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Editors Selection IGR 9-1

Surgical treatment: New filtering procedures

Comment by Richard Lewis on:

13919 External trabeculectomy with T-Flux implant, Jungkim S; Gibran SK; Khan K et al., European Journal of Ophthalmology, 2006; 16: 416-421

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Successful glaucoma surgery using a nonpenetrating or a minimally invasive approach remains a challenge unfulfilled. This has not deterred various investigators using various devices. The paper by Jungkim et al. (565) reports on a novel procedure using the non absorbable T-Flux implant (IOL Tech Laboratories, France) sutured in the deep intrascleral space after unroofing the canal of Schlemm. The study included 35 eyes of 35 patients with medically uncontrolled glaucoma (without a control group). Three patients were converted to a trabeculectomy due to the a perforation into the anterior chamber. Of the 32 subjects, average IOP dropped from 32.8 to 15.4 at 12 months. Complications were limited to 10 eyes with a microhyphema. The success rate was not provided.

The value of this study relates to the continuing efforts of glaucoma surgeons around the world to provide more successful alternatives to conventional trabeculectomy. The study could be criticized for the small sample size, the absence of a control group and the lack of masking. For surgical results to be valid and applicable around the world, it is important to see multicentered studies in multiethnic populations. Let's hope the authors (and others) continue to explore the canal space as a means for controlling pressure in glaucoma patients without depending on the function of a bleb and fistula.

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