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Abstract #18300 Published in IGR 3-3
Non penetrating deep sclerectomy (NPDS) with SKGEL implant and/or 5-fluorouracil (5-FU)
Detry-Morel MBulletin de la Société Belge d'Ophtalmologie 2001; 280: 23-32
PURPOSE: To assess the effectiveness and safety of deep sclerectomy (DS) with a reticulated hyaluronic acid implant (SKGEL) and/or 5-fluorouracil (5-FU). MATERIAL AND METHODS: Sixty-one eyes (48 patients) (mean age: 64.5 ± 10.5 years) with medically uncontrolled open-angle glaucoma and comparable surgical risk failure were included in this retrospective non-randomized study and were categorized into DS + SKGEL (ten eyes), DS + 5-FU (25 eyes), and DS + SKGEL + 5-FU simultaneously (26 eyes). The three groups were comparable with respect to age of patients, diagnosis, severity of VF defects, and bleb failure risk factors. All procedures were performed according to the Kozlov and Mermoud technique. Complete ocular examination was carried out preoperatively and at days 1 and 7, at one, two, and three months, and every three months thereafter. RESULTS: Mean follow-up was 11 ± 4.9 months and was significantly shorter in group C. For all 61 eyes, mean IOP was significantly decreased from 27.8 ± 8.6 mmHg to 15.1 ± 3.5 mmHg. Complete (target IOP reached without medication or YAG laser goniopuncture) and qualified (target IOP reached with medication and/or YAG laser goniopuncture) final success rates were respectively of 54% and 90%. Complete success probability was 95% at six months and 72% at 12 months. Qualified success probability increased to 89.5% at 12 months. The IOP results, the distribution of success rates and complications were similar within the first postoperative year whatever using SKGEL or intra-operative 5-FU application or both. The need for additional glaucoma medication and the percentage of YAG goniopuncture appeared to be lower in the SKGEL group. Success probability appeared to be improved in SKGEL group comparatively with the other two groups. CONCLUSIONS: NPDS is a valid, effective and relatively safe alternative to trabeculectomy although adjunctive medications and/or Nd:YAG goniopuncture are frequently needed. Considering the limitations of their study, the authors can conclude that IOP results, success rates and complications are similar within the first postoperative year whether using peroperative 5-FU or SKGEL implant. A longer follow-up is needed to confirm that SKGEL implant seems to improve IOP control and the long term patency of the sclerectomy site in comparison with the intraoperative application of 5-FU.
Dr M. Detry-Morel, Cliniques Universitaires St Luc Université Catholique de Louvain, Louvain, Belgium
Classification:
12.8.3 Non-perforating (Part of: 12 Surgical treatment > 12.8 Filtering surgery)