Comparison between Mitomycin-C and Ologen Implants in the Treatment of Primary Open Glaucoma by Subscleral Trabeculectomy

Comparison between Mitomycin-C and Ologen Implants in the Treatment of Primary Open Glaucoma by Subscleral Trabeculectomy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison between Mitomycin-C and Ologen Implants in the Treatment of Primary Open Glaucoma by Subscleral Trabeculectomy Hatem Mahmoud, Anas M. Ebrahim, Mohamed Hassanein Farag, Mohamed Gaber Okasha, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3950748/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Trabeculectomy was first performed in 1968 and is currently the greatest public glaucoma management method in the world (Cairns 1968). However, scarring and wound healing can lead to bleb fibrosis and drainage fistula occlusion, which can ultimately result in bleb failure. Methods A randomized approaching comparative interventional research was directed at 45 eyes of 40 participants 25 males and 15 females with primary open-angle glaucoma (POAG), Patients were distributed into three groups, Group A (included 15 eyes) of 13 participants who went through SST with adjuvant intraoperative usage of 0.2 mg/ml MMC, Group B (included 15 eyes) of 14 participants who underwent SST with a collagen matrix implant during surgery. Group C (included 15 eyes) of 13 participants who underwent SST with both a collagen matrix implant and MMC during surgery. Results The study showed no statistically significant variances among the groups concerning age, sex, eye laterality, glaucoma type, preoperative IOP, or the quantity of topical or systemic antiglaucoma medications prescribed. Systemic carbonic anhydrase inhibitors were used by six study participants. All of the eyes of the patients underwent straightforward trabeculectomy procedures, and the study group did not experience any implant-related intraoperative issues. Conclusion Based on these findings, we hypothesize that the Ologen implant could be a secure and reliable substitute for MMC in terms of enhancing the long-term efficacy of trabeculectomy surgery while avoiding the negative consequences connected to the application of supplementary therapy, such as MMC. Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Figure 14 Background Trabeculectomy was first performed in 1968 and is currently the greatest public glaucoma management method in the world (Cairns 1968). However, scarring, and wound healing can lead to bleb fibrosis and drainage fistula occlusion, which can ultimately result in bleb failure [ 1 , 2 ]. Thus, inhibiting wound development during the wound-curative process should increase patient achievement [ 1 ]. Histological investigations have demonstrated that the proliferation of subconjunctival fibroblasts, which are thought to be a key part of bleb malfunction, happens between the third and fifth postoperative days [ 3 ]. Anterior segment optical coherence tomography (AS-OCT) is a noninvasive method that affords cross-sectional pictures of the morphology of the bleb and may help distinguish between functional and nonfunctional blebs and improve the understanding of the healing process [ 4 ]. To expand the success of trabeculectomy, antimetabolites such as mitomycin-C (MMC) and 5-fluorouracil (5-FU) are frequently consumed. Nevertheless, the usage of antimetabolites rises the risk of infection, bleb leakage, and hypotony [ 3 ]. A potential long-term intraocular pressure (IOP) regulation method as well as an alternative to the side effects accompanying the administration of antifibrotic agents and control of the wound-healing progression following filtration surgery should be developed [ 5 ]. Diverting wound healing away from the scar production decreases this biological process. Biodegradable spacers, such as porous collagen matrices, are employed in medical preparation to avoid ocular tissue union and alter fibroblast migration outlines, diverting wound healing away from the production of scars, to decrease this biological process [ 6 ]. Additional results included the amount of postoperative medication given and any issues. Scarring at the scleral flap, covering the episcleral, the internal ostium, or the conjunctiva-Tenon’s episcleral interface may increase the difficulty of maintaining long-term IOP control following trabeculectomy [ 7 ]. Surgical success rates are increased, and postoperative scarring is significantly inhibited by adjuvant antifibrotic medications such as MMC and 5-FU. The risk profile for using MMC after trabeculectomy is low, but several adverse effects, such as endophthalmitis, blebs that vascularize the bloodstream, cataract formation, and conjunctival thinning, have been documented [ 8 ]. Compared to traditional trabeculectomy, this new method demonstrated a non-inferior success rate and fewer surgical problems; nonetheless, the quantity of postoperative needling operations has increased [ 9 ]. Biodegradable tissue-engineered implants have emerged as substitutes for traditional trabeculectomy augmentation. It is possible to create structures that are strikingly similar to normal tissue by modeling tissue growth [ 10 ]. While solitary surgery improved IOP decline in the short-term follow-up, there was no discernible change in long-term follow-up IOP reduction among the two groups [ 11 , 12 , 13 ]. Numerous implants are being produced. The goal of this implantation is to stop the subconjunctival space from collapsing. In studies conducted on animals, the Ologen group was used [ 14 ]. Moreover, the biodegradable implant decreased the scarring that developed soon after surgery. A latent trial review showed no differences between postoperative IOP in the study group after trabeculectomy with ologen and in the control group after trabeculectomy without ologen [ 15 ]. Materials and methods A randomized approaching comparative interventional research was directed at 45 eyes of 40 participants 25 males and 15 females with primary open-angle glaucoma (POAG), and operations were performed at Al-Azhar University Hospitals. Indications for surgery were based on an IOP above 21 mmHg on the highest tolerated treatment. IOP levels should be decreased to decrease the threat of developing glaucoma, glaucomatous visual field loss, or abnormalities in the optic disc that suggest glaucomatous damage. Patients were distributed into three groups, Group A (included 15 eyes) of 13 participants who went through SST with adjuvant intraoperative usage of 0.2 mg/ml MMC, Group B (included 15 eyes) of 14 participants who underwent SST with a collagen matrix implant during surgery. Group C (included 15 eyes) of 13 participants who underwent SST with both a collagen matrix implant and MMC during surgery. This study conformed to the guidelines presented in the Declaration of Helsinki. Written informed agreement was gained from all patients previously they were involved in the research. This study was approved by the ethics committee of the Faculty of Medicine, Al-Azhar University, Cairo, Egypt. Informed consent was obtained from all participants The inclusion criteria: (1) were over the age of eighteen years, (2) had a POAG, (3) had insufficient IOP control (IOP) > 21 mmHg, or increasing visual field degradation on maximally accepted treatment, (4) had suggestions for surgery established on IOP values accompanying through a great possibility of development of glaucoma, glaucomatous visual field loss, or deviated in the optic disc indicative of glaucomatous injury with a lower target IOP. The exclusion criteria: (1) high-tension glaucoma,(2) clinically significant cataracts for which combined surgery was recommended, (3) congenital or juvenile glaucoma, (4) a history of prior surgical or laser methods, (5) a known allergy to MMC, (6) pregnant or nursing women (7) uncontrolled diabetes and hypertension or any extra health condition that increases the danger of side effects. Preoperative assessment: Each patient underwent a thorough ophthalmological examination and a history, and the quantity and kinds of medications used for the three months before trabeculectomy were documented. Optimal corrected visual acuity (BCVA). Before or during the procedure, there should be no history of conjunctival tissue involvement during intraocular or extraocular surgery. slit-lamp analysis. The optic disc was evaluated along with the fundus. Goldman’s applanation tonometry was used to record IOP twice on different days. Angle grading via Schaeffer's method and gonioscopy with the Goldmann 3-mirrors contact goniolens. Surgical procedure The surgical field and eyelids were sterilized with 10% betadine after all groups had received general anesthesia or peribulbar anesthesia. For the conjunctival cul-de-sac, sterile drapes were applied, and an 8/0 virgin silk corneal stay suture was used at the upper cornea, exposing the superior portion of the bulbar conjunctiva, Five percent betadine eye drops were used for this procedure (Fig. 1 ). Also Using Westcott scissors, a fornix-based conjunctival flap was fashioned. and with a number 15 blade, a rectangular half-thickness scleral flap (4 mm × 4 mm) was used dissection of a scleral flap was performed based on the limba (Fig. 2 ). In cases of MMC usage: Under the conjunctiva, beneath the scleral flap, and above it, cellulose sponges immersed in MMC (0.2 mg/ml) were applied for a duration of two minutes (Fig. 3 ), liberal use of 250 milliliters of sterile saline solution was used for MMC irrigation. In cases of Ologen usage, we implanted an Ologen 6 × 2 mm on a scleral flap (Fig. 4 ) In group C Under the conjunctiva, beneath the scleral flap, and above it, cellulose sponges saturated in MMC (0.2-2 mg/ml) were smeared for two minutes. Liberal use of 250 ml of sterile saline solution for MMC irrigation. Subsequently, a peripheral iridectomy was carried out after the surgery. Two disrupted 10 − 0 monofilament nylon sutures were used to nearby the scleral flap after it was repositioned. The scleral flap was positioned over the top of an Ologen implant, a cylinder-shaped implant, 6 mm in diameter and 2 mm in height without sutures (Fig. 5 ). Postoperative follow-up: Throughout the first year following surgery, five postoperative and follow-up visits, were performed 1 day, 1 week, 3 months, 6 months, and a year later. The Moorfields Bleb Grading System (MBGS) grade, Bleb photography, and IOP measured with a calibrated applanation tonometer were the parameters recorded. Several IOP-lowering medications if required. Complications included a lost anterior chamber, bleb-related complications, choroidal detachment, and cataract formation. Results Statistical methods When appropriate, the data are statistically described using the following terms: range, mean standard deviation (SD), median, frequency (number of cases), and percentage. Microsoft Windows, Chicago, IL, USA, version 15. For each group, preoperative data and demographic characteristics are shown. The study showed no statistically significant variances among the groups concerning age, sex, eye laterality, glaucoma type, preoperative IOP, or the quantity of topical or systemic antiglaucoma medications prescribed. Systemic carbonic anhydrase inhibitors were used by six study participants. All of the eyes of the patients underwent straightforward trabeculectomy procedures, and the study group did not experience any implant-related intraoperative issues. Postoperative evaluation: There stayed 5 postoperative and follow-up visits within 1 year of surgery: 1 day, 7 days, 90 days, 6 months, and one year after surgery. The following parameters were recorded: IOP using a calibrated Goldmann applanation tonometer Group A Table 1 Mean IOP in mmHg during 1 year of follow-up Group A Range Mean ± SD Mean difference t P-value Pre 32–45 37.47 ± 3.56 – – 1 day 6–11 9.07 ± 1.22 27.4 ± 4.2 -29.228 0.000 7 days 9–13 11.40 ± 1.18 26.1 ± 4.0 -26.922 0.000 3 months 11–15 13.13 ± 1.06 24.3 ± 4.1 -25.379 0.000 6 months 13 − 21 16.04 ± 1.49 21.4 ± 4.63 -22.480 0.000 1 year 15–18 16.13 ± 0.99 21.3 ± 3.9 -22.367 0.000 The mean preoperative IOP was 37.47 ± 3.56 mmHg in group A., The mean IOP decreased from 37.47 ± 3.56 mmHg to 9.07 ± 1.22 mmHg on a postoperative day one 11.40 ± 1.18 mmHg 7 days postoperative and 13.13 ± 1.06 mmHg 3 months postoperative, 16.04 ± 1.49 mmHg at 6 months postoperative and 16.13 ± 0.99 mmHg 1- year postoperative follow-up, there was a statistically significant variance (Table 1 , Fig. 6 ). Group B Table 2 IOP during the follow-up period. Group B Range Mean ± SD Mean difference t* P-value Pre 28–40 34.13 ± 3.36 – – 1 day 8–11 9.27 ± 0.96 24.87 ± 3.02 -27.553 0.000 7 days 10–16 12.13 ± 1.55 22.00 ± 2.85 -23.027 0.000 3 months 12–18 14.20 ± 1.74 19.93 ± 4.20 -20.400 0.000 6 months 13–21 17.4 ± 1.94 17.03 ± 4.32 -18.028 0.000 1 year 15–20 17.1 ± 1.68 17.03 ± 4.32 -16.970 0.000 The mean preoperative IOP was 34.13 ± 3.36 mmHg in group B. The mean IOP decreased from 34.13 ± 3.36 mmHg to 9.27 ± 0.96 mmHg on postoperative day one and 12.13 ± 1.55 mmHg at 7 days postoperative, 14.20 ± 1.74 mm Hg at 3 months postoperative, 17.4 ± 1.94 mmHg at 6 months postop. and 17.1 ± 1.68 mmHg 1 year postop. follow-up. There was a statistically significant variance in the mean IOP (Table 2 , Fig. 7 ). Group C Table 3 IOP during 1 year of follow-up Group C Range Mean ± SD Mean difference t P-value Pre 30–40 34.73 ± 2.82 – – 1 day 8–10 8.73 ± 0.80 26.00 ± 3.23 -34.353 0.000 7 days 10–14 11.33 ± 1.35 23.40 ± 2.85 -28.987 0.000 3 months 11–15 13.07 ± 1.44 21.67 ± 2.87 -26.494 0.000 6 months 11 − 21 16.08 ± 1.83 18.75 ± 3.26 -23.963 0.000 1 year 11–17 16.07 ± 1.83 18.67 ± 2.74 -23.802 0.000 The mean preoperative IOP was 34.73 ± 2.82 mmHg in group C. The mean IOP decreased from 34.73 ± 2.82 mmHg to 8.73 ± 0.80 mmHg on postoperative day one and 11.33 ± 1.35 mmHg at 7 days postoperative, 13.07 ± 1.44 mmHg at 3 months postop., and 13.93 ± 1.83 mmHg at 6 months postoperative and 16.08 ± 1.83 mm hg 1- year postop. follow-up. There was a statistically significant variance in the mean IOP (Table 3 , Fig. 8 ). Table 4 IOP (%) during the whole follow-up period in all groups Group A Group B Group C One-Way ANOVA Test F P-value Pre Mean ± SD 37.47 ± 3.56 34.13 ± 3.36 34.73 ± 2.82 4.455 0.018 Range 32–45 28–40 30–40 1 day Mean ± SD 9.07 ± 1.22 9.27 ± 0.96 8.73 ± 0.80 1.069 0.353 Range 6–11 8–11 8–10 7 days Mean ± SD 11.40 ± 1.18 12.13 ± 1.55 11.33 ± 1.35 1.578 0.218 Range 9–13 10–16 10–14 3 months Mean ± SD 13.13 ± 1.06 14.20 ± 1.74 13.07 ± 1.44 2.926 0.065 Range 11–15 12–18 11–15 6 months Mean ± SD 16.04 ± 1.49 17.4 ± 1.94 16.8 ± 1.83 1.885 0.161 Range 13–21 13–21 11–21 1 year Mean ± SD 16.13 ± 0.99 17.1 ± 1.68 16.07 ± 1.83 2.804 0.069 Range 15–18 15–20 11–17 Table 5 IOP % during 1 year of follow-up in all groups Group A Mean ± SD of difference Group B Mean ± SD of difference Group C Mean ± SD of difference One-Way ANOVA Test F P-value 1 day 27.4 ± 4.2 24.87 ± 3.02 26.00 ± 3.23 3.932 0.027 7 days 26.1 ± 4.0 22.00 ± 2.85 23.40 ± 2.85 6.061 0.005 3 months 24.3 ± 4.1 19.93 ± 4.20 21.67 ± 2.87 5.103 0.010 6 months 21.4 ± 4.63 17.03 ± 4.32 18.75 ± 3.26 4.252 0.021 1 year 21.3 ± 3.9 16.47 ± 4.32 20.67 ± 2.74 7.497 0.002 Table 6 Mean IOP (%) at the 1-year follow-up. Time A Mean IOP% B Mean IOP % C Mean IOP % 1 day 75.6 72.8 74.8 7 day 69.6 64.4 67.3 3 months 64.8 58.3 62.3 6 months 59.7 52.9 54.1 1 year 56.8 49.8 53.7 IOP % during the whole follow-up period in all groups, Mean IOP distribution over the follow-up period. A, B, and C also show the IOP (%) during 1 year of follow-up. In all groups, the mean IOP was calculated for 1 year of follow-up (Table 4 , 5 , 6 - Fig. 9 ). Bleb photography and grading according to (MBGS): This finding was also consistent between the bleb morphology (area, height, and vascularity) and standardized photos (Table 7 , Fig. 10 ). Central bleb area 1a: Table 7 Grading of the central bleb area according to the MBGS Grading Day 1 Day 7 Day 90 Day 180 One year A B C A B C A B C A B C A B C 1a1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1a2 11 1 0 10 0 0 9 0 0 7 0 0 2 0 0 1a3 2 6 7 3 6 6 4 5 4 6 3 3 9 1 2 1a4 2 8 8 2 9 9 2 10 11 2 12 12 4 14 13 1a5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X2 25.3 26.1 24.502 23.192 20.9 P-value 0.000 0.000 0.000 0.000 0.002 Concerning the extent of the bleb, as shown in (Table 7 , and Fig. 10 ), according to the MBGS, in the central area, on day one, there were 11 pts in group A in grades 1a2 2 pt in 1a3, and 2 pt in grade 1a4 in group B1 pt in 1a2; on 6 pt in 1a3 and 8 pt in group c, there were 7 pt in 1a3 and 8 pt in 1a4, which means that the size of the bleb was greater in the ologen groups. On day 7, there were 10 pt in 1a2 3 pt in 1a3, and 2 pt in 1a4 in group A in group B. There were 6 pt in 1a3 and 9 pt in 1a4, similar to group C. At 3 months, there were 4 pt in 1a3 and 2 pt in 1a4 in group A, while group B had 5 pt in 1a3 and 10 pt in 1a4 group c had 4 pt in 1a3 and 11 pt in 1a4 group c. At 6 months, 7 pt in 1a2, 6 pt in 1a3, and 2 pt in 1a4 Group a Group B had 3 pt in 1a3, 12 pt in 1a4, the same as Group C. At one year in the group, there was 2 pt in 1a2, 9 pt in 1a3, 4 pt in 1a4 in Group A, while the B group had 1 pt in 1a3, 14 pt in 1a4, and 2 pt in 1a3 and 13 pt in 1a4; these findings indicate that the extent of bleeding increased in the early postoperative follow-up until 3 months, as it degraded and that the extent of the MMC bleb increased. Bleb height H Table 8 Grading of bleb height according to the MBGS. Grading day 1 day 7 day 90 day 180 one year A B C A B C A B C A B C A B C H1 4 0 0 1 0 0 0 0 0 0 0 0 0 0 0 H2 10 3 2 13 2 1 3 0 0 2 0 0 0 0 0 H3 1 10 10 2 8 9 8 9 10 9 10 10 11 12 11 H4 0 2 3 0 5 5 4 6 5 4 5 5 4 3 4 X2 26.114 27.543 6.622 4.212 0.241 P-value 0.001 0.000 0.157 0.378 0.886 Regarding bleb height, as shown in (Table 8 , and Fig. 11 , ) according to the MBGS, in the central area, on day one, there were 4 participants in group A in grade H1 10 participants in H2, and 1 patient in grade H3 in group B. At H2 and 10 patients in H3 and 2 patients in H4 in group c, there were 2 patients in H2 and 10 patients in H3 and 3 patients in H4, which clinically significantly indicated that bleb height was greater in the Ologen groups. On day 7, there was 1 pt at H1 13 pt at H2, and 2 pt at H3 in group A, in group B, there was 2 pt at H2 and 8 pt at H3, and 5 pt at H4; and in group C, there was 1 pt at H2 and 9 pt at H3 and 5 pt at H4. At 3 months, there were 3 patients in H2, 8 patients in H3, and 4 patients in H4 in group A, while group B had 9 patients in H3 and 6 patients in H4, group c had 10 patients in H3 and 5 patients in H4, which were clinically insignificant. At 6 months 2 pt in H2, 9 pt in H3, and 4 pt in H4 group A, group B had 10 pt in H3, 5 pt in H4, the same as group C did not significantly differ. At one year in group A, there were 11 participants in H3, 4 participants in H4, 12 participants in group B at H3, 3 patients in H4, 11 patients in group C at H3, and 4 patients in group H4. These findings indicate that the height of the blood in the Ologen groups increased during early postoperative follow-up until 3 months. Bleb Vascularity Central Area 3a Table 9 Grading of bleb vascularity (central area) according to the MBGS Grading Day 1 Day 7 Day 90 Day 180 One year A B C A B C A B C A B C A B C 3a1 0 0 0 1 0 1 4 0 2 13 2 12 15 0 14 3a2 2 1 3 10 10 10 11 10 11 2 6 2 0 2 1 3a3 13 12 11 4 4 5 0 3 2 0 4 1 0 8 0 3a4 0 2 1 0 1 0 0 0 0 0 3 0 0 5 0 3a5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 2 3.167 3.143 6.818 22.622 42.552 P-value 0.530 0.790 0.145 0.001 0.000 As regards bleb vascularity as shown in (Table 9 , Fig. 12 ) according to MBGS the central area shows on day one there is 2 pt in group A with normal vascularization and 13 pt with mild vascularization, in group B 1 pt normal vascularization and 12 pt mild and 2 pt moderate in group C there is 3 pt normal and 11 pt mild and 1 pt moderate vascularization which clinically insignificant it means vascularization is nearly the same in all groups. On day 7, there were 10 patients with normal vascularization in 3 groups, 4 patients with mild vascularization in groups A and B, and 5 patients in group C these results were also nonsignificant. At 3 months, there were 4 participants in group A and 2 participants in group C with avascular bleeding; 11 participants in groups A and C with normal vascularization; and 10 patients in group B, and 3 participants in group A and 2 patients in group B with mild vascularization, which is clinically significant. At 6 months13 pt in group A,12 pt in group C,2 pt in group B with avascular bleb 6 pt in group A 2 pt in B with normal vascularization,4 pt in A 1 pt in B with mild and 3 pt in B moderate vascularization. At one year in group A, there were 15 patients and 14 patients in group C avascular, 1 patient in group C 2pt in group B with normal vascularization, 8 participants with mild vascularization, and 5 patients with moderate vascularization, which indicated that there were significant variances between groups A and C at 3 months to one year of follow up. (Fig. 13 , 14 ) Table 10 Incidence of subconjunctival blood after surgery. Group A Group B Group C Yes 1 2 0 No 14 13 15 Table 11 The amount of IOP-lowering medications Patient number Number of medication A 2 2 B 1 1 C 1 2 For subconjunctival blood after surgery, the p-value was 0.072, which was considered to indicate statistical significance. After 6 months, 2 patients in group A needed IOP-lowering medications to control the IOP. In group B,1 patient needed a single medication, while in group C, 1 patient needed IOP-lowering medications to control the IOP (Table 10 , 11 ). Complications Regarding complications, four patients in group A had a shallow anterior chamber, which had spontaneously changed by the end of the first week. There were also four patients with hypotony in group A. However, Groups B and C did not lead to any recorded complications, such as hypotony or shallow AC. No signs of hyphemia were recorded in any of the groups (Table 12 ). Table 12 The number of complications in all groups Group A Group B Group C Shallow AC 4 0 0 Hypotony 4 0 0 Discussion Surgical treatment for glaucoma most commonly involves SST, first performed by Cairns in 1968. Supplemental antimetabolites were utilized to improve the achievement scale of such surgery because episcleral fibrosis and subconjunctival scarring lower the achievement ratio [ 16 ]. Ologen is a wound modulator it does not inhibit the scarring process by acting as an antifibrotic agent [ 17 ]. Several reports have revealed that the usage of MMC, an antitumor antibiotic derived from streptomycin capacitors, intraoperatively significantly improves success rates and postoperative IOP control. It causes cell death by preventing DNA-dependent RNA synthesis [ 18 ]. Time and dose depend on how well it inhibits proliferation. When MMC is injected intraoperatively during glaucoma filtration surgery, patient outcomes improve, and patients at risk of failure have a lower IOP [ 19 ]. The development of cataracts, along with this [ 7 ], and to improve the outcomes of antiglaucoma surgery, additional treatments including growth factor inhibition, corticosteroids, and amniotic membranes are used [ 20 ]. Through opening sizes ranging from 10 to 300 mm, the Ologen implant is a porous material, The matrix inhibits the formation of scars and new infections while promoting better remodeling of the regenerating tissue [ 21 ]. Recently, Lommatzsch et al. reported on the usage of a collagen matrix implant as a human bevacizumab store in patients undergoing MMC trabeculectomy [ 22 ]. The usage of the Ologen implant in deep sclerotomy augmentation has been tested on human subjects. An efficient and well-tolerated technique for lowering IOP was deep sclerotomy with Ologen implantation in this work, we compared the effectiveness of adjuvant SST with MMC application versus that of the Ologen implant alone and in combination with MMC as a means of lowering the IOP and improving the bleb characteristics (area, height, and vascularity) in patients with POAG. Preoperative and postoperative IOP levels, the mean percent decrease in IOP on the first postoperative day, and the mean percent difference in IOP at 1 year were significantly different among the groups. Patients in the Ologen group had a lower mean IOP. In addition, we observed that the mean IOP in the MMC group initially decreased before gradually increasing over the progression of a one-year follow-up period. In contrast, the Ologen group's mean IOP fluctuated more stably after initially declining. Similarly, group 3 was observed. The Ologen group had a slightly lower IOP than the collective group did, according to a comparison of all the groups' IOP levels during the follow-up visits. For the three groups at 1, 3, 6, and twelve months, there were no significant differences. Surgery for trabeculectomy can account for the initial decrease in IOP in our groups. Because MMC suppresses human fibroblasts for a prolonged period but does not permanently harm them, the behavior of the IOP in this group can be explained. Over the course of a 1-year follow-up period, the study by Hatem et al. aimed to evaluate the outcomes of using Ologen versus MMC as an adjuvant treatment in SSTs. For both groups, there was no statistically significant variation in terms of preoperative IOP, type of glaucoma, number of antiglaucoma medications taken, or age. These variables also did not affect the surgical outcome. The IOP was found to be substantially lower at follow-up visits than before surgery in each group in this investigation [ 23 ]. Eosinophils can decrease infection and fix injured tissue, as evidenced by recent descriptions of them as significant regulators of local immunity and remodeling/healing in both healthiness and illness [ 24 ]. The extent of bleeding varied between groups during the entire follow-up visit in our study, with statistically significant differences. The Bleb height in the combined and Ologen groups was greater in the early postoperative phase than in the MMC group. The implanted older adults were degraded, and all the groups experienced similar bleeding heights from the 7-day to 1-year visit. A clear aqueous lake that might be a representation of aqueous flow appears to be the main cause of the bleb height in the MMC group, according to a comparison of the ASOCT images among the two groups, while the mass of the sponge appears to be the main cause in the Ologen group. In contrast to MMC blebs, Ologen blebs do not appear to have a clear aqueous lake, but there may be aqueous pockets somewhere, probably inside the implant's body. Owing to its three-dimensional porous nature, the Ologen implant has the potential to function as a physical scaffold, serving as a reservoir for the surrounding water. Yuan et al. when observed and scored the blebs using the Indiana Bleb Appearance Grading Scale (IBAGS). The blebs were also observed in two groups. Since the bleb heights in both groups were similar from the 14-day to 5-year visits. After three months, the two groups of patients had significantly different vascularities [ 25 ]. In this study, one of the main issues associated with MMCs on blebs was that the blebs were significantly more avascular in the MMC and combined groups than in the Ologen group (P = 0.001) By comparing the blebs of eyes with the Ologen implant without MMC to those of eyes treated with intraoperative MMC with or without ologen, we determine that the usage of an Ologen implant in SST is equivalent to the usage of MMC from three months to one year, and there were statistically significant variances in vascularity among all groups in follow-up visits. In the MMC group, filtering blebs frequently had noticeable avascular zones, and, after 6 and 12 months, the conjunctiva thinned. This complication was described by Rosentreter et al. Three months after the operation, a single filtering bleb from the MMC group revealed a noticeable avascular zone with leakage that needed to be corrected. No avascular regions were visible in the filtering blebs of the Ologen group. Following surgery, there was no discernible change in the corkscrew vessels. In addition, compared to blebs from the Ologen group, MMC blebs had noticeably more avascular regions. One to twelve months after surgery, a noteworthy distinction was observed. A more pronounced and avascular filtration was observed overall for the filtering blebs of the MMC group. Ologen has not been linked to an increased risk of complications, according to other studies [ 26 ]. There were no potential-specific side effects, such as allergies or implant translocations, that we could find in our study during postoperative follow-up visits Notably, in the MMC group, hypotony was highly prevalent in the early postoperative period (less than 7 days). 4 out of 15 instances. There were no discernible differences of any kind among the three groups. In the combined or Ologen groups, there was no hypotony one week after surgery. Rosentreter et al. stated the onset of endophthalmitis in one patient with Ologen implantation and trabeculectomy. However, in these cases, we looked at, no such issue [ 21 ]. The two groups of patients had comparable rates of postoperative complications, preventing any distinctions between the two adjuvants from being identified [ 27 ]. Hatem et al. discovered that throughout the follow-up period, the use of a shallow anterior chamber with MMC caused greater problems in 4 patients than in 2 patients. Additionally, there was one instance of blebitis in the MMC group and none in the Ologen group. There was also one case of bleb leakage in the MMC group and none in the Ologen group. As we discovered in our study, the group did not have any problems during the follow-up period that were related to the use of Ologen [ 23 ]. Rosenteter et al. found no evidence of any potential OOEs, such as allergies or implant translocations; however, hypotony was prevalent in the early postoperative phase, occurring seven days after surgery, in the Ologen group. However, only 20% of patients had a shallow anterior chamber. There was no discernible difference between the MMC and Ologen groups. One week after surgery, the Ologen patients showed no signs of hypotony, while 30% of the patients in the MMC group showed signs of hypotony. Tenon's cysts developed in two of the Ologen group patients four weeks after surgery, necessitating needling. Surgical resection was required in the MMC group due to a significant bleb cyst and a subsequent late leakage in one of the patients. Conclusion Based on these findings, we hypothesize that the Ologen implant could be a secure and reliable substitute for MMC in terms of enhancing the long-term efficacy of trabeculectomy surgery while avoiding the negative consequences connected to the application of supplementary therapy, such as MMC. For example, the Ologen implant might be recommended when antimetabolite-related dangers must be minimized. It might also be helpful in circumstances requiring IOP lowering and optimal safety. To enhance the functional outcome, additional adjustments to the size of the Ologen implant, surgical method, and molecular makeup will be needed Abbreviations AS-OCT: Anterior segment optical coherence tomography MMC: Mitomycin C 5-FU: 5-fluorouracil IOP: Intraocular pressure POAG: Primary open-angle glaucoma IBAGS: The Indiana Bleb Appearance Grading Scale SST: Subscleral trabeculectomy MBGS: Moorfields bleb grading system Declarations Acknowledgment The authors would like to thank their university hospital, doctors, nurses, and staff who took care of the patients during treatment. Furthermore, they would like to thank their patients who voluntarily contributed to our study. Author contributions The study was designed by AE and HM. The data were collected by AE. The data were analyzed by MH and MG. Manuscript drafting was accomplished by AE and NM. Manuscript revision was accomplished by AM. The integrity of the data was assessed via AG and MA. All the authors drafted and reviewed the manuscript. All authors read and approved the final manuscript Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Availability of Data and Materials All data generated or analyzed during this study are included in this published article. Ethics approval and consent to participate This study conformed to the guidelines presented in the Declaration of Helsinki. Written informed agreement was gained from all patients previously they were involved in the research. This study was approved by the ethics committee of the Faculty of Medicine, Al-Azhar University, Cairo, Egypt. Written informed consent was obtained from all participants Consent for publication Not applicable. Competing interests The authors declare no competing interests References Skuta GL, Parrish RK. wound healing in glaucoma filtering surgery. 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Trabeculectomy with Mitomycin-C: Outcomes and risk factors for failure in phakic open- angle glaucoma. Ophthalmology. 2006;113(6):930–936. https://doi.org/10.1016/j.ophtha.2006.01.062 Article PubMed Google Scholar Siriwardena D, Khaw PT, King AJ, Donaldson ML, Overton BM, Migdal C Cordeiro, MF. Human antitransforming growth factor beta (2) monoclonal antibody– a new modulator of wound healing in trabeculectomy: a randomized placebo controlled clinical study. Ophthalmology. 2002; 109(3):427–431. https://doi.org/10.1016/s0161-6420(01)00997-6 . Article PubMed Google Scholar Rosenteter A, Schild AM, Jordan JF, Krieglstein GK, Dietlein TS. A prospective randomised trial of trabeculectomy using mitomycin C vs an Ologen implant in open angle glaucoma. Eye 2010; 24(9):1449–1457. https://doi.org/10.1038/eye.2010.106 . Article PubMed Google Scholar Lommatzsch C, Heinz C, Rothaus K, Koch JM. Trabeculectomy with Collagen Matrix Implant as Bevacizumab Depot: Clinical Results on Efficacy and Safety. Klin. Monatsblatter Augenheilkd. 2020;237(1):62–70. doi: 10.1055/a-0748-8915 . https://doi.org/10.1055/a-0748-8915 Article PubMed Google Scholar Hatem M. Marey, Sameh S. Mandour, Amin F. Ellakwa. Journal of ocular pharmacology and therapeutic. 2013; Volume 29, Number 3. https://doi.org/10.1089/jop.2012.0120 Article PubMed Google Scholar Coden ME, Berdnikovs S. Eosinophils in wound healing and epithelial remodeling: Is coagulation a missing link?. J Leukoc Biol. 2020;108(1):93–103. https://doi.org/10.1002/JLB.3MR0120-390R . Article PubMed Google Scholar Yuan F, Lei L, Xiuping C, Xiang Y, Liyang W. Biodegradable 3D-Porous Collagen Matrix (Ologen) Compared with Mitomycin C for Treatment of Primary Open-Angle Glaucoma: results at 5 years. J Ophthalmol. 2015:2015:637537. https://doi.org/10.1155/2015/637537 Article PubMed Google Scholar Harizman N, Du J, Tai TY. A prospective randomized trial of Ahmed glaucoma drainage device implantation with or without Ologen collagen matrix. Ophthalmol Glaucoma. 2021;4(4):421–426. https://doi.org/10.1016/j.ogla.2020.12.005 Article PubMed Google Scholar Cillino S, Di Pace F, Casuccio A, Cillino G, Lodato G. Deep sclerectomy vs trabeculectomy with low-dosage mitomycin C: four-year follow-up. Ophthalmologica 2008; 222(2): 81–87. https://doi.org/10.1159/000112623 Article PubMed Google Scholar Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3950748","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":273085430,"identity":"f3141155-eaa9-47c6-a424-a62d2569704d","order_by":0,"name":"Hatem Mahmoud","email":"","orcid":"","institution":"Al Azhar University","correspondingAuthor":false,"prefix":"","firstName":"Hatem","middleName":"","lastName":"Mahmoud","suffix":""},{"id":273085431,"identity":"283ffd91-6f5d-4c1d-a305-b6dac8426980","order_by":1,"name":"Anas M. Ebrahim","email":"","orcid":"","institution":"Al Azhar University","correspondingAuthor":false,"prefix":"","firstName":"Anas","middleName":"M.","lastName":"Ebrahim","suffix":""},{"id":273085432,"identity":"794942f7-83e6-4106-b9d6-170bc3d35350","order_by":2,"name":"Mohamed Hassanein Farag","email":"","orcid":"","institution":"Al Azhar University","correspondingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"Hassanein","lastName":"Farag","suffix":""},{"id":273085433,"identity":"f1a4cf9b-2ab7-4b48-a668-cb0d4f1f294a","order_by":3,"name":"Mohamed Gaber Okasha","email":"","orcid":"","institution":"Al Azhar University","correspondingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"Gaber","lastName":"Okasha","suffix":""},{"id":273085434,"identity":"dc4a4b4b-d538-42bd-9493-bccdae6bdf7c","order_by":4,"name":"Ahmed A. 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Elsayed","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA70lEQVRIiWNgGAWjYHACNiBmZmCQYGw88AHEZSdBS8PBGSAuM/FaGBgO8zBA2HgB/+zmZ49uVFjnARkNh21+bZPnY2Zg/PAxB7cWiTvHzI1zzqQXS9w52HA4t++2YRszA7PkzG14rLmRYCad23Y4seFGIlBLz21GoBY2Zl48WuRvpH+Tzv13OHE+SItlz217gloMbuQAbWk4nLgBpIXhx+1EgloMb+SUSeccS0/cCPTLwd6G28ltzIzNeP0idyN9m3ROjXXivNvtDx/8+HPbdn5788EPH/F5HwUwtoHJBmLVg8AfUhSPglEwCkbBSAEAdE1ZusjlZyAAAAAASUVORK5CYII=","orcid":"","institution":"Al Azhar University","correspondingAuthor":true,"prefix":"","firstName":"Ahmed","middleName":"N.","lastName":"Elsayed","suffix":""}],"badges":[],"createdAt":"2024-02-12 10:30:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3950748/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3950748/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":51237924,"identity":"56a82112-dba6-4ddf-8b09-f5cd5b7dface","added_by":"auto","created_at":"2024-02-16 16:47:17","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":118026,"visible":true,"origin":"","legend":"\u003cp\u003eCorneal stay suturing was performed via virgin silk suture at the upper cornea.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3950748/v1/a209efed5faed52cf14f8bc9.jpeg"},{"id":51237925,"identity":"99fbe078-adce-400c-8fed-2766cadde7cb","added_by":"auto","created_at":"2024-02-16 16:47:17","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":156028,"visible":true,"origin":"","legend":"\u003cp\u003ePicture \u003cstrong\u003eA\u003c/strong\u003e Using Westcott scissors, a fornix-based conjunctival flap was fashioned. Picture \u003cstrong\u003eB \u003c/strong\u003eUsing the number 15 blade, fashion a rectangular half-thickness scleral flap (4 mm × 4 mm). Dissection of a scleral flap was performed based on the limba.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3950748/v1/e0cf7de940dcf4179258a6b0.jpeg"},{"id":51238798,"identity":"48438a47-a00d-4dee-8062-24a28a45b228","added_by":"auto","created_at":"2024-02-16 16:55:17","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":112196,"visible":true,"origin":"","legend":"\u003cp\u003eApplication of MMC\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3950748/v1/d09b556e008925fcb4a7b6b3.jpeg"},{"id":51237931,"identity":"9c14f729-4e17-4c83-90ef-0413bf56a18f","added_by":"auto","created_at":"2024-02-16 16:47:17","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":139790,"visible":true,"origin":"","legend":"\u003cp\u003eOlogen implantation, An Ologen 6 × 2 mm implant was applied to the scleral flap\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3950748/v1/958b0a7e8ec4c7c55bb2a5e6.jpeg"},{"id":51237929,"identity":"2fbd0952-a2c0-402b-95c1-03131d6c7d25","added_by":"auto","created_at":"2024-02-16 16:47:17","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":141566,"visible":true,"origin":"","legend":"\u003cp\u003eSuturing the scleral flap\u003c/p\u003e","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3950748/v1/3059159284d25e13855057bf.jpeg"},{"id":51237926,"identity":"d7f6ecfa-54f0-4a9e-b422-710675f82d20","added_by":"auto","created_at":"2024-02-16 16:47:17","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":4692,"visible":true,"origin":"","legend":"\u003cp\u003eMean IOP distribution over the follow-up period.\u003c/p\u003e","description":"","filename":"Figure6.png","url":"https://assets-eu.researchsquare.com/files/rs-3950748/v1/d405827a399245e430f10425.png"},{"id":51239236,"identity":"725b0795-4a62-4019-85b6-39ef3f916fa5","added_by":"auto","created_at":"2024-02-16 17:03:17","extension":"jpeg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":108044,"visible":true,"origin":"","legend":"\u003cp\u003eMean IOP distribution during the follow-up period\u003c/p\u003e","description":"","filename":"floatimage7.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3950748/v1/be09dac834a5fd391239c151.jpeg"},{"id":51238800,"identity":"f98537b9-5630-4563-bb83-c8e2200d1da2","added_by":"auto","created_at":"2024-02-16 16:55:17","extension":"jpeg","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":129855,"visible":true,"origin":"","legend":"\u003cp\u003eMean IOP distribution during the follow-up period\u003c/p\u003e","description":"","filename":"floatimage8.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3950748/v1/96dbaa6f6361a1f9972a9014.jpeg"},{"id":51237937,"identity":"1a2b2bce-2c0c-4ea1-b89d-12243bae05e0","added_by":"auto","created_at":"2024-02-16 16:47:17","extension":"jpeg","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":167128,"visible":true,"origin":"","legend":"\u003cp\u003eMean IOP distribution during the follow-up period in all groups\u003c/p\u003e","description":"","filename":"floatimage9.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3950748/v1/80d1d5ff97727120ddbfd627.jpeg"},{"id":51237930,"identity":"add2456f-13f3-41ea-b512-7ce405c53bf1","added_by":"auto","created_at":"2024-02-16 16:47:17","extension":"jpeg","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":109305,"visible":true,"origin":"","legend":"\u003cp\u003ePhotographic grading of the central bleb area according to the MBGS\u003c/p\u003e","description":"","filename":"floatimage10.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3950748/v1/001a56b1a6227557fb07b409.jpeg"},{"id":51237933,"identity":"2d25b838-ee02-4699-a69e-bbeb067f64c5","added_by":"auto","created_at":"2024-02-16 16:47:17","extension":"png","order_by":11,"title":"Figure 11","display":"","copyAsset":false,"role":"figure","size":132057,"visible":true,"origin":"","legend":"\u003cp\u003ePhotographic grading of bleb height according to the MBGS.\u003c/p\u003e","description":"","filename":"floatimage11.png","url":"https://assets-eu.researchsquare.com/files/rs-3950748/v1/9f3aab0c35d01a3065a8ee0c.png"},{"id":51237932,"identity":"bfb0a937-67fe-4f64-9ed3-020feaa385d4","added_by":"auto","created_at":"2024-02-16 16:47:17","extension":"png","order_by":12,"title":"Figure 12","display":"","copyAsset":false,"role":"figure","size":124052,"visible":true,"origin":"","legend":"\u003cp\u003ePhotographic grading of bleb vascularity according to the MBGS.\u003c/p\u003e","description":"","filename":"floatimage12.png","url":"https://assets-eu.researchsquare.com/files/rs-3950748/v1/0878eef8b345883b656ce943.png"},{"id":51239237,"identity":"e40e0322-c69b-40bc-8089-927fa02171a2","added_by":"auto","created_at":"2024-02-16 17:03:17","extension":"jpeg","order_by":13,"title":"Figure 13","display":"","copyAsset":false,"role":"figure","size":156604,"visible":true,"origin":"","legend":"\u003cp\u003eOne-day postoperative photograph following trabeculectomy in all groups\u003c/p\u003e","description":"","filename":"floatimage13.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3950748/v1/774f0d436c68070aefc57390.jpeg"},{"id":51237934,"identity":"c309a9ab-8e30-4c7a-a923-893389ed740c","added_by":"auto","created_at":"2024-02-16 16:47:17","extension":"jpeg","order_by":14,"title":"Figure 14","display":"","copyAsset":false,"role":"figure","size":139477,"visible":true,"origin":"","legend":"\u003cp\u003eThe bleb images at 1 year after surgery in all groups\u003c/p\u003e","description":"","filename":"floatimage14.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3950748/v1/29a99e67ae663ebf1a3ae042.jpeg"},{"id":51419243,"identity":"341f61c9-5064-4451-9c10-3c139d9f043f","added_by":"auto","created_at":"2024-02-21 08:36:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1156469,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3950748/v1/3536bcee-ce49-46af-93cf-e39bfc12ef25.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison between Mitomycin-C and Ologen Implants in the Treatment of Primary Open Glaucoma by Subscleral Trabeculectomy","fulltext":[{"header":"Background","content":"\u003cp\u003eTrabeculectomy was first performed in 1968 and is currently the greatest public glaucoma management method in the world (Cairns 1968). However, scarring, and wound healing can lead to bleb fibrosis and drainage fistula occlusion, which can ultimately result in bleb failure [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThus, inhibiting wound development during the wound-curative process should increase patient achievement [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Histological investigations have demonstrated that the proliferation of subconjunctival fibroblasts, which are thought to be a key part of bleb malfunction, happens between the third and fifth postoperative days [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Anterior segment optical coherence tomography (AS-OCT) is a noninvasive method that affords cross-sectional pictures of the morphology of the bleb and may help distinguish between functional and nonfunctional blebs and improve the understanding of the healing process [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo expand the success of trabeculectomy, antimetabolites such as mitomycin-C (MMC) and 5-fluorouracil (5-FU) are frequently consumed. Nevertheless, the usage of antimetabolites rises the risk of infection, bleb leakage, and hypotony [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. A potential long-term intraocular pressure (IOP) regulation method as well as an alternative to the side effects accompanying the administration of antifibrotic agents and control of the wound-healing progression following filtration surgery should be developed [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDiverting wound healing away from the scar production decreases this biological process. Biodegradable spacers, such as porous collagen matrices, are employed in medical preparation to avoid ocular tissue union and alter fibroblast migration outlines, diverting wound healing away from the production of scars, to decrease this biological process [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdditional results included the amount of postoperative medication given and any issues. Scarring at the scleral flap, covering the episcleral, the internal ostium, or the conjunctiva-Tenon\u0026rsquo;s episcleral interface may increase the difficulty of maintaining long-term IOP control following trabeculectomy [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSurgical success rates are increased, and postoperative scarring is significantly inhibited by adjuvant antifibrotic medications such as MMC and 5-FU. The risk profile for using MMC after trabeculectomy is low, but several adverse effects, such as endophthalmitis, blebs that vascularize the bloodstream, cataract formation, and conjunctival thinning, have been documented [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Compared to traditional trabeculectomy, this new method demonstrated a non-inferior success rate and fewer surgical problems; nonetheless, the quantity of postoperative needling operations has increased [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBiodegradable tissue-engineered implants have emerged as substitutes for traditional trabeculectomy augmentation. It is possible to create structures that are strikingly similar to normal tissue by modeling tissue growth [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. While solitary surgery improved IOP decline in the short-term follow-up, there was no discernible change in long-term follow-up IOP reduction among the two groups [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNumerous implants are being produced. The goal of this implantation is to stop the subconjunctival space from collapsing. In studies conducted on animals, the Ologen group was used [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Moreover, the biodegradable implant decreased the scarring that developed soon after surgery. A latent trial review showed no differences between postoperative IOP in the study group after trabeculectomy with ologen and in the control group after trabeculectomy without ologen [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eA randomized approaching comparative interventional research was directed at 45 eyes of 40 participants 25 males and 15 females with primary open-angle glaucoma (POAG), and operations were performed at Al-Azhar University Hospitals. Indications for surgery were based on an IOP above 21 mmHg on the highest tolerated treatment. IOP levels should be decreased to decrease the threat of developing glaucoma, glaucomatous visual field loss, or abnormalities in the optic disc that suggest glaucomatous damage. Patients were distributed into three groups, Group A (included 15 eyes) of 13 participants who went through SST with adjuvant intraoperative usage of 0.2 mg/ml MMC, Group B (included 15 eyes) of 14 participants who underwent SST with a collagen matrix implant during surgery. Group C (included 15 eyes) of 13 participants who underwent SST with both a collagen matrix implant and MMC during surgery. This study conformed to the guidelines presented in the Declaration of Helsinki. Written informed agreement was gained from all patients previously they were involved in the research. This study was approved by the ethics committee of the Faculty of Medicine, Al-Azhar University, Cairo, Egypt. Informed consent was obtained from all participants\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria: (1) were over the age of eighteen years, (2) had a POAG, (3) had insufficient IOP control (IOP)\u0026thinsp;\u0026gt;\u0026thinsp;21 mmHg, or increasing visual field degradation on maximally accepted treatment, (4) had suggestions for surgery established on IOP values accompanying through a great possibility of development of glaucoma, glaucomatous visual field loss, or deviated in the optic disc indicative of glaucomatous injury with a lower target IOP.\u003c/p\u003e\n\u003cp\u003eThe exclusion criteria: (1) high-tension glaucoma,(2) clinically significant cataracts for which combined surgery was recommended, (3) congenital or juvenile glaucoma, (4) a history of prior surgical or laser methods, (5) a known allergy to MMC, (6) pregnant or nursing women (7) uncontrolled diabetes and hypertension or any extra health condition that increases the danger of side effects.\u003c/p\u003e\n\u003cp\u003ePreoperative assessment: Each patient underwent a thorough ophthalmological examination and a history, and the quantity and kinds of medications used for the three months before trabeculectomy were documented. Optimal corrected visual acuity (BCVA). Before or during the procedure, there should be no history of conjunctival tissue involvement during intraocular or extraocular surgery. slit-lamp analysis. The optic disc was evaluated along with the fundus. Goldman\u0026rsquo;s applanation tonometry was used to record IOP twice on different days. Angle grading via Schaeffer's method and gonioscopy with the Goldmann 3-mirrors contact goniolens.\u003c/p\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003eSurgical procedure\u003c/h2\u003e\n\u003cp\u003eThe surgical field and eyelids were sterilized with 10% betadine after all groups had received general anesthesia or peribulbar anesthesia. For the conjunctival cul-de-sac, sterile drapes were applied, and an 8/0 virgin silk corneal stay suture was used at the upper cornea, exposing the superior portion of the bulbar conjunctiva, Five percent betadine eye drops were used for this procedure (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Also Using Westcott scissors, a fornix-based conjunctival flap was fashioned. and with a number 15 blade, a rectangular half-thickness scleral flap (4 mm \u0026times; 4 mm) was used dissection of a scleral flap was performed based on the limba (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eIn cases of MMC usage:\u003c/p\u003e\n\u003cp\u003eUnder the conjunctiva, beneath the scleral flap, and above it, cellulose sponges immersed in MMC (0.2 mg/ml) were applied for a duration of two minutes (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e), liberal use of 250 milliliters of sterile saline solution was used for MMC irrigation.\u003c/p\u003e\n\u003cp\u003eIn cases of Ologen usage, we implanted an Ologen 6 \u0026times; 2 mm on a scleral flap (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\n\u003cp\u003eIn group C\u003c/p\u003e\n\u003cp\u003eUnder the conjunctiva, beneath the scleral flap, and above it, cellulose sponges saturated in MMC (0.2-2 mg/ml) were smeared for two minutes. Liberal use of 250 ml of sterile saline solution for MMC irrigation. Subsequently, a peripheral iridectomy was carried out after the surgery. Two disrupted 10\u0026thinsp;\u0026minus;\u0026thinsp;0 monofilament nylon sutures were used to nearby the scleral flap after it was repositioned. The scleral flap was positioned over the top of an Ologen implant, a cylinder-shaped implant, 6 mm in diameter and 2 mm in height without sutures (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003ePostoperative follow-up: Throughout the first year following surgery, five postoperative and follow-up visits, were performed 1 day, 1 week, 3 months, 6 months, and a year later. The Moorfields Bleb Grading System (MBGS) grade, Bleb photography, and IOP measured with a calibrated applanation tonometer were the parameters recorded. Several IOP-lowering medications if required. Complications included a lost anterior chamber, bleb-related complications, choroidal detachment, and cataract formation.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n\u003ch2\u003eStatistical methods\u003c/h2\u003e\n\u003cp\u003eWhen appropriate, the data are statistically described using the following terms: range, mean standard deviation (SD), median, frequency (number of cases), and percentage. Microsoft Windows, Chicago, IL, USA, version 15. For each group, preoperative data and demographic characteristics are shown. The study showed no statistically significant variances among the groups concerning age, sex, eye laterality, glaucoma type, preoperative IOP, or the quantity of topical or systemic antiglaucoma medications prescribed. Systemic carbonic anhydrase inhibitors were used by six study participants. All of the eyes of the patients underwent straightforward trabeculectomy procedures, and the study group did not experience any implant-related intraoperative issues.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n\u003ch2\u003ePostoperative evaluation:\u003c/h2\u003e\n\u003cp\u003eThere stayed 5 postoperative and follow-up visits within 1 year of surgery: 1 day, 7 days, 90 days, 6 months, and one year after surgery. The following parameters were recorded: IOP using a calibrated Goldmann applanation tonometer\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n\u003ch2\u003eGroup A\u003c/h2\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eMean IOP in mmHg during 1 year of follow-up\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGroup A\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eRange\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMean difference\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003et\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP-value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePre\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32\u0026ndash;45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e37.47\u0026thinsp;\u0026plusmn;\u0026thinsp;3.56\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ndash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ndash;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 day\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u0026ndash;11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e9.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e27.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-29.228\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7 days\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u0026ndash;13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e11.40\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e26.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-26.922\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u0026ndash;15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e13.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e24.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-25.379\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13 \u0026minus;\u0026thinsp;21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e16.04\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e21.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.63\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-22.480\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 year\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15\u0026ndash;18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e16.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e21.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-22.367\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe mean preoperative IOP was 37.47\u0026thinsp;\u0026plusmn;\u0026thinsp;3.56 mmHg in group A., The mean IOP decreased from 37.47\u0026thinsp;\u0026plusmn;\u0026thinsp;3.56 mmHg to 9.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22 mmHg on a postoperative day one 11.40\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18 mmHg 7 days postoperative and 13.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06 mmHg 3 months postoperative, 16.04\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49 mmHg at 6 months postoperative and 16.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99 mmHg 1- year postoperative follow-up, there was a statistically significant variance (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003eGroup B\u003c/h2\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eIOP during the follow-up period.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGroup B\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eRange\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMean difference\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003et*\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP-value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePre\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28\u0026ndash;40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e34.13\u0026thinsp;\u0026plusmn;\u0026thinsp;3.36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ndash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ndash;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 day\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8\u0026ndash;11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e9.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e24.87\u0026thinsp;\u0026plusmn;\u0026thinsp;3.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-27.553\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7 days\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u0026ndash;16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e12.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e22.00\u0026thinsp;\u0026plusmn;\u0026thinsp;2.85\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-23.027\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12\u0026ndash;18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e14.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e19.93\u0026thinsp;\u0026plusmn;\u0026thinsp;4.20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-20.400\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13\u0026ndash;21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e17.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.94\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e17.03\u0026thinsp;\u0026plusmn;\u0026thinsp;4.32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-18.028\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 year\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15\u0026ndash;20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e17.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e17.03\u0026thinsp;\u0026plusmn;\u0026thinsp;4.32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-16.970\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe mean preoperative IOP was 34.13\u0026thinsp;\u0026plusmn;\u0026thinsp;3.36 mmHg in group B. The mean IOP decreased from 34.13\u0026thinsp;\u0026plusmn;\u0026thinsp;3.36 mmHg to 9.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96 mmHg on postoperative day one and 12.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.55 mmHg at 7 days postoperative, 14.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74 mm Hg at 3 months postoperative, 17.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.94 mmHg at 6 months postop. and 17.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.68 mmHg 1 year postop. follow-up. There was a statistically significant variance in the mean IOP (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\n\u003ch2\u003eGroup C\u003c/h2\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eIOP during 1 year of follow-up\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGroup C\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eRange\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMean difference\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003et\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP-value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePre\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30\u0026ndash;40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e34.73\u0026thinsp;\u0026plusmn;\u0026thinsp;2.82\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ndash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ndash;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 day\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8\u0026ndash;10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e8.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e26.00\u0026thinsp;\u0026plusmn;\u0026thinsp;3.23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-34.353\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7 days\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u0026ndash;14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e11.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e23.40\u0026thinsp;\u0026plusmn;\u0026thinsp;2.85\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-28.987\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u0026ndash;15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e13.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e21.67\u0026thinsp;\u0026plusmn;\u0026thinsp;2.87\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-26.494\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11 \u0026minus;\u0026thinsp;21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e16.08\u0026thinsp;\u0026plusmn;\u0026thinsp;1.83\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e18.75\u0026thinsp;\u0026plusmn;\u0026thinsp;3.26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-23.963\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 year\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u0026ndash;17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e16.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.83\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e18.67\u0026thinsp;\u0026plusmn;\u0026thinsp;2.74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-23.802\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe mean preoperative IOP was 34.73\u0026thinsp;\u0026plusmn;\u0026thinsp;2.82 mmHg in group C. The mean IOP decreased from 34.73\u0026thinsp;\u0026plusmn;\u0026thinsp;2.82 mmHg to 8.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80 mmHg on postoperative day one and 11.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.35 mmHg at 7 days postoperative, 13.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.44 mmHg at 3 months postop., and 13.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.83 mmHg at 6 months postoperative and 16.08\u0026thinsp;\u0026plusmn;\u0026thinsp;1.83 mm hg 1- year postop. follow-up. There was a statistically significant variance in the mean IOP (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eIOP (%) during the whole follow-up period in all groups\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eGroup A\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eGroup B\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eGroup C\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eOne-Way ANOVA Test\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP-value\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003ePre\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37.47\u0026thinsp;\u0026plusmn;\u0026thinsp;3.56\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34.13\u0026thinsp;\u0026plusmn;\u0026thinsp;3.36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34.73\u0026thinsp;\u0026plusmn;\u0026thinsp;2.82\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e4.455\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.018\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRange\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32\u0026ndash;45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28\u0026ndash;40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30\u0026ndash;40\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1 day\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1.069\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.353\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRange\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u0026ndash;11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8\u0026ndash;11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8\u0026ndash;10\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e7 days\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11.40\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1.578\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.218\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRange\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u0026ndash;13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u0026ndash;16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u0026ndash;14\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e3 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e2.926\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.065\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRange\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u0026ndash;15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12\u0026ndash;18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u0026ndash;15\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e6 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16.04\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.94\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.83\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1.885\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.161\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRange\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13\u0026ndash;21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13\u0026ndash;21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u0026ndash;21\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1 year\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.83\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e2.804\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.069\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRange\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15\u0026ndash;18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15\u0026ndash;20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u0026ndash;17\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab5\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eIOP % during 1 year of follow-up in all groups\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eGroup A\u003c/p\u003e\n\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003cp\u003eof difference\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eGroup B\u003c/p\u003e\n\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003cp\u003eof difference\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eGroup C\u003c/p\u003e\n\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003cp\u003eof difference\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eOne-Way ANOVA Test\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eF\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP-value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 day\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e27.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e24.87\u0026thinsp;\u0026plusmn;\u0026thinsp;3.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e26.00\u0026thinsp;\u0026plusmn;\u0026thinsp;3.23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.932\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.027\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7 days\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e26.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e22.00\u0026thinsp;\u0026plusmn;\u0026thinsp;2.85\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e23.40\u0026thinsp;\u0026plusmn;\u0026thinsp;2.85\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6.061\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.005\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e24.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e19.93\u0026thinsp;\u0026plusmn;\u0026thinsp;4.20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e21.67\u0026thinsp;\u0026plusmn;\u0026thinsp;2.87\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5.103\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.010\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e21.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.63\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e17.03\u0026thinsp;\u0026plusmn;\u0026thinsp;4.32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e18.75\u0026thinsp;\u0026plusmn;\u0026thinsp;3.26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4.252\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.021\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 year\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e21.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e16.47\u0026thinsp;\u0026plusmn;\u0026thinsp;4.32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e20.67\u0026thinsp;\u0026plusmn;\u0026thinsp;2.74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e7.497\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.002\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab6\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eMean IOP (%) at the 1-year follow-up.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTime\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eA\u003c/p\u003e\n\u003cp\u003eMean IOP%\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003cp\u003eMean IOP %\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eC\u003c/p\u003e\n\u003cp\u003eMean IOP %\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 day\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e72.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e74.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7 day\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e69.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e64.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e67.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e64.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e58.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e62.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e59.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e52.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e54.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 year\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e56.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e49.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e53.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eIOP % during the whole follow-up period in all groups, Mean IOP distribution over the follow-up period. A, B, and C also show the IOP (%) during 1 year of follow-up. In all groups, the mean IOP was calculated for 1 year of follow-up (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e,\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e,\u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e - Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\n\u003ch2\u003eBleb photography and grading according to (MBGS):\u003c/h2\u003e\n\u003cp\u003eThis finding was also consistent between the bleb morphology (area, height, and vascularity) and standardized photos (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e10\u003c/span\u003e ).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCentral bleb area 1a:\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab7\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eGrading of the central bleb area according to the MBGS\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eGrading\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eDay 1\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eDay 7\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eDay 90\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eDay 180\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eOne year\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eA\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eC\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eA\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eC\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eA\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eC\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eA\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eC\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eA\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eC\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e1a1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e1a2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e1a3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e1a4\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e1a5\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eX2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e25.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e26.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e24.502\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e23.192\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e20.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0.002\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eConcerning the extent of the bleb, as shown in (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e, and Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e10\u003c/span\u003e), according to the MBGS, in the central area, on day one, there were 11 pts in group A in grades 1a2 2 pt in 1a3, and 2 pt in grade 1a4 in group B1 pt in 1a2; on 6 pt in 1a3 and 8 pt in group c, there were 7 pt in 1a3 and 8 pt in 1a4, which means that the size of the bleb was greater in the ologen groups. On day 7, there were 10 pt in 1a2 3 pt in 1a3, and 2 pt in 1a4 in group A in group B. There were 6 pt in 1a3 and 9 pt in 1a4, similar to group C. At 3 months, there were 4 pt in 1a3 and 2 pt in 1a4 in group A, while group B had 5 pt in 1a3 and 10 pt in 1a4 group c had 4 pt in 1a3 and 11 pt in 1a4 group c. At 6 months, 7 pt in 1a2, 6 pt in 1a3, and 2 pt in 1a4 Group a Group B had 3 pt in 1a3, 12 pt in 1a4, the same as Group C. At one year in the group, there was 2 pt in 1a2, 9 pt in 1a3, 4 pt in 1a4 in Group A, while the B group had 1 pt in 1a3, 14 pt in 1a4, and 2 pt in 1a3 and 13 pt in 1a4; these findings indicate that the extent of bleeding increased in the early postoperative follow-up until 3 months, as it degraded and that the extent of the MMC bleb increased.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBleb height H\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab8\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eGrading of bleb height according to the MBGS.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eGrading\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eday 1\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eday 7\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eday 90\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eday 180\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eone year\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eA\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eC\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eA\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eC\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eA\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eC\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eA\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eC\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eA\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eC\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eH1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eH2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eH3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eH4\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eX2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e26.114\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e27.543\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e6.622\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e4.212\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0.241\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0.157\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0.378\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0.886\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eRegarding bleb height, as shown in (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e8\u003c/span\u003e, and Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e11\u003c/span\u003e, ) according to the MBGS, in the central area, on day one, there were 4 participants in group A in grade H1 10 participants in H2, and 1 patient in grade H3 in group B. At H2 and 10 patients in H3 and 2 patients in H4 in group c, there were 2 patients in H2 and 10 patients in H3 and 3 patients in H4, which clinically significantly indicated that bleb height was greater in the Ologen groups. On day 7, there was 1 pt at H1 13 pt at H2, and 2 pt at H3 in group A, in group B, there was 2 pt at H2 and 8 pt at H3, and 5 pt at H4; and in group C, there was 1 pt at H2 and 9 pt at H3 and 5 pt at H4. At 3 months, there were 3 patients in H2, 8 patients in H3, and 4 patients in H4 in group A, while group B had 9 patients in H3 and 6 patients in H4, group c had 10 patients in H3 and 5 patients in H4, which were clinically insignificant. At 6 months 2 pt in H2, 9 pt in H3, and 4 pt in H4 group A, group B had 10 pt in H3, 5 pt in H4, the same as group C did not significantly differ. At one year in group A, there were 11 participants in H3, 4 participants in H4, 12 participants in group B at H3, 3 patients in H4, 11 patients in group C at H3, and 4 patients in group H4. These findings indicate that the height of the blood in the Ologen groups increased during early postoperative follow-up until 3 months.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBleb Vascularity Central Area 3a\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab9\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 9\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eGrading of bleb vascularity (central area) according to the MBGS\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eGrading\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eDay 1\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eDay 7\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eDay 90\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eDay 180\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eOne year\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eA\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eC\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eA\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eC\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eA\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eC\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eA\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eC\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eA\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eC\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e3a1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e3a2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e3a3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e3a4\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e3a5\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eX\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e3.167\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e3.143\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e6.818\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e22.622\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e42.552\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0.530\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0.790\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0.145\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAs regards bleb vascularity as shown in (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e9\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e12\u003c/span\u003e) according to MBGS the central area shows on day one there is 2 pt in group A with normal vascularization and 13 pt with mild vascularization, in group B 1 pt normal vascularization and 12 pt mild and 2 pt moderate in group C there is 3 pt normal and 11 pt mild and 1 pt moderate vascularization which clinically insignificant it means vascularization is nearly the same in all groups. On day 7, there were 10 patients with normal vascularization in 3 groups, 4 patients with mild vascularization in groups A and B, and 5 patients in group C these results were also nonsignificant. At 3 months, there were 4 participants in group A and 2 participants in group C with avascular bleeding; 11 participants in groups A and C with normal vascularization; and 10 patients in group B, and 3 participants in group A and 2 patients in group B with mild vascularization, which is clinically significant. At 6 months13 pt in group A,12 pt in group C,2 pt in group B with avascular bleb 6 pt in group A 2 pt in B with normal vascularization,4 pt in A 1 pt in B with mild and 3 pt in B moderate vascularization. At one year in group A, there were 15 patients and 14 patients in group C avascular, 1 patient in group C 2pt in group B with normal vascularization, 8 participants with mild vascularization, and 5 patients with moderate vascularization, which indicated that there were significant variances between groups A and C at 3 months to one year of follow up. (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e13\u003c/span\u003e, \u003cspan class=\"InternalRef\"\u003e14\u003c/span\u003e )\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab10\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 10\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eIncidence of subconjunctival blood after surgery.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGroup A\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGroup B\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGroup C\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab11\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 11\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eThe amount of IOP-lowering medications\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePatient number\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNumber of medication\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eFor subconjunctival blood after surgery, the p-value was 0.072, which was considered to indicate statistical significance. After 6 months, 2 patients in group A needed IOP-lowering medications to control the IOP. In group B,1 patient needed a single medication, while in group C, 1 patient needed IOP-lowering medications to control the IOP (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e10\u003c/span\u003e, \u003cspan class=\"InternalRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n\u003ch2\u003eComplications\u003c/h2\u003e\n\u003cp\u003eRegarding complications, four patients in group A had a shallow anterior chamber, which had spontaneously changed by the end of the first week. There were also four patients with hypotony in group A. However, Groups B and C did not lead to any recorded complications, such as hypotony or shallow AC. No signs of hyphemia were recorded in any of the groups (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab12\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 12\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eThe number of complications in all groups\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGroup A\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGroup B\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGroup C\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eShallow AC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHypotony\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eSurgical treatment for glaucoma most commonly involves SST, first performed by Cairns in 1968. Supplemental antimetabolites were utilized to improve the achievement scale of such surgery because episcleral fibrosis and subconjunctival scarring lower the achievement ratio [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Ologen is a wound modulator it does not inhibit the scarring process by acting as an antifibrotic agent [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSeveral reports have revealed that the usage of MMC, an antitumor antibiotic derived from streptomycin capacitors, intraoperatively significantly improves success rates and postoperative IOP control. It causes cell death by preventing DNA-dependent RNA synthesis [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Time and dose depend on how well it inhibits proliferation. When MMC is injected intraoperatively during glaucoma filtration surgery, patient outcomes improve, and patients at risk of failure have a lower IOP [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The development of cataracts, along with this [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], and to improve the outcomes of antiglaucoma surgery, additional treatments including growth factor inhibition, corticosteroids, and amniotic membranes are used [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThrough opening sizes ranging from 10 to 300 mm, the Ologen implant is a porous material, The matrix inhibits the formation of scars and new infections while promoting better remodeling of the regenerating tissue [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Recently, Lommatzsch et al. reported on the usage of a collagen matrix implant as a human bevacizumab store in patients undergoing MMC trabeculectomy [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe usage of the Ologen implant in deep sclerotomy augmentation has been tested on human subjects. An efficient and well-tolerated technique for lowering IOP was deep sclerotomy with Ologen implantation in this work, we compared the effectiveness of adjuvant SST with MMC application versus that of the Ologen implant alone and in combination with MMC as a means of lowering the IOP and improving the bleb characteristics (area, height, and vascularity) in patients with POAG. Preoperative and postoperative IOP levels, the mean percent decrease in IOP on the first postoperative day, and the mean percent difference in IOP at 1 year were significantly different among the groups. Patients in the Ologen group had a lower mean IOP.\u003c/p\u003e \u003cp\u003eIn addition, we observed that the mean IOP in the MMC group initially decreased before gradually increasing over the progression of a one-year follow-up period. In contrast, the Ologen group's mean IOP fluctuated more stably after initially declining. Similarly, group 3 was observed. The Ologen group had a slightly lower IOP than the collective group did, according to a comparison of all the groups' IOP levels during the follow-up visits. For the three groups at 1, 3, 6, and twelve months, there were no significant differences.\u003c/p\u003e \u003cp\u003eSurgery for trabeculectomy can account for the initial decrease in IOP in our groups. Because MMC suppresses human fibroblasts for a prolonged period but does not permanently harm them, the behavior of the IOP in this group can be explained. Over the course of a 1-year follow-up period, the study by Hatem et al. aimed to evaluate the outcomes of using Ologen versus MMC as an adjuvant treatment in SSTs. For both groups, there was no statistically significant variation in terms of preoperative IOP, type of glaucoma, number of antiglaucoma medications taken, or age. These variables also did not affect the surgical outcome. The IOP was found to be substantially lower at follow-up visits than before surgery in each group in this investigation [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEosinophils can decrease infection and fix injured tissue, as evidenced by recent descriptions of them as significant regulators of local immunity and remodeling/healing in both healthiness and illness [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The extent of bleeding varied between groups during the entire follow-up visit in our study, with statistically significant differences. The Bleb height in the combined and Ologen groups was greater in the early postoperative phase than in the MMC group. The implanted older adults were degraded, and all the groups experienced similar bleeding heights from the 7-day to 1-year visit. A clear aqueous lake that might be a representation of aqueous flow appears to be the main cause of the bleb height in the MMC group, according to a comparison of the ASOCT images among the two groups, while the mass of the sponge appears to be the main cause in the Ologen group.\u003c/p\u003e \u003cp\u003eIn contrast to MMC blebs, Ologen blebs do not appear to have a clear aqueous lake, but there may be aqueous pockets somewhere, probably inside the implant's body. Owing to its three-dimensional porous nature, the Ologen implant has the potential to function as a physical scaffold, serving as a reservoir for the surrounding water. Yuan et al. when observed and scored the blebs using the Indiana Bleb Appearance Grading Scale (IBAGS). The blebs were also observed in two groups. Since the bleb heights in both groups were similar from the 14-day to 5-year visits. After three months, the two groups of patients had significantly different vascularities [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, one of the main issues associated with MMCs on blebs was that the blebs were significantly more avascular in the MMC and combined groups than in the Ologen group (P\u0026thinsp;=\u0026thinsp;0.001) By comparing the blebs of eyes with the Ologen implant without MMC to those of eyes treated with intraoperative MMC with or without ologen, we determine that the usage of an Ologen implant in SST is equivalent to the usage of MMC from three months to one year, and there were statistically significant variances in vascularity among all groups in follow-up visits.\u003c/p\u003e \u003cp\u003eIn the MMC group, filtering blebs frequently had noticeable avascular zones, and, after 6 and 12 months, the conjunctiva thinned. This complication was described by Rosentreter et al. Three months after the operation, a single filtering bleb from the MMC group revealed a noticeable avascular zone with leakage that needed to be corrected. No avascular regions were visible in the filtering blebs of the Ologen group. Following surgery, there was no discernible change in the corkscrew vessels.\u003c/p\u003e \u003cp\u003eIn addition, compared to blebs from the Ologen group, MMC blebs had noticeably more avascular regions. One to twelve months after surgery, a noteworthy distinction was observed. A more pronounced and avascular filtration was observed overall for the filtering blebs of the MMC group. Ologen has not been linked to an increased risk of complications, according to other studies [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere were no potential-specific side effects, such as allergies or implant translocations, that we could find in our study during postoperative follow-up visits Notably, in the MMC group, hypotony was highly prevalent in the early postoperative period (less than 7 days). 4 out of 15 instances. There were no discernible differences of any kind among the three groups. In the combined or Ologen groups, there was no hypotony one week after surgery.\u003c/p\u003e \u003cp\u003eRosentreter et al. stated the onset of endophthalmitis in one patient with Ologen implantation and trabeculectomy. However, in these cases, we looked at, no such issue [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The two groups of patients had comparable rates of postoperative complications, preventing any distinctions between the two adjuvants from being identified [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Hatem et al. discovered that throughout the follow-up period, the use of a shallow anterior chamber with MMC caused greater problems in 4 patients than in 2 patients. Additionally, there was one instance of blebitis in the MMC group and none in the Ologen group. There was also one case of bleb leakage in the MMC group and none in the Ologen group. As we discovered in our study, the group did not have any problems during the follow-up period that were related to the use of Ologen [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRosenteter et al. found no evidence of any potential OOEs, such as allergies or implant translocations; however, hypotony was prevalent in the early postoperative phase, occurring seven days after surgery, in the Ologen group. However, only 20% of patients had a shallow anterior chamber. There was no discernible difference between the MMC and Ologen groups. One week after surgery, the Ologen patients showed no signs of hypotony, while 30% of the patients in the MMC group showed signs of hypotony. Tenon's cysts developed in two of the Ologen group patients four weeks after surgery, necessitating needling. Surgical resection was required in the MMC group due to a significant bleb cyst and a subsequent late leakage in one of the patients.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBased on these findings, we hypothesize that the Ologen implant could be a secure and reliable substitute for MMC in terms of enhancing the long-term efficacy of trabeculectomy surgery while avoiding the negative consequences connected to the application of supplementary therapy, such as MMC. For example, the Ologen implant might be recommended when antimetabolite-related dangers must be minimized. It might also be helpful in circumstances requiring IOP lowering and optimal safety. To enhance the functional outcome, additional adjustments to the size of the Ologen implant, surgical method, and molecular makeup will be needed\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAS-OCT:\u003c/em\u003e\u003c/strong\u003e Anterior segment optical coherence tomography\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eMMC:\u003c/em\u003e\u003c/strong\u003e Mitomycin C\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e5-FU:\u003c/em\u003e\u003c/strong\u003e 5-fluorouracil\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eIOP:\u003c/em\u003e\u003c/strong\u003e Intraocular pressure\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePOAG:\u003c/em\u003e\u003c/strong\u003e Primary open-angle glaucoma\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eIBAGS:\u003c/em\u003e\u003c/strong\u003e The Indiana Bleb Appearance Grading Scale\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSST:\u003c/em\u003e\u003c/strong\u003e Subscleral trabeculectomy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eMBGS:\u003c/em\u003e\u003c/strong\u003e Moorfields bleb grading system\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank their university hospital, doctors, nurses, and staff who took care of the patients during treatment. Furthermore, they would like to thank their patients who voluntarily contributed to our study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was designed by AE and HM. The data were collected by AE. The data were analyzed by MH and MG. Manuscript drafting was accomplished by AE and NM. Manuscript revision was accomplished by AM. The integrity of the data was assessed via AG and MA. All the authors drafted and reviewed the manuscript. All authors read and approved the final manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study conformed to the guidelines presented in the Declaration of Helsinki. Written informed agreement was gained from all patients previously they were involved in the research. This study was approved by the ethics committee of the Faculty of Medicine, Al-Azhar University, Cairo, Egypt. Written informed consent was obtained from all participants\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003eSkuta GL, Parrish RK. wound healing in glaucoma filtering surgery. Surv Ophthalmol. 1987;32(3):149\u0026ndash;170. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/0039-6257(87)90091-9\u003c/span\u003e\u003c/span\u003e. Article PubMed Google Scholar\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003ePicht G, Grehn F. Classification of filtering blebs in trabeculectomy: biomicroscopy and functionality. 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However, scarring and wound healing can lead to bleb fibrosis and drainage fistula occlusion, which can ultimately result in bleb failure.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA randomized approaching comparative interventional research was directed at 45 eyes of 40 participants 25 males and 15 females with primary open-angle glaucoma (POAG), Patients were distributed into three groups, Group A (included 15 eyes) of 13 participants who went through SST with adjuvant intraoperative usage of 0.2 mg/ml MMC, Group B (included 15 eyes) of 14 participants who underwent SST with a collagen matrix implant during surgery. Group C (included 15 eyes) of 13 participants who underwent SST with both a collagen matrix implant and MMC during surgery.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study showed no statistically significant variances among the groups concerning age, sex, eye laterality, glaucoma type, preoperative IOP, or the quantity of topical or systemic antiglaucoma medications prescribed. Systemic carbonic anhydrase inhibitors were used by six study participants. All of the eyes of the patients underwent straightforward trabeculectomy procedures, and the study group did not experience any implant-related intraoperative issues.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eBased on these findings, we hypothesize that the Ologen implant could be a secure and reliable substitute for MMC in terms of enhancing the long-term efficacy of trabeculectomy surgery while avoiding the negative consequences connected to the application of supplementary therapy, such as MMC.\u003c/p\u003e","manuscriptTitle":"Comparison between Mitomycin-C and Ologen Implants in the Treatment of Primary Open Glaucoma by Subscleral Trabeculectomy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-16 16:47:11","doi":"10.21203/rs.3.rs-3950748/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d0c015f0-3570-4d6d-ba73-84e70181952d","owner":[],"postedDate":"February 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-02-21T08:35:46+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-16 16:47:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3950748","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3950748","identity":"rs-3950748","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}