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Editors Selection IGR 16-4
Surgical Treatment: Wound healing
Comment by Jeffrey Liebmann on:
52014 Efficacy and safety of collagen matrix implants in phacotrabeculectomy, and comparison with mitomycin C augmented phacotrabeculetcomy at one year, Narayanaswamy A; Perera SA; Htoon HM et al., Clinical and Experimental Ophthalmology, 2013; 41: 552-560
The need for management of patients with both glaucoma and cataract is a frequent occurrence for both glaucoma subspecialists and cataract surgeons. Surgical options include: (1) Cataract surgery alone (which by itself may lower intraocular pressure to some degree); (2) Incisional glaucoma surgery first, followed by later cataract surgery; (3) Combined cataract and glaucoma surgery. Advances in 'minimally invasive' glaucoma surgery and modifications to existing glaucoma surgical techniques have increased the safety and available options for glaucoma surgery. Finally, the decision to perform glaucoma surgery at the time of cataract surgery is driven by factors such as the extent of existing glaucoma damage, number of and likely adherence to glaucoma medications, and patient age, among others. Narayanaswamy et al. have performed a well-designed pilot study to determine the efficacy of trabeculectomy with mitomycin versus trabeculectomy with a porous collagen glycoaminoglycan matrix implant (Ologen TM) at the time of cataract surgery. The study used logical outcome measures such as intraocular pressure, bleb appearance, need for postoperative manipulation, and complications. Although a trend towards better IOP reduction was present in the MMC group, this did not always reach statistical significance in the multivariable and life table analyses using different IOP endpoint criteria, perhaps because baseline intraocular were statistically different in the two groups (suggesting that the groups were different in subtle, but meaningful ways). Traditional measures of bleb appears (height, width, vascularity) favored the MMC group, but whether these parameters will predict better long-term outcomes for the MMC arm needs to be demonstrated. The authors carefully discuss their findings and acknowledge the need for a larger, prospective, randomized trial to ultimately determine which approach may provide better intraocular pressure control, visual functional outcomes, and long-term safety.
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