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Abstract #15852 Published in IGR 2-3
Viscocanalostomy for primary open-angle glaucoma: the Gross Pankow experience
Drusedau MUH; Von Wolff K-D; Bull H; Von Barsewisch BJournal of Cataract and Refractive Surgery 2000; 26: 1367-1373
PURPOSE: To assess the pressure-lowering effect and postoperative complications of the viscocanalostomy nonpenetrating filtering procedure. SETTING: A private practice ophthalmic surgery referral center. METHODS: Fifty-six eyes of 41 patients with medically uncontrolled primary open-angle glaucoma underwent viscocanalostomy. After a superficial scleral flap had been raised, a deep sclerectomy was performed in the scleral bed with deroofing of Schlemm's canal and preparation of a window of Descemet's membrane. The ostia of Schlemm's canal were probed and stretched with sodium hyaluronate 1.4% (Healon GV™), and the scleral flap and conjunctiva sutured. Examinations were performed before surgery and one, three, and 14 days and one, three, six, and 12 months postoperatively. RESULTS: Mean preoperative intraocular pressure (IOP) was 28.1 mmHg ± 7.4 (SD) with a mean of 2.4 ± 0.7 medications. Mean postoperative IOP was 18.6 ± 7.5 mmHg with zero medications at one day, 17.4 ± 5.2 mmHg with 0.1 medications at three days, 19.1 ± 4.3 mmHg with 0.1 medications at 14 days, 19.4 ± 4.3 mmHg with 0.4 medications at one month, 18.3 ± 3.6 mmHg with 0.6 medications at three months, 18.0 ± 2.6 mmHg with 0.6 medications at six months, and 17.8 ± 3.8 mmHg with 0.7 medications at one year. After one year, IOP was lower than 21 mmHg without medication in 36% of patients and lower than 21 mmHg with medication in 79%. Five patients (9%) required a second operation for pressure control. The following postoperative complications occurred: hyphema (2%); postoperative hypotony of less than 10 mmHg (2%); positive Seidel test (17%); further surgery to lower IOP (12%). Cataract surgery was performed in one patient (2%) at four months. Despite an attempt to close the scleral flap watertight, 26 patients had evidence of subconjunctival drainage (conjunctival microcysts or filtration bleb) at one year. CONCLUSIONS: Viscocanalostomy lowered IOP and reduced the need for pressure-controlling medications with a low postoperative complication rate. The high success rates of earlier publications were not reproduced.
Dr. M.U.H. Drusedau, Kastanienalle 12, 19395 Plau am See, Germany
Classification:
12.8.3 Non-perforating (Part of: 12 Surgical treatment > 12.8 Filtering surgery)