Ologen Implant versus Mitomycin-C in Trabeculectomy: An Updated Systematic Review and Meta-Analysis
Authors: Mohammad Karam1, Abdulmalik Alsaif2, Abdullah AlRefaie3, Mohammad Alazemi3, Abdulaziz Almazyed4, Rand Alazaz5, Nahla Alkhowaiter6, Ahmed Aldubaikhi7, Marko Popovic8, Ahmad Alali9, Matthew Schlenker8. 1AlBahar Eye Center, Ibn Sina Hospital, Ministry of Health, State of Kuwait, 2Walsall Healthcare NHS Trust, West Midlands, UK, 3Farwaniya Hospital, Ministry of Health, State of Kuwait, 4Al-Amiri Hospital, Ministry of Health, State of Kuwait, 5King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia, 6College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, 7Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, 8Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada, 9Department of Ophthalmology, Jaber Al-Ahmad Armed Forces Hospital, State of Kuwait.
Author Disclosures: M. Karam: None. A. Alsaif: None. A. AlRefaie: None. M. Alazemi: None. A. Almazyed: None. R. Alazaz: None. N. Alkhowaiter: None. A. Aldubaikhi: None. M. Popovic: None. A. Alali: None. M. Schlenker: None.
Abstract Body:
Purpose: To compare the outcomes of adjuvant Ologen implant versus mitomycin-C (MMC) in patients undergoing trabeculectomy.
Study Design: Systematic Review and Meta-Analysis.
Methods: A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A search of electronic information through MEDLINE, EMBASE and Cochrane Library was conducted to identify all studies comparing adjuvant Ologen implant and MMC during trabeculectomy. Surgical success and IOP were primary outcome measures. Secondary outcome measures included reduction in glaucoma medications, best corrected visual acuity (BCVA), bleb score based on the Moorfields Bleb Grading System (MBGS) and complications. A random effects model was used for the analysis.
Results: From 4554 screened articles, 15 studies enrolling 672 eyes from 666 patients were included. There was no significant difference between the Ologen implant and MMC groups in terms of complete (odds ratio [OR] = 0.59, P = 0.25) and relative surgical success (OR = 1.34, P = 0.32). There was no significant difference between the two groups in IOP change at different time points following surgery, except at month 1 (mean difference [MD] = 1.41, P = 0.02) postoperatively, at which time the MMC group was favoured. For secondary outcomes, no statistically significant difference was noted in the reduction in glaucoma medications (MD = 0.03, P = 0.85) and change in BCVA (MD = 0.05, P = 0.36). The Ologen implant had similar results compared with MMC regarding bleb score and various complications, including conjunctival wound leaks (OR = 1.03, P = 0.94), blebitis (OR = 1.50, P = 0.63), bleb leak (OR = 0.24, P = 0.08), hypotony (OR = 0.67, P = 0.27), hyphema (OR = 1.44, P = 0.39), shallow anterior chamber (OR = 0.83, P = 0.60), anterior chamber reaction (OR = 1.10, P = 0.81), choroidal detachment (OR = 1.25, P = 0.66) and reoperation rate (OR = 0.35; P = 0.16).
Conclusions: The Ologen implant is a comparable option to MMC used in patients undergoing trabeculectomy. The Ologen implant produces similar results in terms of surgical success, post-operative IOP, reduction of glaucoma medications, BCVA and bleb scoring as well as post-operative complications at final follow-up.
