach, prevent morbidity of nerve, and give esthetic satisfaction. We performed two cases of parotidectomy through facelift incision. One case was reconstructed with superficial musculoaponeurotic system (SMAS) flap and sternocleidomastoid (SCM) muscle rotated flap at the parotid bed. In second case, same procedures were performed, but collagen membrane was additionally implanted for prevention of Frey's syndrome. After surgery, two cases showed esthetic results without neck scar and hollow defect on parotid bed area.

Comparison of outcomes of trabeculectomy with mitomycin C vs. ologen implant in primary glaucoma.

Purpose: To compare the safety and efficacy of trabeculectomy with Ologen implant vs. trabeculectomy with Mitomycin C (MMC). Materials and Methods: In a prospective, randomized, pilot study, 39 eyes of 33 subjects with medically uncontrolled primary glaucoma, aged 18 years or above underwent trabeculectomy either with MMC (20 eyes) or with Ologen implant (19 eyes). The primary outcome measure was cumulative success probability, defined as complete if the intraocular pressure (IOP) was > 5 and ≤ 21 mm Hg without anti-glaucoma medications or additional surgery and qualified if an IOP was > 5 and ≤ 21 mm Hg with or without anti-glaucoma medications. Results: Mean (± standard deviation) follow-up in Ologen group was 19.1 ± 8.1 months, and in MMC group was 18.0 ± 8.4 months. Mean IOP reduction at 6 months was significantly lower (P = 0.01) in the MMC group (11.9 ± 2.9 mm Hg) as compared to Ologen group (14.6 ± 2.7 mm Hg). However, at 12 months (P = 0.81) and 24 months (P = 0.32), the mean IOP was similar between the 2 groups. Complete success probability at the end of 6 months in Ologen group was 100% (95% confidence interval: 59.1 - 99.0) was similar (P = 0.53) to that in MMC group (93.8%, 95% CI: 63.2 - 99.1). The incidences of early post-operative complications were similar in the 2 groups, except hyphema, which was significantly more in Ologen group (P = 0.02). Conclusion: In this pilot study, the success of trabeculectomy and complications were similar in both Ologen and MMC groups at the end of 6 months.

Long-term Results of Deep Sclerectomy with Small Collagen Implant in Korean

PURPOSE: To describe the long-term results of deep sclerectomy with collagen implant (DSCI) with or without adjuvant mitomycin C in Korean patients with primary or secondary open-angle glaucoma (OAG). METHODS: This retrospective review was comprised of 65 Korean patients who received DSCI with or without adjuvant mitomycin C due to primary or secondary OAG. Patients were followed for 72 months after surgery. Complete success was defined as intraocular pressure (IOP) <21 mmHg without medication and qualified success was defined as IOP <21 mmHg with or without medication. RESULTS: Mean postoperative follow-up period was 53.0 +/- 16.2 months. Mean IOP was 30.5 +/- 11.7 mmHg preoperatively, 8.4 +/- 4.3 mmHg at postoperative day one and 13.4 +/- 3.8 mmHg 60 months after surgery. The mean number of glaucoma medications was decreased from 3.6 +/- 1.1 to 1.6 +/- 1.3 at 60 months after the operation. Complete and qualified success rates were 36.7% and 79.6% at postoperative 60 months, respectively (Kaplan-Meier survival curve). No shallow or flat anterior chamber, endophthalmitis, or surgery-induced significant cataract was observed. CONCLUSIONS: The results of DSCI in Korean patients presented here seem reasonably excellent with qualified success rates of over 70% at six years with negligible complications.

Surgical Outcomes of Conventional Trabeculectomy Converted from Deep Sclerectomy with Collagen Implant (DSCI)

PURPOSE: To assess the surgical outcomes of the conventional trabeculectomy converted from DSCI due to a perforation of trabeculo-descemet's membrane during surgery. METHODS: We retrospectively analyzed the surgical outcomes of 9 patients (11 eyes) who underwent the conventional trabeculectomy converted from DSCI during surgery. RESULTS: The mean age of the subjects was 44.6+/-17.8 years. The types of glaucoma of the subjects were primary open angle glaucoma in nine eyes and secondary glaucoma in two eyes. The mean preoperative intraocular pressure(IOP) was 23.4+/-9.5mmHg with 3.0+/-1.2 of mean anti-glaucoma medications. The mean immediate postoperative IOP was 7.7+/-5.3mmHg and 10.5+/-3.9 mmHg with 0.5+/-0.5 of mean anti-glaucoma medications after 12.0+/-6.6 months of mean follow-up period. Defining the qualified success to be 6 to 21 mmHg of IOP with 2 or lower glaucoma medication without complications such as hypotony maculopathy, the success rate was 82%. There were four eyes (36%) having IOP below 4 mmHg and shallow anterior chamber at one day postoperatively. Two eyes of them recovered within 2 weeks, but the other two (18%) developed hypotony maculopathy. Cataract progressed in two eyes (18%). CONCLUSIONS: The surgical outcomes of conventional trabeculectomy converted from DSCI during surgery was comparable to the elective trabeculectomy, but there was a tendency to have more complications associated with hyperfiltration at the immediate postoperative period.

Five Cases of Laser Goniopuncture after Deep Sclerectomy with Collagen implant

PURPOSE: To investigate the intraocular pressure-lowering efficacy of laser goniopuncture in 5 cases after hypertrophy of the trabecular-Descemet membrane resulting from deep sclerectomy with collagen implant (DSCI). METHODS: Among the twenty-one patients (26eyes) who received DSCI, laser goniopuncture was performed in 5 patients (19%) by Nd:YAG laser at 5-10 mJ, 3 burst mode, and 2-10 times. RESULTS: Of the 5 cases who received Nd:YAG laser goniopuncture, 2 cases showed a decrease in intraocular pressure after 1 session of treatment while 3 cases resulted in increase of intraocular pressure due to anterior synechiae of the iris. The anterior synechiae were resolved by Argon and Nd:YAG laser in 1 case, peripheral iridectomy and iridoplasty in 1 case but in the third case, patient refused to receive recommended further laser treatment such as peripheral iridectomy and iridoplasty. CONCLUSIONS: In cases of increased intraocular pressure caused by hypertrophy of the trabecular-Descemet membrane after DSCI, laser goniopuncture is an effective method of treatment. However, iris prolapse and anterior synechiae may occur during the follow-up period which can be resolved by peripheral iridectomy and synechiolysis.

Surgical outcomes of deep sclerectomy with collagen implant

We evaulated the effectiveness and adverse effects of deep sclerectomy with collagen implant (DSCI), which is a kind of nonpenetrating filtering surgery. In this retrospective study, DSCI was performed in 15 eyes of 11 glaucoma patients. An trabeculo-Descemet's membrane (TDM) window is created by a deep sclerokeratectomy, and the collagen implant is placed in the sclera bed under a superficial flap (deep sclerectomy with collagen implant). In 3 of 15 eyes the DSCI was intraoperatively converted to conventional filtering surgery for a large perforation of the TDM. These eyes were not included in the results of the surgical outcomes. The mean age of the patients was 50.3 +/- 14.4 years, and the mean follow-up period was 11.1 +/- 5.9 months. A diagnosis of chronic open angle glaucoma was made in 7 eyes and a diagnosis of secondary glaucoma in 5 eyes. The mean preoperative IOP was 25.8 +/- 11.9 mmHg, the immediate postoperative IOP was 6.4 +/- 2.9 mmHg, and at the final follow-up, the IOP was 11.9 +/- 2.5 mmHg. The IOP in 5 eyes was under 6 mmHg temporarily. However, there was no serious complication such as shallow anterior chamber. DSCI is considered to be a good surgical procedure that has similar surgical outcomes to a conventional trabeculectomy without serious complications.