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1 General aspects (0)   1.1 Epidemiology (12)   1.2 Population genetics (1)   1.3 Pathogenesis (1)   1.4 Quality of life (4)   1.5 Glaucomas as cause of blindness (2)   1.6 Prevention and screening (3) 2 Anatomical structures in glaucoma (0)   2.1 Conjunctiva (3)   2.2 Cornea (34)   2.3 Sclera (4)   2.4 Anterior chamber angle (3)   2.5 Meshwork (0)     2.5.1 Trabecular meshwork (6)     2.5.2 Schlemms canal (0)     2.5.3 Scleral outlet channels (0)   2.6 Aqueous humor dynamics (1)     2.6.1 Production (3)     2.6.2 Outflow (0)       2.6.2.1 Trabecular meshwork (0)       2.6.2.2 Uveoscleral (1)     2.6.3 Compostion (1)   2.7 Episcleral veins and venous pressure (1)   2.8 Iris (3)   2.9 Ciliary body (2)   2.10 Lens (0)   2.11 Vitreous body (0)   2.12 Choroid, peripapillary choroid, peripapillary atrophy (1)   2.13 Retina and retinal nerve fibre layer (25)   2.14 Optic disc (23)   2.15 Optic nerve (4)   2.16 Chiasma and retrochiasmal central nervous system (2)   2.17 Stem cells (0)   2.20 Other (2) 3 Laboratory methods (0)   3.1 Microscopy (1)   3.2 Electron microscopy (0)   3.3 Immunohistochemistry (3)   3.4 Molecular genetics (0)     3.4.1 Linkage studies (1)     3.4.2 Gene studies (12)   3.5 Molecular biology incl. 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(4)

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Abstract #15189 Published in IGR 8-4

Intrastromal diathermal keratostomy: a new micropenetrating clear-cornea glaucoma procedure

Kessing SV; Heegaard S; Nissen OI
Journal of Glaucoma 2006; 15: 437-445

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PURPOSE: The filtering intrastromal diathermal keratostomy (IDK) was developed to comply with the call for a low postoperative intraocular pressure (IOP) and a bleb morphology without a thin, cystic appearance. PATIENTS AND METHODS: A diathermal microkeratostomy (150 to 200 μm) was created into the anterior chamber, anterior to the Schwalbe line through the floor of a surgical corneoscleral tunnel incision into the subconjunctival space. A newly developed, bipolar diathermal microneedle was used to create the keratostomy, replacing the Holmium laser used previously. Subconjunctival injections of 3 μg mitomycin C were used in each eye 1 week before the IDK to obtain maximum antiproliferative effect at the time of the operation. Nine patients (10 eyes) with complicated, refractory primary and secondary open-angle glaucoma are discussed. RESULTS: Histologic examination of the IDK and clinical postoperative ultrasound biomicroscopy showed an optimal appearance of the diathermal microkeratostomy. After 34 months (range 24 to 42 mo) the mean IOP was 11 mmHg (SD ± 3, range 6 to 16) without medication in all 10 eyes. IDK revision with internal needling of postoperative subconjunctival fibrosis through the tunnel incision was performed in 5 eyes after an average of 3 months (range 0.2 to 7 mo). After 33 months (range 19 to 38 mo), the postrevision mean IOP was 10 mmHg (SD ± 2, range 8 to 14) without medication in all 5 eyes. All 10 eyes showed noncystic diffuse blebs with optimal spongy subepithelial morphology: in 2 eyes the blebs were totally avascular and in 8 eyes they were relatively avascular. CONCLUSIONS: The preliminary results of the new clear-cornea IDK seem promising because of postoperative IOP of about 10 mmHg despite a low dose of mitomycin C and noncystic bleb morphology.

Dr. S.V. Kessing, Glaucoma Clinic, Eye Clinic, Copenhagen University Hospital, Rigshospitalet, Denmark. svend.kessing@dadlnet.dk

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Classification:

12.8.5 Other (Part of: 12 Surgical treatment > 12.8 Filtering surgery)

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