Ahmed Glaucoma Valve Implantation With Ologen Augmentation in Secondary Pediatric Glaucomas

Ahmed Glaucoma Valve Implantation with Ologen augmentation in secondary pediatric glaucomas: A 2-year randomized controlled trial.

Background:

The management of secondary pediatric glaucoma is challenging in terms of maintaining lifelong vision and avoiding an aggressive scarring course after surgery. Secondary Pediatric glaucoma includes a variety of ocular conditions that lead to high intraocular pressure (IOP) and progressive optic neuropathy. Glaucoma is a well-known complication of congenital cataract extraction and is the most frequent long-term complication of lensectomy with or without intraocular lens (IOL) implantation. The reported incidence in the literature is between 15% and 45%4. Another cause is aphakic glaucoma.Management of secondary pediatric glaucoma is mainly surgical, and medical therapy is used either as a temporizing measure or as an adjunctive treatment.

Traditionally, "staged approach" has been favored by many ophthalmologists. This involves starting with angle surgeries and their repetition in the case of failure, proceeding with trabeculectomy or combined trabeculotomy-trabeculectomy for refractory patients, and drainage device or cyclodestruction for very advanced patients.The poor clinical outcomes prompted surgeons to adapt glaucoma drainage devices (GDDs) as a mainstay of treatment for refractory glaucoma in both pediatric and adult populations.In children, Ahmed glaucoma valves (AGV) have greater than 80% success rate at 1- year, but success decreases to less than 50% by 5 years2. In order to improve long-term IOP control, mitomycinC (MMC) has been used as an adjuvant during implant placement. While MMC is a commonplace in trabeculectomy, its use with GDDs is controversial due to increased complications such as bleb leaks and endothelial cell damage. More recently, Ologen, a biodegradable Type-I collagen matrix, has been used in glaucoma surgeries. Ologen is safe and effective in enhancing trabeculectomy surgery in adults and children,.

Many studies have investigated the clinical benefits of Ologen for trabeculectomy. However, its benefits for Ahmed glaucoma valve implantation have not been widely investigated. Reports in adult patients have shown that Ologen may increase AGV success and decrease hypertensive phase incidence. Many studies have investigated the clinical benefits of Ologen for trabeculectomy. However, its benefits for Ahmed glaucoma valve implantation have not been widely investigated. As glaucoma drainage devices are being increasingly used for pediatric glaucoma,investigators decided to report the results and safety of Ahmed glaucoma valve (AGV) implantation in a series of secondary pediatric glaucoma as well as the clinical benefits of concomitant use Ologen as an adjuvant for for Ahmed glaucoma valve implantation .