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    Interventional procedure overview of trabeculectomy with a biodegradable collagen matrix implant for glaucoma

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    Description of the procedure

    Indications and current treatment

    Glaucoma is usually a chronic condition associated with raised intraocular pressure (IOP). It leads to progressive damage to the optic nerve. Early stages are usually asymptomatic. But, as the condition progresses, it can cause visual impairment and, if untreated, blindness. There are several types of glaucoma but the most common type of glaucoma in the UK is primary (or chronic) open-angle glaucoma.

    NICE's guideline on glaucoma describes its diagnosis and management. Treatment usually involves eye drops containing different drugs that either reduce aqueous humour production or increase its drainage. Surgical procedures such as trabeculectomy, drainage tubes, deep sclerectomy, viscocanalostomy, laser trabeculoplasty and cyclodiode laser treatment may also be used.

    What the procedure involves

    Trabeculotomy with an adjunctive biodegradable collagen matrix aims to modify wound healing and improve the drainage of aqueous humour to lower IOP. It reduces or avoids the use of antimetabolites and antifibrotic agents (mitomycin C [MMC] and 5-fluorouracil).

    In this procedure, usually with the patient under local anaesthesia, the conjunctiva is dissected to access the sclera, and then a partial-thickness scleral flap is dissected. Within the scleral bed a full-thickness opening is created into the anterior chamber, to allow drainage of aqueous humor. Sometimes the trabecular meshwork and adjacent structures are also removed. The scleral flap is then sutured loosely with 1 or 2 loops, to allow the aqueous fluid to drain into the subconjunctival space through the scleral fistula. Viscoelastic may be injected under the scleral flap. Then a subconjunctival biodegradable collagen matric implant is placed directly on top of the scleral flap, and the conjunctiva is sutured and closed on top of it.