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Abstract #10838 Published in IGR 6-2
Long-term results of deep sclerectomy with collagen implant
Shaarawy T; Mansouri K; Schnyder C; Ravinet E; Achache F; Mermoud AJournal of Cataract and Refractive Surgery 2004; 30: 1225-31
PURPOSE: To study prospectively the success rate and complications of deep sclerectomy with collagen implant (DSCI). SETTING: Glaucoma Unit, Department of Ophthalmology, Hopital Ophtalmique Jules Gonin, University of Lausanne, Lausanne, Switzerland. METHODS: This nonrandomized prospective trial comprised 105 eyes of 105 patients with medically uncontrolled primary and secondary open-angle glaucoma. Visual acuity, intraocular pressure (IOP), and slitlamp examinations were performed before surgery and after surgery at 1 and 7 days, and 1, 3, 6, 9, 12, 18, 24, 30, 36, 48, 54, 60, 66, 72, 78, 84, 90, and 96 months. Visual field examinations were repeated every 6 months. RESULTS: Mean follow-up period was 64 months ± 26.6 (SD). Mean preoperative IOP was 26.8 ± 7.7 mmHg, and mean postoperative IOP was 5.2 ± 3.35 mmHg at day 1 and 12 ± 3 mmHg at month 78. At 96 months, the qualified success rate (ie, patients who achieved IOP <21 mmHg with and without medication) was 91%, and the complete success rate (ie, IOP <21 mmHg without medication) was 57%. At 96 months, 34% of patients had an IOP <21 mmHg with medication. Fifty-one patients (49%) achieved an IOP < or =15 mmHg without medication. Neodymium:YAG goniopuncture was performed in 54 patients (51%); mean time of goniopuncture performance was 21 months, and mean IOP before goniopuncture was 20 mmHg, dropping to 11 mmHg after goniopuncture. No shallow or flat anterior chamber, endophthalmitis, or surgery-induced cataract was observed. However, 26 patients (25%) showed a progression of preexisting senile cataract (mean time 26 months; range 18 to 37 months). Injections of 5-fluorouracil were administered to 25 patients (23%) who underwent DSCI to salvage encysted blebs. Mean number of medications per patient was reduced from 2.3 ± 0.7 to 0.5 ± 0.7 (signed rank P<.0001). CONCLUSION: Deep sclerectomy with collagen implant appears to provide stable and reasonable control of IOP at long-term follow-up with few immediate postoperative complications.
Hopital Ophtalmique Jules Gonin, Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland. shaarwy@glaucoma-surgery.com
Classification:
12.8.3 Non-perforating (Part of: 12 Surgical treatment > 12.8 Filtering surgery)