Trabeculectomy was introduced in 1968 and is now the most common operation for the treatment of glaucoma (Yanoff M & Duker JS 2008). However, wound healing and scar formation may result in fibrosis of the bleb and obstruction of the drainage fistula, eventually leading to bleb failure (Picht G & Grehn F 1998). Hence, the inhibition of scar formation during the wound-healing process should promote greater success (Mietz H et al. 1996).
Histological studies have shown that proliferation of sub-conjunctival fibroblasts, which is believed to play an important role in bleb failure, occurs during the third to fifth post-operative day (Pescosolido N et al. 2002). Adjunctive anti-metabolites, such as 5-fluorouracil (5-FU) and mitomycin-C (MMC), are commonly used to enhance the success of trabeculectomy (Cillino S et al. 2011). However, the use of anti-metabolites increases the risks of hypotony, bleb leakage and infection (Lama PJ & Fechtner RD 2003).
Studies in animal models reported that the use of a bioengineered, biodegradable, porous collagen- glycoaminoglycan matrix implant (Ologen) in the sub-conjunctival space offers an alternative method for controlling the wound-healing process following filtration surgery, avoiding the complications of the administration of anti-fibrotic agents and offering the potential for maintaining long-term intraocular pressure (IOP) control (Chen et al. 2006).