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Abstract #26780 Published in IGR 12-3
Deep sclero-canalostomy: Open-angle filtering surgery for glaucoma
Bovet J; Ngondi CETechniques in Ophthalmology 2010; 8: 60-65
Introduction: The aim of the conventional filtering procedure in the surgical treatment of primary open-angle glaucoma has been to effectively reduce intraocular pressure (IOP) with minimal complications and a lower cost. We describe a new surgical approach, deep sclero-canalostomy, which is a synthesis of positive aspects of the 2 main surgical techniques of nonpenetrating glaucoma surgery: (1) deep sclerectomy (DS) with implant and (2) viscocanalostomy. The renovation consists of a few modifications in the DS procedure and presentation of a new type of implant, devitalized autologous corneostromal implant, inserted between the remaining thin scleral layer and the choroid. Materials and methods: The pilot study led in our center consisted of 12 eyes with medically uncontrolled primary open-angle glaucoma. All patients agreed to take part in the study and underwent the usual preoperative and postoperative examinations (1 day, 1 month, and every 3 months). The technique of the DS was applied with some modifications and that of the viscocanalostomy, as described by Stegmann et al. RESULTS: Mean follow-up period was 40.6 weeks. Mean preoperative IOP was 22.6 (plus or minus) 5.7 mm Hg. Postoperative IOPs were, respectively, 17.1 (plus or minus) 4.5 mm Hg at 3 months, 17.6 (plus or minus) 4.9 mm Hg at 6 months, and 17.2 (plus or minus) 2.2 mm Hg at 1 year. Complete success rates were 62.5% at 6 months and 55.5% at 1 year, whereas qualified success rates were 37.5% at 6 months and 44.4% at 1 year. The numbers of eye medications were 1.8 (plus or minus) 0.8 preoperatively and 0.3 (plus or minus) 0.5 at 6 months postoperatively and 0.4 (plus or minus) 0.5 at 1 year. Discussion: Deep sclero-canalostomy decreases IOP as much as any of the previously mentioned techniques taken alone. It also provides the advantage of avoiding their complications and of lowering the cost of the operation. Results are comparable to those of studies using collagen and autologous implants. A steep learning curve associated with the performance of the procedure is necessary. Conclusions: Deep sclero-canalostomy is a safe procedure that significantly reduces IOP in primary open-angle glaucoma. This new lower-cost method is especially beneficial for populations disposing of limited means. Although trial studies have not yet been carried out, the results are encouraging. Further long-term studies are needed to determine the exact value of this technique and to evaluate its long-term results.
C. E. Ngondi. Clinique de l'aeIl. OnO, Ophthalmology Network Organisation S A, Geneva, Switzerland. ngondi12@yahoo.fr
Classification:
12.8.3 Non-perforating (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
