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OPHTHALMIC IMAGE
Year : 2022  |  Volume : 2  |  Issue : 3  |  Page : 858

A rare, idiopathic, direct side effect of the ologen implant after combined surgery: A case series of unusual, dark, and discolored ologen blebs


1 Medical Officer, Department of Glaucoma and Research, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
2 Director, Sathyan Eye Care Hospital and Coimbatore Glaucoma Foundation, Coimbatore, Tamil Nadu, India
3 Senior Medical Officer, Department of Retina, Sathyan Eye Care Hospital and Coimbatore Glaucoma Foundation, Coimbatore, Tamil Nadu, India
4 Consultant Optometrist, Department of Optometry and Visual Science, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India

Date of Web Publication16-Jul-2022

Correspondence Address:
Dr. Prasanna V Ramesh
Mahathma Eye Hospital Private Limited, No. 6, Seshapuram, Tennur, Trichy - 620 017, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_520_22

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How to cite this article:
Ramesh PV, Parthasarathi S, Sathyan P, Devadas AK, Ray P. A rare, idiopathic, direct side effect of the ologen implant after combined surgery: A case series of unusual, dark, and discolored ologen blebs. Indian J Ophthalmol Case Rep 2022;2:858

How to cite this URL:
Ramesh PV, Parthasarathi S, Sathyan P, Devadas AK, Ray P. A rare, idiopathic, direct side effect of the ologen implant after combined surgery: A case series of unusual, dark, and discolored ologen blebs. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Aug 19];2:858. Available from: https://www.ijoreports.in/text.asp?2022/2/3/858/351199



OlogenTM (biodegradable collagen matrix) implant, used to modulate the tissue repair process in trabeculectomy, is highly absorbent and completely degrades within 90–180 days after implantation.[1–3] Side effects directly attributable to Ologen reported so far are allergy, translocation and poor degradation of the implant.[4],[5] In this manuscript, we have reported a series of five cases, with discolored Ologen bleb [Figure 1] and [Figure 2]. The bleb integrity and intraocular pressure (IOP) control were good in all the cases. According to our knowledge, Ologen discoloration has never been reported in the literature.
Figure 1: Slit lamp photograph revealing the mild discoloration (red arrows) of the Ologen bleb in (a) a 62-year-old male patient, two months after combined surgery, (b) a 50-year-old female patient, three months after combined surgery, and (c) a 75-year-old male patient, two months after combined surgery

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Figure 2: Slit lamp photograph revealing the occurrence of prominent discoloration of the Ologen bleb in (a) a 67-year-old female, two months after combined surgery, and (b) a 59-year-old female, three months after combined surgery

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When encountered with such clinical scenarios, it is prudent to look at the manufacturing and expiry dates, and the circumstances in which it was handled prior to surgery. Also, further enquiries should be made to the company about the batch of the Ologen which was used for surgery. In our scenario, we did check the manufacturing dates and expiry dates of the Ologen implants used for all the five cases. The dates were perfectly fine. The circumstances in which the Ologen implant was handled in all the five cases were uneventful. The recommendation given by the company was strictly followed while handling the Ologen prior to the five surgeries.

We also did enquire to the company about the batches of the Ologen materials. The five implants were from different batches. One implant belonged to one batch (batch A), another belonged to another batch (batch B), and three implants belonged to another different batch (batch C). All the five Ologen implants did not belong to the same batch.

After expert evaluation by the manufacturers, it was concluded that oxidation of the Ologen material seemed to be the possible culprit. The postulated hypothesis for oxidation of the Ologen bleb was its reaction with the intracameral antibiotic, injected at the end of the surgery. The intracameral antibiotic probably gained access to the subconjunctival space through the ostium and may have triggered this reaction. Incidentally, in all the five cases, intracameral vigamox (Alcon Laboratories Inc., Fort Worth, Tx, USA) was used. These are commercially available moxifloxacin eye drops in a concentration of 0.5%. They were used as recommended by the manufacturer.

Ologen users should be aware of this unusual dark reaction, and need not worry while encountering it in postoperative period, as the bleb integrity and IOP control were good in all the cases. Further, histopathology report of the conjunctival tissue, and long-term characteristics of these discolored blebs would provide more insight.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Product. OlogenTM Collagen Matrix. 2017. Available from: https://ologen.com/product/. [Last accessed on 2022 Jan 17].  Back to cited text no. 1
    
2.
Yuan F, Li L, Chen X, Yan X, Wang L. Biodegradable 3D-Porous collagen matrix (Ologen) compared with mitomycin C for treatment of primary open-angle glaucoma: Results at 5 years. J Ophthalmol 2015;2015:e637537.  Back to cited text no. 2
    
3.
Rosentreter A, Gaki S, Cursiefen C, Dietlein TS. Trabeculectomy using mitomycin C versus an atelocollagen implant: Clinical results of a randomized trial and histopathologic findings. Ophthalmologica 2014;231:133-40.  Back to cited text no. 3
    
4.
Senthil S, Rao H, Babu J, Mandal A, Garudadri C. Comparison of outcomes of trabeculectomy with mitomycin C vs. ologen implant in primary glaucoma. Indian J Ophthalmol 2013;61:338-42.  Back to cited text no. 4
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5.
Zelefsky JR, Hsu W-C, Ritch R. Biodegradable collagen matrix implant for trabeculectomy. Expert Rev Ophthalmol 2008;3:613-7.  Back to cited text no. 5
    


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