June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
The application of collagen matrix to reverse hypotony following trabeculectomy with mitomycin C
Author Affiliations & Notes
  • Jordan Safran
    Thomas Jefferson University, Philadelphia, Pennsylvania, United States
  • Jae-Chiang Wong
    Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • Daniel Lee
    Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • Footnotes
    Commercial Relationships   Jordan Safran None; Jae-Chiang Wong None; Daniel Lee None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 3711 – A0396. doi:
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      Jordan Safran, Jae-Chiang Wong, Daniel Lee; The application of collagen matrix to reverse hypotony following trabeculectomy with mitomycin C. Invest. Ophthalmol. Vis. Sci. 2022;63(7):3711 – A0396.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To assess the role of collagen matrix in reversing ocular hypotony following trabeculectomy.

Methods : This retrospective cohort study included patients who required surgical revision due to hypotony following trabeculectomy from January 2019 to October 2021. Patients with at least 3 months of follow-up post-surgery were included. Demographic and clinical data were collected at the pre-operative and post-operative visits for up to 6 months. Post-operative complications were recorded at each visit.

Surgical Technique: The conjunctiva was horizontally incised approximately 8-mm posterior to the limbus. Conjunctiva and tenon were dissected anteriorly to the limbus. The collagen matrix was placed overlying the prior trabeculectomy site. The incision was closed using an 8-0 Vicryl suture in a running fashion. All surgeries were performed by a single surgeon (DL).

Results : Of the 18 patients identified, 11 eyes of 11 patients met inclusion criteria. Mean patient age was 71.3±7.5 years and mean follow-up duration was 110.8±78.6 days (range 22-247). Eight (73%) eyes had hypotony associated with an over-filtering bleb and three (27%) were associated with cystic bleb leaks. Four (36%) eyes had prior bleb revisions which included bleb needling (2) which led to over-filtration and conjunctival advancement (1) and thermocautery (1) for cystic bleb leak. 12x1mm implants were used in five (45%) eyes and 6x2mm implants were used in six (55%) eyes. Mean IOP at the pre-operative visit, and 1-day, 1-week, 1-month, 3-month, and 6-month postoperative visits were 3.3±2.1 (n=11), 6.6±4.7 (n=11), 7.8±3.2 (n=11), 8.5±4.0 (n=10), 7.6±2.5 (n=7), 11.0±6.5 (n=4) mmHg, respectively (p<0.05 at all time points). All three bleb leak patients were noted to be seidel negative by postoperative week 1. One patient required lamellar keratoplasty for persistent corneal edema, but no additional glaucoma surgeries or medications were indicated during the follow-up period.

Conclusions : Our initial experience with collagen matrix shows promise as an effective method of reversing hypotony while maintaining therapeutic IOP levels. Additionally, it was also effective in reversing leaks associated with thin-walled cystic blebs without the need for additional tissue manipulation. No surgical failures were recorded. Our findings are consistent with previously published literature.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

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