Comparison of deep sclerectomy with collagen implant and trabeculectomy in open-angle glaucoma

PURPOSE: To assess the efficacy and postoperative complications of deep sclerectomy with collagen implant (DSCI), a nonpenetrating filtration procedure. SETTING: Glaucoma Unit, Department of Ophthalmology, University of Lausanne, Switzerland. METHODS: Forty-four eyes of 44 patients with medically uncontrolled open-angle glaucoma had DSCI and a matched control group of 44 patients, trabeculectomy. A superficial scleral flap was raised and a deep sclerectomy performed in the scleral bed. Schlemm's canal was opened, and the cornea was dissected to Descemet's membrane. At that stage, aqueous filtered through the remaining trabeculo-Descemet's membrane. A collagen implant was sutured radially in the scleral bed; the scleral flap and conjunctiva were then closed. Examinations were performed before surgery and postoperatively at 1 and 7 days and 1, 2, 3, 6, 9, 12, 15, 18, and 24 months. RESULTS: The mean follow-up was 14.4 months +/- 6.3 (SD) (range 3 to 24 months). The mean preoperative intraoperative pressure (IOP) was 26.7 +/- 7.3 mm Hg. The mean postoperative IOP was 6.1 +/- 4.5 mm Hg at 1 day and 11.0 +/- 4.4 mm Hg at 1 week; it remained stable for the next 24 months. The success rate, defined as an IOP lower than 21.0 mm Hg without medication, was 69% in the DSCI group and 57% in the trabeculectomy group at 24 months postoperatively (P = .047). The number of postoperative complications was significantly lower in the DSCI group than in the trabeculectomy group. CONCLUSIONS: The success rate of DSCI may be comparable to that of trabeculectomy, with fewer complications.     

小梁造瘘联合深层巩膜切除术的疗效观察

目的：评价小梁造瘘联合深层巩膜切除术治疗闭型青光眼的疗效。方法：对16例（16只眼）闭角型青光眼患者实施了小梁造瘘联合深层巩膜切除术，术后观察视力，前房、房角，眼压及滤过泡变化，随访时间6－15个月，平均11．5个月。结果：11只眼视力增加2－4行，5只眼无变化，术后第1天12只眼前房形成，房角镜检查见巩膜条之间的房角开放，16只眼术后7个月眼压均低于15.75mmHg(1mmHg=0.133kPa），其中2只眼术后8个月眼压达19．25mmHg，16只眼结膜滤过泡弥散。4只眼术后浅前房，其中1例经B超证实为脉络膜脱离，给予局部滴类固醇眼药水，口服醋氮酰胺和加压包扎等处理后前房加深，脉络膜脱离复位。结论：小梁造瘘联合深层巩膜切除术是一种安全可靠有效的抗青光眼手术。     

Laser-assisted deep sclerectomy

PURPOSE: To study the clinical effectiveness of deep sclerectomy using the erbium:YAG (Er:YAG) laser in patients with open-angle glaucoma (OAG). SETTING: Department of Ophthalmology, Institut Universitari Dexeus, Universitat Autonoma de Barcelona, Barcelona, Spain. METHODS: This nonrandomized prospective clinical study was performed in 46 consecutive eyes with OAG. Seventeen patients had not received any treatment for glaucoma. Eight had received 1 medication; 14, 2 medications; and 7, 3 medications. The mean duration of treatment was 18.3 months +/- 9.4 (SD). After mitomycin-C 0.02% was administered for 2 minutes, a superficial 4.0 mm x 4.0 mm scleral flap was created and a deep 3.0 mm x 3.0 mm scleral ablation was performed with the Er:YAG laser. Schlemm's canal was removed, and the cornea was dissected to Descemet's membrane until aqueous humor percolated. The scleral flap and conjunctiva were closed. Postoperative follow-up examinations were done at 1, 3, and 7 days, 2, 3, and 4 weeks, and then every 3 months up to 15 months. RESULTS: The mean preoperative intraocular pressure (IOP) was 28.3 +/- 6.1 mm Hg. The mean postoperative IOP was 14.1 +/- 3.5 mm Hg at 24 hours, 16.3 +/- 4.2 mm Hg at 3 months, and 15.3 +/- 2.7 mm Hg at 15 months (P <.001). There were no statistically significant differences in IOP by sex or age. There was a statistically significant difference between patients receiving no medication and those who received more than 2 medications and a treatment period longer than 1 year preoperatively (P <.006). The presence of a filtering bleb was associated with a longer period of decreased IOP (P <.007). The success rate (IOP < or =18 mm Hg without medication) was 93.47% at 1 month and 84.78% at 15 months. The number of complications was significantly lower than in previous reports of trabeculectomy. One patient lost 2 lines of visual acuity because of cystoid macular edema. CONCLUSIONS: Deep sclerectomy using the Er:YAG laser was safe and effective in eyes with OAG. More studies are needed to analyze the mechanism of lowering IOP.     

Change in outflow pathway of porcine eyes in vitro by nonpenetrating filtering surgery

Objective: To study the change in different outflow pathways of porcine eyes in vitro by nonpenetrating filtering surgery.Design: Experimental study.Participants: Sixty-four enucleated porcine eyes were studied.Methods: Deep sclerectomy was performed on isolated porcine eyes (Group 1A), then the superficial scleral flap was watertight sealed (Group 1B), and finally the oracles and the exterior wall of the Schlemm canal were watertight sealed (Group 1C). In another series of experiments, deep sclerectomy was performed with the scleral lake volume of 4 mm × 4 mm × 0.5 mm (Group 2A), 4 mm × 2 mm × 0.5 mm (Group 2B), and 4 mm × 1mm × 0.5 mm (Group 2C), respectively; then the superficial scleral flap was watertight sealed. The control eye (Groups 1D and 2D) underwent creation and watertight sealing of a superficial scleral flap. Intraocular pressure (IOP) and outflow facility were determined preoperatively and postoperatively.Results: Compared with the preoperative value, IOP was decreased and outflow facility was increased in Groups 1A, 1B, and 1C (p < 0.05). In deep sclerectomy, the outflow facility was decreased by more than 0.18 μL/min/mm Hg after the conjunctival pathway was blocked. After the oracles and external wall of the Schlemm canal were blocked, the outflow facility decreased further by more than 0.09 μL/min/mm Hg but was still 0.06 μL/min/mm Hg higher than before surgery. There was a positive linear correlation between the deep sclerectomy volume and the ratio of IOP decrease or outflow facility increase postoperatively.Conclusions: Deep sclerectomy can increase the outflow of porcine eyes in vitro. The major factors maintaining the postoperative outflow increase include the subconjunctival pathway, the functional deep scleral lake, and the opening of the Schlemm canal.     

Deep sclerectomy with mitomycin C in failed trabeculectomy

AIM: To evaluate the success rate and complications associated with deep sclerectomy with mitomycin C (MMC) and a reticulated hyaluronic acid implant in previously failed trabeculectomy. METHODS: This prospective study included 20 eyes with a previously failed trabeculectomy, which were treated with deep sclerectomy with 0.2 mg/ml MMC application under the conjunctiva and superficial scleral flap. Intraocular pressure (IOP), glaucoma medications, visual acuity, and complications were recorded preoperatively and 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. RESULTS: The mean preoperative IOP was 25.8+/-7.3 mmHg; the IOP significantly decreased to 14.6+/-3.2 mmHg 1 year postoperative. At each interval, the mean IOP was significantly lower than preoperatively (P=0.000). At 1 year, the complete success rate (IOP相似文献   

Preliminary evaluation of nonpenetrating deep sclerectomy with autologous scleral implant in open-angle glaucoma

AIM: The aim of this study is to evaluate the short-term result of the use of an autologous scleral implant during the nonpenetrating deep sclerectomy operation instead of the more expensive collagen implant. DESIGN: Prospective nonrandomized pilot study. PATIENTS AND METHODS: This study included 20 eyes of 20 patients with a mean age of 42.3+/-8.1 years and the mean of preoperative best-corrected visual acuity was 0.66+/-6.2. All patients were indicated for conventional deep sclerectomy operation but with implantation of an autologous scleral implant. The operation was considered completely successful if the intraocular pressure (IOP) is below 18 mmHg without medications while qualified success was considered if the IOP was below 18 mmHg with medications. RESULTS: This technique succeeded in declining the mean IOP from 33.1+/-6.2 mmHg preoperatively to 14.6+/-3.8 mmHg postoperatively by the end of the follow-up period (12 months). Complete and qualified successful results were seen in 85% of cases. Nd:YAG goniopuncture was needed in 45% of the cases. This intervention was needed 14.0+/-10.0 weeks postoperatively. The study group showed low incidence of postoperative complication with statistically nonsignificant effect on the postoperative visual acuity. CONCLUSION: The use of autologous scleral implant can be of value in controlling the IOP with low cost to the patient. Nd:YAG goniopuncture is to be performed around the third month postoperatively in cases with advanced glaucomatous changes to avoid the problem of early implant induced fibrosis. Further long-term comparative study on wider scale is needed to detect the exact value of this technique and to evaluate its long-term result.     

羊膜植入在非穿透性小梁切除术中的应用

目的:评价非穿透性小梁切除（Non-perforating deep sclerectomy,NPDS）联合羊膜植入术治疗原发性开角型青光眼（Primary open-angle glaucoma,POAG）的效果。方法:对14例23眼POAG分别进行NPDS联合羊膜植入术,术中巩膜瓣下放置0.04％丝裂霉素（Mitomycin C,MMC）4 min,并于巩膜瓣下植入6 mm×9 mm羊膜植片。结果:术后1个月,眼压≤21 mmHg者23眼,总成功率为 100％;随访3个月及以上者20眼,完全成功率达90％,部分成功率达100％;随访6个月及以上者11眼,完全成功率为72.7％,部分成功率达 100％,手术前后视力无明显变化;随访12个月及以上者6眼,成功率为 66.7％。所有眼压控制良好的患眼滤过泡形成良好,且无严重并发症发生。结论:羊膜是NPDS术中安全和有效的辅助植入材料。     

Intraocular pressure on the first postoperative day as a prognostic indicator in phacoemulsification combined with deep sclerectomy

PURPOSE: To study the intraocular pressure (IOP) as a prognostic indicator on the first day after combined phacoemulsification and nonpenetrating deep sclerectomy. SETTING: Ramón y Cajal Hospital, Madrid, Spain. METHODS: This retrospective study included 70 eyes of 70 patients who had combined phacoemulsification-nonpenetrating deep sclerectomy with a reticulated hyaluronic acid implant. Visual acuity, IOP, and slitlamp examinations were performed preoperatively and 1 and 7 days and 1, 3, 6, 12, and 24 months postoperatively. A split point of 9.0 mm Hg on the first postoperative day was used. Success probability analysis was performed using a Kaplan-Meier survival curve. The need for medication and postoperative neodymium:YAG goniopuncture was also recorded. RESULTS: The mean preoperative IOP was 22.5 mm Hg +/- 5.2 (SD). The mean postoperative IOP was 11.6 +/-8.1 mm Hg, 16.4 +/- 4.7 mm Hg, and 17.0 +/- 5.3 SD mm Hg at 1 day, 12 months, and 24 months, respectively. A greater success rate was observed in terms of survival (P = .006, log rank test) in patients with an IOP of 9 mm Hg or less on the first postoperative day; these patients also had a significantly reduced need for glaucoma treatment (P = .015) and goniopuncture (P = .009). CONCLUSION: An IOP of 9 mm Hg or less on the first postoperative day might serve as a positive prognostic indicator in combined phacoemulsification with deep sclerectomy.     

Viscocanalostomy for primary open-angle glaucoma: the Gross Pankow experience

PURPOSE: To assess the pressure-lowering effect and postoperative complications of the viscocanalostomy nonpenetrating filtering procedure. SETTING: A private practice ophthalmic surgery referral center. METHODS: Fifty-six eyes of 41 patients with medically uncontrolled primary open-angle glaucoma had a viscocanalostomy. After a superficial scleral flap was raised, a deep sclerectomy was performed in the scleral bed with deroofing of Schlemm's canal and preparation of a window of Descemet's membrane. The ostia of Schlemm's canal were probed and stretched with sodium hyaluronate 1.4% (Healon GV(R)), and the scleral flap and conjunctiva were sutured. Examinations were performed before surgery and 1, 3, and 14 days and 1, 3, 6, and 12 months postoperatively. RESULTS: Mean preoperative intraocular pressure (IOP) was 28.1 mm Hg +/- 7.4 (SD) with a mean of 2.4 +/- 0.7 medications. Mean postoperative IOP was 18.6 +/- 7.5 mm Hg with 0 medications at 1 day, 17.4 +/- 5.2 mm Hg with 0.1 medications at 3 days, 19.1 +/- 4. 3 mm Hg with 0.1 medications at 14 days, 19.4 +/- 4.3 mm Hg with 0.4 medications at 1 month, 18.3 +/- 3.6 mm Hg with 0.6 medications at 3 months, 18.0 +/- 2.6 mm Hg with 0.6 medications at 6 months, and 17. 8 +/- 3.8 mm Hg with 0.7 medications at 1 year. After 1 year, IOP was lower than 21 mm Hg without medication in 36% of patients and lower than 21 mm Hg with medication in 79%. Five patients (9%) required a second operation for pressure control. The following postoperative complications occurred: hyphema (2%); postoperative hypotony less than 10 mm Hg (2%); positive Seidel test (17%); further surgery to lower IOP (12%). Cataract surgery was performed in 1 patient (2%) at 4 months. Despite an attempt to close the scleral flap watertight, 26 patients had evidence of subconjunctival drainage (conjunctival microcysts or filtration bleb) at 1 year. CONCLUSION: Viscocanalostomy lowered IOP and reduced the need for pressure-controlling medications with a low postoperative complication rate. The high success rates of earlier publications were not reproduced.     

Primary deep sclerectomy versus primary deep sclerectomy with the use of mitomycin C in primary open-angle glaucoma

PURPOSE: To prospectively study and compare the effectiveness and the safety of primary deep sclerectomy with and without the use of mitomycin C in eyes with open-angle glaucoma. PATIENTS AND METHODS: A total of 90 eyes of 90 patients with primary open-angle glaucoma or pseudoexfoliative glaucoma underwent deep sclerectomy. Patients were enrolled consecutively and assigned randomly to undergo deep sclerectomy without the use of mitomycin C (DS group) and deep sclerectomy with the application of mitomycin C (DSMMC group) in a concentration of 0.2 mg/mL for 2.5 minutes, before the superficial scleral flap formation. RESULTS: The intraocular pressure was significantly decreased by 7.13 mm Hg or 27.59% in the DS group and by 11.68 mm Hg or 42.25% in the DSMMC group at the end of the follow-up period. The intraocular pressure reduction in the DSMMC group was statistically significant when compared with that in the DS group (P <0.05). The complete (IOP <22 mm Hg without medication) and qualified (IOP < 22 mm Hg with or without medication) success rates at the end of the follow-up period were 42.5% and 72.5% in the DS group and 50% and 95% in the DSMMC group. The qualified success rate in the DSMMC group was statistically significant when compared with that in the DS group. Differences in complications (choroidal detachment, hyphema, leakage) seen between the two groups were statistically nonsignificant. A hemorrhagic detachment of the Descemet membrane was observed in one eye in the DSMMC group. CONCLUSIONS: The use of intraoperative mitomycin C during deep sclerectomy significantly reduced the postoperative IOP and increased the success rate of the procedure.     

Tiefe Sklerektomie mit Hyaluronatimplantat vs. Trabekulektomie

BACKGROUND: It was investigated whether a very low target pressure could be achieved by modification of deep sclerectomy without losing the advantages of non penetrating surgery in comparison to conventional filtration surgery. PATIENTS AND METHODS: A total of 22 eyes from 22 patients with advanced open angle glaucoma were randomly assigned to receive a deep sclerectomy or a trabeculectomy. Both groups received 0.02% mitomycin C under the conjunctiva prior to preparation of the scleral flap. In the deep sclerectomy group at least parts of the outer trabecular meshwork were removed until an apparent filtration was achieved. A dry cross-linked hyaluronate served as an implant. In the other group a classical trabeculectomy was performed. RESULTS: The median intraocular pressure 12 months post-operation was 11.5 mm Hg in the deep sclerectomy group compared to 11 mm Hg in the trabeculectomy group; the median of the relative IOP reduction was -47% in the deep sclerectomy group, and -57% in the trabeculectomy group. The best corrected visual acuity was unchanged 12 months postoperatively in both groups. DISCUSSION: As a more aggressive IOP-lowering procedure (intended filtration, use of antimetabolites) deep sclerectomy proved to be as effective as trabeculectomy. Nevertheless, the advantages of the more difficult surgical procedure concerning visual acuity, complications and surgical interventions were lost postoperatively.     

Prognostic value of gonioscopy after deep sclerectomy

PURPOSE: To ascertain gonioscopic characteristics and identify prognostic indicators related to intraocular pressure (IOP) after deep sclerectomy (DS). METHODS: A transversal, prospective, and nonselected study was performed in 106 eyes (95 patients) after DS. Three surgeons performed all the surgeries and the gonioscopic examination, using the same protocol including 13 gonioscopic data. These data were evaluated for an association with postoperative IOP and time after surgery. RESULTS: A subscleral space was found in 91 eyes (85.8%), with visualization of the line of scleral flap in 48 eyes (45.3%). The trabeculo-Descemet membrane (TDM) was transparent in 46 eyes (43.4%), opaque in 4 cases, and pigmented in 18 eyes. This TDM was broken using Nd:YAG laser goniopuncture in 38 eyes(35.8%). Thin vessels around TDM were found in 58 eyes (54.7%), and blood remained in 25 eyes (23.5%). Gonioscopic variables significantly positively related with postoperative IOP were as follows: presence of subscleral space, scleral flap line view, and a Schwalbe line depressed. A narrow anterior chamber angle and iris synechia in TDM had a statistically significant negative effect on the postoperative IOP control. Similarly, eyes requiring Nd:YAG goniopuncture had a worse IOP control. The frequency of eyes with visible subscleral space and transparent TDM decreases with time after surgery (p=0.001). CONCLUSIONS: A visible subscleral space was a gonioscopic sign positively related to IOP control after surgery, although it decreased with follow-up. Eyes with goniopuncture, postoperative narrow angle, and iris synechia had worse postoperative IOP control. Although new vessels in TDM were a common finding after DS, the authors did not find any association with postoperative IOP.     

Effect of different application depths of mitomycin-C in deep sclerectomy with collagen implant: a randomized controlled trial

Purpose: To evaluate effects of mitomycin‐C (MMC) in deep sclerectomy with collagen implant applied under the superficial scleral flap or under the deep scleral flap. Methods: Twenty‐five patients with primary or secondary open‐angle glaucoma and at high risk for postoperative cicatrization underwent deep sclerectomy and were randomly distributed to the two treatment arms. In the superficial MMC group (S‐MMC), MMC was applied under the superficial scleral flap using a soaked sponge for 60 s; in the deep MMC group (D‐MMC), MMC was applied under the deep scleral flap for 60 s before entering the Schlemm's canal. In both groups, remaining MMC was irrigated with 40 mL balanced salt solution. Patients were followed up for up to 2 years. The volume of filtering blebs was studied with ultrasound biomicroscopy at the last follow‐up visit. Results: Mean preoperative intraocular pressure (IOP) was 20.5 ± 8.9 mmHg for D‐MMC and 21.6 ± 6.6 mmHg for S‐MMC eyes (P = 0.67). The mean postoperative IOP was 5.3 ± 3.3 mmHg (D‐MMC) and 6.9 ± 4.8 mmHg (S‐MMC) at day 1 (P = 0.22) and 11.4 ± 6.3 mmHg (D‐MMC) versus 11.3 ± 4.6 mmHg (S‐MMC) at last follow up (P = 0.54). The mean number of medications per patient was reduced from 2.5 ± 0.5 to 0.4 ± 0.5 (D‐MMC) (P < 0.001) and from 2.5 ± 0.9 to 0.3 ± 0.4 (S‐MMC) (P < 0.001). Ultrasound biomicroscopy at 24 months showed mean intrascleral space volume of 1.97 ± 0.35 mm3 (D‐MMC) and 5.68 ± 0.42 mm3 (S‐MMC) (P < 0.05). Conclusion: No significant difference in efficacy and safety was found between the two groups at a mean of 19.2 months of follow up. Deep scleral application of MMC, however, seems to produce significantly smaller intrascleral blebs.     

Does the dissection depth and thickness of the deep scleral flap affect intraocular pressure after viscocanalostomy? A clinico-pathologic correlation

BACKGROUND: Non-perforating glaucoma surgery preserves the integrity of the trabecular meshwork in order to avoid postoperative hypotony. The purpose of our study was to investigate whether the morphologic variability of the excised deep scleral flap influences the postoperative intraocular pressure (IOP) after viscocanalostomy. METHODS: Light-microscopy of the deep scleral flap was performed in 17 patients who had undergone viscocanalstomy. Morphologic parameters (thickness and dissection level of the deep scleral flap) were correlated with the postoperative IOP. RESULTS: The mean thickness of the deep scleral flap was 309 +/- 95 microns; the dissection level was too deep in 5 cases (trabecular tissue excised) and too high in 6 cases (no signs of Schlemm's canal). The max. preop. IOP was 36.2 +/- 8.5 mmHg and came down to 10.6 +/- 5.7 mmHg at day 1 postop. and 12.4 +/- 4.9 mmHg at day 3/4 postop. At a median follow-up of 6 months IOP was 21.7 +/- 5.5 mmHg. A significant correlation between postop. IOP and the morphology of the deep scleral flap could not be demonstrated. CONCLUSIONS: Variations of the thickness and depth of the deep scleral flap showed little influence on the initial IOP level following viscocanalostomy. Other factors, f.e. the suturing of the external flap or invisible microruptures of the trabecular meshwork, could be of importance for the early postoperative IOP.     

Ultrasound biomicroscopy of eyes undergoing deep sclerectomy with collagen implant.

AIMS--To assess the intraocular pressure (IOP) lowering mechanism of deep sclerectomy with collagen implant (DSCI), a non-penetrating glaucoma surgery. METHODS--Nine eyes of nine patients with medically uncontrolled open angle glaucoma underwent DSCI. Ultrasound biomicroscopy (UBM) of the sclerectomy site was performed 1 month after surgery. The following factors were assessed: length and height of collagen implant, and thickness of the residual trabeculocorneal membrane. RESULTS--Postoperative IOP decreased significantly in all nine eyes from a preoperative mean value of 25.8 (SD 4.8) mm Hg to a postoperative (1 month) mean value of 11.3 (6.3) mm Hg (p = 0.001). In all nine eyes, UBM at 1 month after surgery showed a subconjunctival filtration through the thin trabeculocorneal membrane and through the scleral flap around the collagen implant. In four cases, a hypoechoic area in the suprachoroidal space was observed and might represent ciliary body detachment or be due to suprachoroidal drainage of aqueous humour through the thin deep scleral wall. At 1 month after surgery the mean trabeculocorneal membrane thickness was 110.1 (16.8) microns, and the mean length and height of the collagen implant were 2.3 (0.1) mm and 1.1 (0.1) mm respectively. CONCLUSION--DSCI lowered IOP by allowing aqueous filtration through a thin trabeculocorneal membrane to the subconjunctival space and, eventually, to the suprachoroidal space.     

深层巩膜切除联合激光小梁灼滤术治疗开角型青光眼

目的　观察深层巩膜切除联合激光小梁灼滤术治疗开角型青光眼的临床疗效。方法对 32例 (32只眼 )中、晚期开角型青光眼患者施行深层巩膜切除术 ,暴露Schlemm管外壁及残存的小梁网菲薄角膜缘组织 ,采取半导体激光器眼内用导光纤维 ,紧靠巩膜突前方小梁网角膜缘区域 ,直视下激光热灼击开 2或 3个圆形滤孔 ,滤孔直径 5 0 0 μm ,房水缓缓溢出。巩膜瓣缝合 1或 2针。术后观察患者眼压、眼内反应、滤过泡形态、前房角镜及超声生物显微镜 (UBM)检查结果。随访时间 4～ 2 4个月 ,平均 (7 94± 6 2 0 )个月。结果　 32只眼术后早期前房形成良好 ,视力稳定。最终随访患者平均眼压 (14 86± 4 15 )mmHg(1mmHg =0 133kPa) ,明显低于术前 (2 9 6 8± 5 76 )mmHg ,差异有非常显著意义 (t=7 4 15 ,P <0 0 0 1)。术后 32只眼均形成明显弥散性滤过泡 ;随访期间 ,2 7只眼有功能性滤过泡 ,5只眼于术后 2～ 3个月功能性滤过泡消失。 2只眼术中虹膜轻微灼伤 ,出现前房一过性色素脱失和房水混浊 ;角膜与晶状体无激光性损伤。 2只眼术后眼压偏高 ,局部应用抗青光眼药物后眼压控制正常。结论　深层巩膜切除联合激光小梁灼滤术能有效降低眼压 ,无穿透性小梁切除术常见的严重并发症 ,是治疗开角型青光眼的有效术式之一。     

Comparison of surgical outcomes between small collagen and chromic catgut implants in deep sclerectomy

In deep sclerectomy, collagen implant has been used to maintain space under the scleral flap. However, the effect of other implants has not been studied. In this retrospective study, we compared surgical outcomes between small collagen and chromic catgut used as implants in deep sclerectomy. Deep sclerectomy was performed on 23 patients (25 eyes) who either had an open angle and a high intraocular pressure (IOP) (> 22 mmHg) in spite of receiving the maximal tolerable medical treatment, or who were intolerant to medications. Our study consisted of 14 patients (15 eyes) in the small collagen group and 8 (9 eyes) in the chromic catgut group. The mean follow-up period was 8.6 +/- 3.3 months in the small collagen group and 4.4 +/- 1.2 months in the chromic catgut group. The mean preoperative IOP was not significantly different between the two groups. The complete success rate of the small collagen group was significantly better than that of the chromic catgut group at the final follow-up when data were analyzed using the Kaplan-Meier survival curve (87% versus 30%; P = .01). As for the qualified success rate, the small collagen group showed significantly better results at the final follow-up (93% versus 80%; P = .046). The mean number of postoperative medications was significantly lower in the small collagen group (0.26 versus 1.10; P < .05). These results confirmed that the use of small collagen implant in deep sclerectomy produced a higher success rate and a lowered need for postoperative medication compared to the use of chromic catgut implant. Because equal sized implants were used, the difference in biochemical properties, particularly the severity of inflammation caused by the implant, is presumed to be the cause of the different surgical outcomes.     

Vergleich von resorbierbaren und nichtresorbierbaren skleralen Implantaten bei tiefer Sklerektomie (SK-Gel und T-Flux)

BACKGROUND: The intraocular pressure (IOP) lowering effects of deep sclerectomy (partially combined with phacoemulsification) with different scleral implants (T-Flux- or SK-Gel) were investigated. PATIENTS AND METHODS: In a retrospective study, 72 patients with medically uncontrollable glaucoma underwent non-penetrating deep sclerectomy. Of these, 54 patients received T-Flux implants and 18 SK-Gel implants. Examinations were carried out shortly before and after surgery, as well as after 12 months. RESULTS: Prior to surgery IOP was 18.4+/-5.5 mmHg (n=72) and 12 months after surgery it was 13.1+/-3.8 mmHg (n=65). The number of antiglaucomatous eyedrops used prior to surgery was 2.3+/-1.3 (n=72) and 12 months after surgery 0.2+/-0.6 mmHg (n=65). Secondary IOP-lowering surgery after 12 months was carried out on 15.3% of the operated eyes, and consecutive goniopunctures after 12 months were 25%. No significant differences were found between the two groups. CONCLUSIONS: The short- and mid-term IOP lowering effects in deep sclerectomy with scleral implants were quite satisfying no matter which implant was used. There was no difference in deep sclerectomy whether or not combined with cataract surgery.     

Nonpenetrating deep sclerectomy versus trabeculectomy in bilateral primary open-angle glaucoma

OBJECTIVE: To establish the efficacy and safety of nonpenetrating deep sclerectomy versus trabeculectomy in primary open-angle glaucoma. DESIGN: Prospective randomized trial. PARTICIPANTS: Thirty-nine patients (78 eyes) with bilateral primary open angle glaucoma were included in the study. INTERVENTION: Eyes were randomly assigned to receive deep sclerectomy in one eye and trabeculectomy in the other eye. MAIN OUTCOME MEASURES: Mean intraocular pressure (IOP), postoperative medications, visual acuity, success rate, and complications. RESULTS: At 12 months, mean IOP reduction was 12.3 +/- 4.2 (sclerectomy) versus 14.1 +/- 6.4 mmHg (trabeculectomy) (P = 0.15), and an IOP 相似文献   

Conversion from trabeculectomy to deep sclerectomy. Prospective study of the first 44 cases

PURPOSE: To evaluate the outcomes of conversion from trabeculectomy to deep sclerectomy with placement of a drainage implant. SETTING: Department of Ophthalmology, Hospital of Buskerud, Drammen, Norway. METHODS: Deep sclerectomy was performed in 41 patients (44 eyes) from November 1999 to January 2002. An absorbable implant (AquaFlow((R)), Staar Surgical) and a nonabsorbable implant (T.Flux((R)), IOLTech Laboratories) were used in 75% and 25% of eyes, respectively. Patients with open-angle glaucoma who needed filtering surgery were enrolled consecutively in a prospective study. Patients with 2 or more previous filtering surgeries or neovascular glaucoma were excluded, as were children. Of the original 48 eyes, accidental perforation of the trabeculo-Descemet's membrane occurred in 8.3%; these eyes were excluded from the study. The severity of optic nerve damage was considered in the decision to start therapy. An intraocular pressure (IOP) above 22 mm Hg was always treated. RESULTS: After a mean follow-up of 12.9 months +/- 7.1 (SD), 61.4% of eyes were controlled without therapy. When eyes with previous surgery were excluded, the rate increased to 66.7% after a mean follow-up of 13.8 +/- 7.2 months. The mean IOP preoperatively and after 12 months was 27.9 +/- 6.9 mm Hg and 14.6 +/- 3.5 mm Hg, respectively (P<.001). The mean number of medications decreased from 3.4 +/- 1.0 preoperatively to 0.6 +/- 1.1 12 months postoperatively (P<.001). A reoperation was required in 2 cases (4.5%). There were no complications related to hypotony or other significant complications. CONCLUSIONS: This study shows that conversion from trabeculectomy to deep sclerectomy with placement of an implant is safe. The postoperative IOP reduction was acceptable, and no significant complications occurred.