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Papers by HERMES ENRIQUE Morelo Sanchez
Klinische Monatsblätter für Augenheilkunde, 1997
OBJECTIVE To study the learning risk of a new surgical technique, the deep sclerectomy (DS), whic... more OBJECTIVE To study the learning risk of a new surgical technique, the deep sclerectomy (DS), which may be complicated with a perforation of the trabeculodescemetic membrane. To do so, we compared the results and the complications of patients who underwent DS transformed in trabeculectomy (DSt) and those of patients who underwent trabeculectomy (TE). MATERIALS AND METHODS Between june 1994 and june 1996, we performed 234 DS, 19 of them had to be transformed into a TE, because of a perforation of the trabeculodescemetic membrane during the deep sclerocorneal dissection. Two matched groups of patients were prospectively followed, one group including 19 DSt and a control group including 19 TE. RESULTS The IOP decrease on the first postoperative day was greater in the DSt-group compared to the TE-group (2.32 +/- 3.89 vs 6.73 +/- 4.31, p = 0.004). Scleral perforations occurred mainly during the learning phase of this new surgical technique. Postoperative complications were similar in both groups, except for hypotony and hyphema which were more frequent in the DSt-group (hypotony: 90% vs 37%, p = 0.0019; hyphema: 68% vs 16%, p = 0.017). The long term success rate with or without medication were comparable in both groups. CONCLUSION This study shows that, when a DS is complicated with a perforation of the trabeculodescemetic membrane, the long term success rate of the surgery is similar to that of trabeculectomy. However, immediate postoperative complications such as hypotony and hyphema are increased. These results should encourage surgeons to learn this new non perforating filtration surgery.
Journal of Cataract and Refractive Surgery, 2001
To study prospectively the success rate and complications of deep sclerectomy with collagen impla... more To study prospectively the success rate and complications of deep sclerectomy with collagen implant (DSCI), a nonpenetrating filtration procedure. Glaucoma Unit, Department of Ophthalmology, Hôpital Ophtalmique Jules Gonin, University of Lausanne, Lausanne, Switzerland. This nonrandomized prospective trial comprised 105 eyes of 105 patients with medically uncontrolled primary or secondary open-angle glaucoma. Visual acuity, intraocular pressure (IOP), and slitlamp examinations were performed before and after surgery at 1 and 7 days and 1, 3, 6, 9, 12, 18, 24, 30, 36, 48, 54, 60, and 66 months. Visual field examinations were repeated every 6 months. A qualified success was defined as IOP below 21 mm Hg with or without medication. A complete success was defined as IOP lower than 21 mm Hg without medication. The mean follow-up was 43.2 months +/- 14.3 (SD). The mean IOP was 26.8 +/- 7 mm Hg preoperatively, 5.1 +/- 3 mm Hg 1 day postoperatively, and 11.8 +/- 3 mm Hg 60 months postoperatively. At 60 months, the qualified success rate was 94.8% and the complete success rate, 61.9%. The IOP was lower than 21 mm Hg with medication in 32.1% of patients at 60 months; 48 patients (45.7%) had an IOP of 15 mm Hg or lower without medication. No patient developed a shallow or flat anterior chamber, endophthalmitis, or surgery-induced cataract. However, 23 (21.9%) had progression of a preexisting senile cataract. Injections of 5-fluorouracil were given to 25 patients (23.8%) who had DSCI to salvage encysted blebs. The mean number of medications per patient was reduced from 2.30 +/- 0.76 to 0.49 +/- 0.72. Deep sclerectomy with collagen implant provided reasonable IOP over a long-term follow-up with few immediate postoperative complications.
International Ophthalmology, 1997
To study the need, the safety and the success rate of collagen implant in eyes that underwent dee... more 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. 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. 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). The collagen implant device is safe, increases the success rate of deep sclerectomy, and lowers the need for postoperative glaucoma medications.
British Journal of Ophthalmology, 1999
Aims-To study prospectively the success rate and complications of deep sclerectomy with collagen ... more 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 diVerent types of open angle glaucoma, no diVerence 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.
Klinische Monatsblätter für Augenheilkunde, 1997
OBJECTIVE To study the learning risk of a new surgical technique, the deep sclerectomy (DS), whic... more OBJECTIVE To study the learning risk of a new surgical technique, the deep sclerectomy (DS), which may be complicated with a perforation of the trabeculodescemetic membrane. To do so, we compared the results and the complications of patients who underwent DS transformed in trabeculectomy (DSt) and those of patients who underwent trabeculectomy (TE). MATERIALS AND METHODS Between june 1994 and june 1996, we performed 234 DS, 19 of them had to be transformed into a TE, because of a perforation of the trabeculodescemetic membrane during the deep sclerocorneal dissection. Two matched groups of patients were prospectively followed, one group including 19 DSt and a control group including 19 TE. RESULTS The IOP decrease on the first postoperative day was greater in the DSt-group compared to the TE-group (2.32 +/- 3.89 vs 6.73 +/- 4.31, p = 0.004). Scleral perforations occurred mainly during the learning phase of this new surgical technique. Postoperative complications were similar in both groups, except for hypotony and hyphema which were more frequent in the DSt-group (hypotony: 90% vs 37%, p = 0.0019; hyphema: 68% vs 16%, p = 0.017). The long term success rate with or without medication were comparable in both groups. CONCLUSION This study shows that, when a DS is complicated with a perforation of the trabeculodescemetic membrane, the long term success rate of the surgery is similar to that of trabeculectomy. However, immediate postoperative complications such as hypotony and hyphema are increased. These results should encourage surgeons to learn this new non perforating filtration surgery.
Journal of Cataract and Refractive Surgery, 2001
To study prospectively the success rate and complications of deep sclerectomy with collagen impla... more To study prospectively the success rate and complications of deep sclerectomy with collagen implant (DSCI), a nonpenetrating filtration procedure. Glaucoma Unit, Department of Ophthalmology, Hôpital Ophtalmique Jules Gonin, University of Lausanne, Lausanne, Switzerland. This nonrandomized prospective trial comprised 105 eyes of 105 patients with medically uncontrolled primary or secondary open-angle glaucoma. Visual acuity, intraocular pressure (IOP), and slitlamp examinations were performed before and after surgery at 1 and 7 days and 1, 3, 6, 9, 12, 18, 24, 30, 36, 48, 54, 60, and 66 months. Visual field examinations were repeated every 6 months. A qualified success was defined as IOP below 21 mm Hg with or without medication. A complete success was defined as IOP lower than 21 mm Hg without medication. The mean follow-up was 43.2 months +/- 14.3 (SD). The mean IOP was 26.8 +/- 7 mm Hg preoperatively, 5.1 +/- 3 mm Hg 1 day postoperatively, and 11.8 +/- 3 mm Hg 60 months postoperatively. At 60 months, the qualified success rate was 94.8% and the complete success rate, 61.9%. The IOP was lower than 21 mm Hg with medication in 32.1% of patients at 60 months; 48 patients (45.7%) had an IOP of 15 mm Hg or lower without medication. No patient developed a shallow or flat anterior chamber, endophthalmitis, or surgery-induced cataract. However, 23 (21.9%) had progression of a preexisting senile cataract. Injections of 5-fluorouracil were given to 25 patients (23.8%) who had DSCI to salvage encysted blebs. The mean number of medications per patient was reduced from 2.30 +/- 0.76 to 0.49 +/- 0.72. Deep sclerectomy with collagen implant provided reasonable IOP over a long-term follow-up with few immediate postoperative complications.
International Ophthalmology, 1997
To study the need, the safety and the success rate of collagen implant in eyes that underwent dee... more 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. 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. 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). The collagen implant device is safe, increases the success rate of deep sclerectomy, and lowers the need for postoperative glaucoma medications.
British Journal of Ophthalmology, 1999
Aims-To study prospectively the success rate and complications of deep sclerectomy with collagen ... more 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 diVerent types of open angle glaucoma, no diVerence 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.