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SINGAPORE: To minimise scars from glaucoma surgery, the trade-off has always been the increased risk of eye infection.
But some patients now have another option that does not reduce eye immunity: A biodegradable collagen implant, instead of anti-scarring agent.
Some hospitals recently introduced the implant in the treatment of glaucoma - a life-long disease in which fluid in the eye builds up pressure in the eyeball, damages the optic nerve and potentially leads to blindness.
Each year, about three in 100 Singaporeans aged 40 and above develop the condition. Those with moderate glaucoma and those prone to eye infections are suitable for the implant, said opthalmologist Dr Lim Boon Ang from Tan Tock Seng Hospital (TTSH), the first hospital to use the implant here.
TTSH introduced it last year after running clinical trials in 2007. The Singapore National Eye Centre is now carrying out trials, while the National University Hospital began using the implant from Feburary.
Usually, how it works during surgery is that anti-scarring agent Mitomycin C is applied over a drainage channel created to divert the fluid in the eye. The agent keeps the drain from closing - but is quite toxic.
With a mint-sized biodegradable collagen implant, a mould forms for the scar tissue to heal over, without closing the drain. "Within three months, the scaffold is absorbed by the body, leaving a porous structure," said Dr Lim.
Manufactured in Taiwan, the implant has been on the market for about three years. TTSH, which performs about 150 glaucoma surgeries a year, has used it for over 20 surgeries, with no side effects noted.
So far, TTSH's success rate in preventing further vision loss is about 80 to 90 per cent in the first 18 months using the implant, comparable with conventional glaucoma surgery.
But vision should drop over time. The success rate for conventional surgery is 70 per cent by the third year, said Dr Lim.
NUH consultant and head of glaucoma services Jovina See said the results are "alright" but "not amazingly better compared to conventional filtration surgery". NUH is researching whether better materials or novel surgical implants can be used.
TTSH patients using the collagen implant pay $200 to $300 more for surgery - which is the last option after eye drops and laser treatment - or $2,600 (non-subsidised) and $1,200 (subsidised) per eye.
Retiree Lim Pok Beng underwent the surgery using the implant in 2007. He described the outcome as "positive".
- TODAY/so
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