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Abstract #3707 Published in IGR 4-2
Enzymatic sclerostomy: pilot human study
Dan JA; Honavar SG; Belyea DA; Mandal AK; Garudadri C; Levy B; Ramakrishnan R; Krishnadas R; Lieberman MF; Stamper RLArchives of Ophthalmology 2002; 120: 548-553
OBJECTIVE: To evaluate the feasibility and safety of enzymatic sclerostomy as a new modality to lower intraocular pressure in patients with open-angle glaucoma. METHODS: This single-center, prospective, noncomparative, interventional case series included 15 blind symptomatic eyes of 15 patients with primary open-angle glaucoma. Enzymatic sclerostomy was performed with the patient under topical or peribulbar anesthesia. A specially designed polymethylmethacrylate enzyme applicator filled with a mean ± SD of 123 ± 13 μg of collagenase was introduced through a 5-mm peritomy, and affixed to the limbus by means of cyanoacrylate tissue glue. After 22-24 hours, the applicators were removed and the patients were followed up for one year. Intraocular pressure (IOP) changes from baseline and complications related to the procedure were the main outcome measures. RESULTS: Controlled thinning of the treated sclera associated with aqueous percolation and shallow filtration bleb was seen in all eyes in the immediate postoperative period. The mean ± SD IOP decreased from 43.5 ± 9.8 mmHg (while the patients were receiving a mean ± SD of 1.75 ± 0.75 antiglaucoma medications) preoperatively to 24.8 ± 10.6 mmHg (a 43.0% decrease from baseline with no antiglaucoma medication) on the first postoperative day and to 34.8 ± 10.5 mmHg (a 20.0% decrease from baseline with no antiglaucoma medication) at the end of one year. Ophthalmic adverse effects were limited to the treated area and included immediate postoperative transient conjunctival reaction ranging from mild chemosis to conjunctival maceration. Immediate full-thickness perforation developed in one eye; the patient was treated and excluded from data analysis. Two eyes developed symptoms related to increase in IOP after nine months; the patients were treated and excluded from further data analysis. No systemic complications were noted. CONCLUSIONS: Enzymatic sclerostomy demonstrated immediate and sustained IOP reduction and provided symptomatic relief in blind eyes with primary open-angle glaucoma. However, the procedure needs further technical refinement.
Dr. J.A. Dan, PO Box 38, Hod-Hasharon 45100, Israel. jdan@netvision.net.il
Classification:
12.8.5 Other (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
