Non-penetrating deep sclerectomy without or with autologous scleral implant in open-angle glaucoma: medium-term results

Background This study compares the medium-term success rate and complications of non-penetrating deep sclerectomy (NPDS) without and with autologous scleral implant in open-angle glaucoma. Methods Retrospective review of 93 eyes of 93 patients with medically uncontrolled open-angle glaucoma who underwent NPDS without (n=69, group 1) or with (n=24, group 2) autologous scleral implant. Results The mean follow-up was 16 months (range 5–36) in group 1 and 15 months (range 4–28) in group 2. The mean intra-ocular pressures (IOP) pre- and postoperatively were, respectively, 23.8 and 16.1 mmHg in group 1, and 25.6 and 15.8 mmHg in group 2. The absolute success rate was 41% in group 1 and 54% in group 2. The qualitative success rate was 83% in group 1 and 75% in group 2. An IOP lower than 16 mmHg was obtained in 51% of patients in group 1 and 58% of patients in group 2. A Nd:YAG laser goniopuncture was performed in 30% of patients in group 1 and 50% of patients in group 2, and resulted in a better controlled IOP. Conclusions NPDS without or with an autologous scleral implant is a safe procedure reducing the IOP significantly, but probably not sufficient when an IOP below 16 mmHg is required. We found no statistically significant difference between the two groups.     

Deep sclerectomy with collagen implant: medium term results

AIMS—To study prospectively the success rate and complications of deep sclerectomy with collagen implant (DSCI), a new non-penetrating filtration procedure.
METHODS—Non-randomised prospective trial involving consecutive patients. 100 eyes of 100 patients with medically uncontrolled primary and secondary open angle glaucoma. A superficial scleral flap was raised and a deep sclerectomy was performed in the scleral bed. Schlemm's canal was opened and dissection of the cornea was performed up to Descemet's membrane, at which point aqueous percolated through the remaining trabeculo-Descemet's membrane. A collagen implant was sutured radially in the scleral bed. Visual acuity, intraocular pressure (IOP) measurements, and slit lamp examinations were performed before surgery and after surgery at 1 and 7 days, and 1, 3, 6, 9, 12, 18, 24, 30, and 36 months.
RESULTS—The mean follow up period was 17.8 (SD 8.7) months. The mean preoperative IOP was 27.8 (8.6) mm Hg; the mean postoperative IOP was 5.7 (4.0) at day 1, 11.2 (4.6) at month 1, 14.0 (3.5) at month 12, and 13.0 (3.8) at month 36. Complete success rate, defined as an IOP lower than 21 mm Hg without medication, was 44.6% at 36 months. Qualified success rate, defined as an IOP lower than 21 mm Hg with medication, was 97.7% at 36 months. Early postoperative complications included hyphaema in seven patients, wound leak in 10 patients, and subtle choroidal detachment in 11 patients. Goniopuncture was performed in 41 of the patients, and 5-fluorouracil injections were made in 23 patients; cataract progression occurred in seven patients. When comparing the different types of open angle glaucoma, no difference was found in terms of reduction in IOP, number of patients requiring antiglaucoma medications, or success rate.
CONCLUSIONS—Deep sclerectomy with collagen implant appears to provide reasonable control of IOP at medium term follow up, with few immediate postoperative complications.

Keywords: deep sclerectomy; glaucoma surgery; collagen implant     

Efficacy and safety of deep sclerectomy in childhood glaucoma in Saudi Arabia

Purpose: To evaluate the efficacy and safety of deep sclerectomy in childhood glaucoma. Methods: A prospective cohort of 120 children presenting with glaucoma to King Abdul Aziz University Hospital (KAUH) was subjected to nonpenetrating deep sclerectomy surgery (NPDS). Eventually, 57 patients had macro perforation and converted to penetrating deep sclerectomy (PDS). Intra‐operative mitomycin C (MMC) 0.2 mg/ml was used in all patients. Pre‐ and postintervention glaucoma indices were assessed. Complete success rate (CSR) was identified as achieving an end‐point of intraocular pressure <21 without any antiglaucoma medications. Data were analysed to compare pre‐ and postintervention changes and to compare both procedures. Results: After follow‐up of 35.8 (34.5) months, NPDS procedure went smooth in 74 eyes of 63 patients. The complete success rate was 79.7%, whereas the overall success rate was 82.4%. Thirteen cases failed. The probability to survive was 74.6% after the 12th month. The mean intraocular pressure (IOP) went down to 11.5 ± 3.0 mmHg compared to 31.9 mmHg preoperatively. Comparing cases with NPDS to those with PDS, the magnitude of IOP reduction (15.8) was higher than that of the PDS (14.8); however, this difference was not statistically significant (p = 0.259). Apart from involuntary perforation of trabeculodescemetic window (TDW), neither intra‐operative nor early postoperative complications were observed. Conclusions: Deep sclerectomy in childhood glaucoma can effectively reduce the IOP, without the occurrence of serious complications that are commonly seen after trabeculotomy or combined trabeculotomy trabeculectomy.     

青光眼深层巩膜切除联合可吸收缝线植入术

目的探讨一种非穿透性深层巩膜切除术治疗开角型青光眼的新方法,观察其疗效和并发症.方法对18例(26眼)开角型青光眼采用深层巩膜切除联合可吸收缝线植入术治疗.结果术前平均眼压为(38.5±4.3)mmHg(1 mmHg=0.133kPa),随访3～14月(平均6月),术后不用任何降眼压药物,平均眼压为(17.1±5.2)mmHg,差异具有显著性意义(P＜0.05),其中术后眼压≤21 mmHg者21眼,占80.8%.术后5眼眼压＞21 mmHg(19.2%),2眼前房积血.但无浅前房、炎症反应或脉络膜脱离等并发症.结论深层巩膜切除联合可吸收缝线植入术是治疗开角型青光眼一种有效方法,但手术操作较为复杂,远期疗效有待进一步观察.     

Deep sclerectomy: results with and without collagen implant

Purpose: To study the need, the safety and the success rate of collagen implant in eyes that underwent deep sclerectomy, a new non penetrating filtration procedure, we compared the results of deep sclerectomy with (DSCI) and without (DS) collagen implant. Methods: Of 168 patients (168 eyes) with various types of medically uncontrolled open angle glaucoma, 86 (86 eyes) underwent DSCI, and 82 (82 eyes) underwent DS. Visual acuity, slit lamp examination, intraocular pressure (IOP) measurements were performed before surgery and prospectively at days 1 and 7 and months, 1, 2, 3, 6, 9, 12, 15, 18, and 24 after surgery. Deep sclerectomy was performed according to Kozlov's original technique. The collagen implant drainage device was radially secured in the center of the deep sclerectomy dissection. Results: The mean follow-up period was 9.7 ± 6.5 months for DSCI, and 9.0 ± 4.8 months for DS. The mean preoperative IOP was 26.9 ± 8.8 mmHg for DSCI and 25.8 ± 8.5 mmHg for DS. The mean postoperative IOP and visual acuity were similar between the two groups. Complete and qualified success rates were better when the collagen implant was used (Log-Rank test: p = 0.0002 and 0.033 for complete and qualified success respectively). The need for postoperative glaucoma medications was significantly lower when the collagen implant was used (0.2 ± 0.5 versus 0.5 ± 0.7 medication per patient in the DSCI and DS respectively, Student's t test: p = 0.0038). There was significantly less bleb fibrosis when the collagen implant was used (2% and 11% in DSCI and DS respectively, p = 0.029). Conclusion: The collagen implant device is safe, increases the success rate of deep sclerectomy, and lowers the need for postoperative glaucoma medications.     

深层巩膜切除联合羊膜植入术近期疗效观察

目的　观察深层巩膜切除联合羊膜植入对开角型青光眼的近期治疗效果。方法　对 15例 18眼原发性开角型青光眼患者行深层巩膜切除联合羊膜植入手术 ,术后观察视力、眼压、前房反应和滤过泡情况。结果　术前平均眼压为2 7.7mm Hg± 8.3m m Hg(1k Pa=7.5 m m Hg) ,术后 3个月平均眼压为 15 .1mm Hg± 4 .6 mm Hg ,差异有显著性 (P <0 .0 1) ,平均眼压下降幅度为 4 5 .5 % (12 .6 mm Hg)。单纯手术治疗术后眼压控制≤ 2 1mm Hg者 11眼 (6 1.1% ) ,需加用局部降眼压药物方可控制眼压者 6例 (33.3% )。术后发生浅前房、前房积血各 1例 ,未观察到脉络膜脱离、黄斑水肿、白内障及眼内炎等严重并发症的发生 ,所有病例术前与术后1、7d、3个月视力统计学差异无显著性。结论　深层巩膜切除联合羊膜植入能有效降低开角型青光眼患者眼压 ,且并发症少 ,视力恢复快 ,是一种很有临床应用前景的抗青光眼术式。     

深层巩膜切除术联合透明质酸片植入治疗原发性开角型青光眼

目的:探讨深层巩膜切除联合透明质酸片植入(DSHI)治疗原发性开角型青光眼(POAG)的临床疗效。方法:回顾性总结在Saarland大学眼科医院行DSHI治疗的POAG。结果:符合条件并入选的有216患者的377只POAG。平均随诊31(5～51)mo。术前平均眼压(28.3±8.4)mmHg(1mmHg=0.133kPa),术后1wk,6mo,1、2、3、4a眼压分别为(9.7±3.6)、(12.4±5.3)、(15.5±8.7)、(15.4±6.8)、(16.1±6.7)、(17.4±7.5)mmHg。术前平均视力为0.65,术后1wk,6mo,1、2、3、4a视力分别为0.63、0.68、0.72、0.71、0.76、0.70。术后1a显效(不加抗青光眼药物且眼压≤21mmHg)率为89%,有效(加抗青光眼药物时眼压≤21mmHg)率为9%。术后4a时,显效率为45%,有效率48%。并发症包括切口渗漏、前房出血、脉络膜脱离等。结论:DSHI对POAG治疗效果良好,并发症少且轻微。     

In vivo study comparing an X-shaped polymethylmethacrylate and a cylindrical collagen implant for deep sclerectomy

Background: Study in vivo characteristics of a polymethylmethacrylate (PMMA) implant compared to the standard cylindrical collagen implant for deep sclerectomy (DS). Design: Six‐month comparative study. Samples: Twenty eyes of ten rabbits. Methods: Eyes were randomized to have DS with PMMA implant in one eye and collagen implant in the opposite eye. The growth of the new subconjunctival drainage vessels was assessed by combined fluorescein and indocyanin green anterior segment angiography; intrascleral and subconjunctival blebs were imaged by ultrasound biomicroscopy (UBM). At six months, outflow facility (C) was measured by anterior chamber perfusion and portions of one side of the DS were compared to portions on the 180° opposite side and native sclera on histology. Results: The mean IOP preoperatively and at one, four, twelve, and twenty‐four weeks was comparable in both groups (P > 0.1). UBM showed a statistically insignificant quicker regression of the subconjunctival bleb as well as a durable intrascleral lake in the PMMA group (P > 0.05). New drainage vessels were initially observed one month after surgery; they were more numerous in the PMMA group on angiographic and histological findings at 6 months (P < 0.05). The mean C increased significantly after surgery compared to preoperative values (P < 0.05) and no difference was observed between the implants (0.24 ± 0.06 µl/min/mmHg [PMMA] and 0.23 ± 0.07 µl/min/mmHg [collagen implant]) (P = 0.39). Conclusions: Deep sclerectomy performed with PMMA or collagen implants showed similar IOP lowering effects, outflow facility increase, and degree of inflammatory reaction.     

Deep sclerectomy with mitomycin C in eyes with failed glaucoma surgery and pseudophakia

Purpose

To report outcomes of deep sclerectomy (DS) with intraoperative mitomycin C (MMC) application in eyes with previous failed glaucoma surgery (GS) and/or cataract extraction (CE).

Patients and methods

Single-surgeon case series of 82 eyes of 82 patients undergoing DS with MMC. The patients had previous CE with IOL and/or conjunctival GS and treated intraocular pressure (IOP) >18 mm Hg. MMC (0.2 mg/ml) was applied for 2–3 min before scleral flap dissection. Complete success was defined as IOP between 6 and 21 mm Hg or a reduction of 20% from baseline without medications. Reoperation for glaucoma or related complications, or loss of light perception vision was considered as failure.

Results

Mean follow-up was 57.7±22.4 months with 78% of patients completing the 3-year follow-up. Mean IOP decreased from 24.0 mm Hg (22.3–25.6, 95% confidence intervals) to 13.4 mm Hg (12.0–14.2) at 3 years after surgery (P<0.001). There was a significant decrease in the number of glaucoma medications from 2.0±1 preoperatively, to 0.3±0.7, 3 years after surgery. Kaplan–Meier cumulative success rates were 85.6% at 1 year, 80.0% at 2 years, and 76% at 3 years. At 3 years, IOP was maintained <19 and 15 mm Hg in 83 and 70% of eyes, respectively. Fourteen eyes (17.1%) had complications. Delayed hypotony (IOP <6 mm Hg) was the commonest complication in five eyes (6.1%).

Conclusion

DS with MMC appears to be a safe and effective surgical procedure for eyes with previous intraocular surgery.     

Non-penetrating deep sclerectomy and collagen implant surgery in glaucoma patients with advanced field loss

Purpose: The aim of the study was to determine the medium term intraocular pressure (IOP) lowering effects and the potential complications of non-penetrating deep sclerectomy and collagen implant (DSCI) surgery in glaucoma patients. Patients and methods: 54 eyes of 52 patients with medically uncontrolled open angle glaucoma with advanced field loss underwent DSCI under topical anaesthesia. Follow-up period was 24 months. Results: The mean preoperative IOP was 24.7 ± 6.2 mmHg and decreased to 15.1 ± 4.0 mmHg at 24 months (p = 0.0068). During the follow- up period, 36 of 54 eyes (66%) received no topical antiglaucomatous medications. In 18 eyes, monotherapy with topical beta blockers (Betaxolol HCl) was added to the regimen. At last visit , only two patients (3.8%) had IOP greater than 18 mmHg. We did not detect any additional optic disc changes, visual field or visual acuity defects postoperatively. Detailed slit-lampexamination revealed no anterior segment complications regarding the probablecomplications of trabeculectomy. None of the patients developed surgery relatedcataract. As a complication, we diagnosed one case of self-limited, shallow choroidal detachment. Conclusion: DSCI appears to provide considerable medium term IOP decrease with few postoperative complications without deteriorating visual acuity. Owing to our medium term results, we believe that DSCI could be a valuable alternative to trabeculectomy especially in cases of advanced medically uncontrolled open angle glaucoma.     

Ex-press微型引流器植入联合深层巩膜切除术治疗难治性青光眼

目的：：探讨Ex-press微型引流器植入联合深层巩膜切除术治疗难治性青光眼的临床疗效。方法：收集2014-01/11难治性青光眼患者24例30眼,施行Ex-press微型引流器( P-50)植入联合深层巩膜切除术。术后随访12mo,分析术前及术后疼痛感、眼压、视力、并发症等情况。结果：术后随访期间所有患者眼痛症状均缓解。术前平均眼压为51.15±2.60mmHg,末次随访时平均眼压15.11±2.51mmHg,术后眼压与术前相比,差异有统计学意义( P<0.05)。术后视力有提高者8眼,无显著改变者22眼。术后前房出血2眼(7%),1wk后出血吸收。结论：Ex-press微型引流器植入联合深层巩膜切除术是治疗难治性青光眼相对安全、有效的方法,能显著降低眼压,减少患者痛苦,且并发症少。     

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。     

改良式小梁切除联合深层巩膜切除术

小梁切除术一直是最为经典的抗青光眼手术,也是适应证最广、降眼压幅度最大的外滤过性手术代表。根据小梁切除术的降眼压机制及其术式改良的演变与发展,本文在既往各种术式改良的基础上,总结了一种较为优化的术式——小梁切除联合深层巩膜切除术。此术式发挥了多种引流机制、降眼压幅度大、可有效避免滤过泡相关远期并发症;手术适应证与小梁切除术相同,更适合于中晚期青光眼患者;操作简单、易学;术后并发症相对较少。(眼科,2022,31:175-180)     

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.     

Outflow mechanisms after deep sclerectomy with two different designs of collagen implant in an animal model

Background To study experimentally two different shapes of collagen implants (CI) used in deep sclerectomy (DS). The ability to promote drainage vessels, outflow mechanisms, success rates, and biodegradability, were studied prospectively in an animal model.Materials and methods DS was performed in 20 eyes of ten rabbits. Each rabbit randomly received a cylindrical CI in one eye, while the other eye received a flat CI. Intraocular pressure (IOP) measurement, ultrasound biomicroscopy (UBM) examination of DS site and simultaneous fluorescein and indocyanin green anterior-segment angiography were performed preoperatively, at 1 and 2 weeks, 1, 2, 3, 6 and 9 months for each eye. At the end of the follow-up period, outflow facility (OF) was measured and histological examinations of the filtration site were performed.Results In the cylindrical implant group, IOP significantly dropped from a mean preoperative value of 14.8±2.2 mmHg to a mean postoperative values of 10.9±3.3, 12.5±2.2, 11.8±2.6, 11.2±2.3, 10.7±1.9, 14.0± 3.2, 12.6±2.4 mmHg at 1, 2 weeks, and 1, 2, 3, 6, and 9 months, respectively. In the flat CI group, IOP significantly dropped from a mean preoperative value of 14.1±1.8 mmHg to a mean postoperative values of 10.4±2.7, 12.7±1.9, 12.5±3.2, 11.2±1.6, 11.6±1.8, 11.5±2.3, 11.0±2.2 mmHg at 1, 2 weeks, and at 1, 2, 3, 6, and 9 months, respectively. UBM images showed a gradual resorption of both type of CI during the first 3 months, and angiographies showed progressive growth of drainage vessels around the filtration site in both groups. The mean OF 9 months postoperatively for the cylindrical CI was 0.53 (SD ± 0.23) ml/min per mmHg and was 0.56 (SD±0.17) ml/min per mmHg for the flat CI (P=0.6). Histological examination revealed excellent biocompatibilty and a high density of drainage vessels in the sclera around the operative site in both groups.Conclusion Using IOP and OF measurements, UBM, angiography, and histology, we were able to compare two types of CI used as space maintainer in DS. Both CIs showed efficient IOP lowering effect and outflow facility increase, possibly explained by stimulation of drainage vessels growth. Both implants showed excellent biocompatibility. The flat CI showed a slight tendency towards better overall performances.Financial support: Fonds National Suisse pour la Recherche Scientifique N° 32-64103.00.Financial interest: the study was partly sponsored (implants) by STAAR surgical AG, Nidau, Switzerland.     

Deep sclerectomy in pediatric glaucoma filtering surgery

Purpose

To study the additive value of deep sclerectomy to the procedure of combined trabeculotomy—trabeculectomy with mitomycin C (CTTM) for the treatment of primary congenital glaucoma.

Study design

This study is a prospective, randomized case series.

Patients and methods

The study was conducted on 20 eyes of 20 children with primary congenital glaucoma presenting to the Department of Ophthalmology of the Alexandria Main University Hospital. Preoperative examination under anesthesia was followed by surgical intervention. Postoperative examinations were conducted immediately after surgery and at 1, 2, 3, 6, 9, and 12 months. Intraoperative and postoperative complications, as well as operative time, were recorded.

Results

The mean (±SD, range) age of the study patients in the CTTM group and in the combined trabeculotomy–trabeculectomy with mitomycin C with deep sclerectomy (CTTM-DS) group was 4.7 (±2.0, 2–8) and 7.0 (±3.8, 3–13) months, respectively. The mean (±SD, range) preoperative intraocular pressure (IOP) in the CTTM and CTTM-DS groups was 16.7 (4.3, 10–26) and 16.4 (8.4, 8–36), respectively, and these dropped at 12 months of follow-up to 4.9 (2.0, 2–8) and 5.6 (3.3, 2–10), respectively. The mean (±SD, range) of the duration of the operation in the CTTM and the CTTM-DS was 57 (±8, 50–71) min and 53 (±7, 42–64) min, respectively (P=0.428). Two eyes (20%) in the CTTM-DS group developed hypotony disc edema at the first 2 months and resolved spontaneously thereafter. No other complications were noted in either of the groups.

Conclusion

The addition of deep sclerectomy to the procedure of CTTM in pediatric glaucoma surgery facilitates the finding of Schlemm''s canal, shortens the duration of surgery, and is not associated with any additional complications. Hence, the author recommends the addition of deep sclerectomy to CTTM surgery for primary congenital glaucoma.     

基于UBM观察的CO2激光辅助深层巩膜切除术对开角型青光眼患者的治疗效果分析

目的　观察CO₂激光辅助深层巩膜切除术（CLASS）治疗开角型青光眼（OAG）的临床效果,并应用超声生物显微镜（UBM）检查探讨手术区域房水引流途径。方法　对25例（25眼）OAG患者行CLASS治疗,术后随访12个月,观察患者最佳矫正视力、眼压、滤过泡形态,同时对手术区域进行UBM检查,观察巩膜瓣下形成液间腔（巩膜池）的大小（前后长度和高度）、剩余后弹力层-小梁网膜（TDM）厚度的变化。结果　随访12个月,手术前后最佳矫正视力差异无统计学意义（F=7.716,P>0.05)。术后1周眼压最低,之后逐渐回升,术后3个月趋于平稳,术后各时间点眼压与术前相比,差异均有统计学意义（均为P＜0.05)。术后12个月,4眼具有功能性滤过泡,21眼为无功能性滤过泡。UBM检查可见所有患眼均形成巩膜池,均具有完整的TDM。随访期间,剩余TDM厚度未见明显变化（P>0.05）。术后1个月与术后3个月、6个月、12个月相比,巩膜池前后长度、巩膜池高度差异均有统计学意义（均为P<0.05）;术后3个月、6个月、12个月两两相比,巩膜池前后长度、巩膜池高度差异均无统计学意义（均为P>0.05）。结论　CLASS能有效降低眼压,远期效果良好,是一种治疗OAG的有效方法。UBM检查能清楚地显示CLASS术后主要通过小梁网、深层巩膜、脉络膜引流房水降低眼压,适合CLASS术后的随访。     

深层巩膜切除联合Healon GV注入治疗开角型青光眼

目的　观察深层巩膜切除联合玻璃酸钠 (HealonGV)注入对开角型青光眼的近期治疗效果。方法　对 15例 19眼原发性开角型青光眼患者行深层巩膜切除联合浅巩膜瓣下HealonGV注入 ,术后观察视力变化、眼压、前房反应和滤过泡情况。结果　术前眼压为 (2 7 6± 8 1)mmHg ,术后 3个月为 (15 2± 4 7)mmHg ,差异有显著性 (P <0 0 0 1) ,平均眼压下降幅度为 44 9% (12 4mmHg)。术后发生浅前房、前房积血各 1例 1眼 ,未观察到严重并发症。所有病例术前与术后 1d、7d、3个月视力统计学差异无显著性。结论　深层巩膜切除联合HealonGV注入能有效降低开角型青光眼患者眼压 ,且并发症少 ,视力恢复快 ,是一种很有临床应用前景的抗青光眼术式     

Factors associated with non‐penetrating deep sclerectomy failure in controlling intraocular pressure

Acta Ophthalmol. 2011: 89: 58–61

Abstract.

Purpose: To identify factors related to non‐penetrating deep sclerectomy (NPDS) failure in controlling intraocular pressure (IOP). Methods: A case–control study was performed through a logistic regression modelling. All cases and controls had at least 2 years of follow‐up. Cases comprised eyes that had undergone an NPDS and presented an end‐point IOP > 18 mmHg; controls consisted of eyes that had undergone an NPDS and achieved an end‐point IOP < 18 mmHg without medication. Cases and controls were paired by sex and postoperative time. The following independent variables were tested: race, previous ocular surgery, number of topical medications prior to surgery, age, preoperative IOP, severity of glaucomatous visual field loss, use of mitomycin C (MMC), YAG laser goniopuncture and IOP in the first day after surgery. Results: Two hundred and sixty‐nine eyes were studied (136 cases and 133 controls). Absence of intraoperative MMC and high preoperative IOP were related to an end‐point IOP > 18 mmHg after 2 years of follow‐up. Conclusion: Two factors seem to be associated to NPDS failure: the absence of intraoperative MMC and preoperative IOP.     

Non-penetrating deep sclerectomy (NPDS) with or without collagen device (CD) in primary open-angle glaucoma: middle-term retrospective study

The purpose of this study is to evaluate the middle-term tonometric results of a new filtering procedure, the non-penetrating deep sclerectomy with or without collagen device, in primary open-angle glaucoma. This technic aims to eliminate or minimize the complications of classical trabeculectomy. Method: This procedure was carried out by Koslov and colleagues. This is performed under a limbal-based conjunctival flap and a superfical scleral flap, the ablation of a deep scleral flap taking away the external wall of Schlemm's canal, only living in place the Descemet membrane. One must obtain a visible filtration across the opened Schlemm's canal and Descemet membrane. To improve the aqueous filtration, a cylindric collagen device, made from porcine scleral tissue, biocompatible, known for its high water content, is fixed in the deep scleral bed with a 10/0 nylon suture. This device provides a support for the elimination route of aqueous humor and acts like a sponge, carrying the liquid by capillary action. It is sterilized by irradiation. Full guarantee against viral contamination is provided. This procedure ends in one suture (10/0 nylon) of superficial scleral flap and conjunctival closing suture. When NPDS is performed without CD, a sponge of 5FU is used and the superficial scleral flap is not sutured. Retrospective study: Our material included 111 patients, 148 eyes in CD group; 43 patients, 55 eyes in the group without CD. The average follow-up was 13.3 ± 5.8 months in the CD group, 7.2 ± 3.5 months in the group without CD. All patients presented a POAG without risk factors of bleb failure. Results: The average IOP before the operation and at the end of the follow-up period was 7.2 ± 6.3 mmHg in the CD group; 8.3 ± 7.6 mmHg in the group without CD (no significant difference). The probability-success rate with the Kaplan-Meier method (IOP 20 mmHg) was, in the CD group, at 18 months, 68% and 69% in the group without CD, without medical treatment. With monotherapy, the success rate was 85% in the CD group, 74% in the group without CD (p 0.05). Prospective study: Afterwards, we have conducted a prospective study comparing two groups of patients with POAG without risk factors of bleb failure, operated with and without collagen device, without 5FU in the second group. Our material included 31 patients, 31 eyes, one eye for each patient, two surgeons; 17 eyes in the CD group, 14 eyes in the group without CD. The average age was 65.8 ± 8.2 years in the first group; 64.1 ± 10.3 in the second group. The average follow-up was 11 months in both groups. Results: A average IOP was 8.3 ± 5.8 in the CD group; 12.3 ± 6 in the group without CD (p < 0.05). The probability-success rate without treatment at 12 months: 58% in the first group, 90% in the second group (p < 0.05) and with monotherapy: 80% and 90% (N.S.). In both studies, in both groups, except microperforations, more frequent in the prospective group without CD, no complications of the trabeculectomy were observed. The mean change in visual acuity was inferior to 0.1 at the end of the follow-up. A postoperative rise in IOP can occur. It can be due to an internal obstruction (goniosynechiae or bad filtration). It can be treated with Nd-Yag laser. It can also be due to external obstruction, treated by 5FU injections into the bleb. The success of these procedures were similar in the whole group. Conclusion: Non penetrating deep sclerectomy can be considered as an excellent alternative to trabeculectomy in open and wide angles. It does not modify visual acuity. It carries away less complications than trabeculectomy and the use of antimitotic agents is safer. Collagen device does not seem, at middle-term, to improve tonometric results.