Modified deep sclerectomy for the surgical treatment of glaucoma (original) (raw)
Related papers
Clinical Ophthalmology
To report the outcome and complications of a combined surgical technique of modified deep sclerectomy and trabeculectomy (mDST) for glaucoma. Patients and Methods: Retrospective study of 44 eyes of 43 patients with open and closed angle glaucoma who underwent mDST. Outcome measures were: Surgical Success with 3 criteria-(i) criterion 1 = intraocular pressure (IOP) ≤21 mmHg or reduced by ≥20% of preoperative IOP or IOP ≥6 mmHg on 2 consecutive time points after 3 months; (ii) criterion 2 = IOP ≤18 mmHg or reduced by ≥30% of pre-operative IOP or IOP ≥6 mmHg on 2 consecutive time points after 3 months and (iii) criterion 3 = IOP ≤15 mmHg or reduced by ≥40% of preoperative IOP or IOP ≥6 mmHg on 2 consecutive time points after 3 months; IOP Reduction; Use of Anti-glaucoma Medication; Complications; Visual Acuity and Postoperative Interventions. Results: Median follow-up was 40 months (range 24-77 months). At the final follow-up visit, the mean postoperative IOP was 11.5 ± 4.7 mmHg (p<0.0001). Mean number of antiglaucoma medications decreased from 2.45 ± 1.21 to 0.54 ± 0.95 (p<0.0001). Surgical success in terms of IOP reduction was 50%; 43.2%; 36.4% for the 3 criteria respectively (complete success) and 70.5%; 56.8%; 47.7% for the 3 criteria respectively (qualified success). The complications noted were shallow/flat anterior chamber in 2 (4.54%), hyphema & bleb leak in 3 (6.81%), aqueous misdirection in 1 (2.27%), hypotonic maculopathy in 2 (4.45%) and hypotony requiring intervention in 6 (13.63%) eyes. Conclusion: Combined mDST was found to be an effective surgical procedure in reducing IOP. It was associated with complications commonly encountered in glaucoma filtering surgery. The use of intra-scleral space maintainer may help lower the risk of flat or shallow anterior chamber during the early postoperative period.
Efficacy and Safety of Trabeculectomy vs Nonpenetrating Surgical Procedures
JAMA Ophthalmology, 2013
IMPORTANCE To date, only a few studies have directly compared nonpenetrating surgery (NPS) and trabeculectomy (TE). Therefore, there is no strong evidence as to which surgical technique leads to the best results in terms of ocular hypotensive effect and safety. OBJECTIVE To compare the hypotensive effect and safety of NPS and TE in terms of intraocular pressure (IOP) reduction and incidence of complications. DATA SOURCES The MEDLINE and EMBASE databases were searched for studies potentially eligible in any language published up to March 31, 2013. STUDY SELECTION Systematic review and meta-analysis of comparative studies of 2 or more surgical techniques (1 of which had to be TE), including patients with open-angle glaucoma. DATA EXTRACTION AND SYNTHESIS The considered interventions were TE, deep sclerectomy (DS), viscocanalostomy, and canaloplasty. MAIN OUTCOMES AND MEASURES The primary outcome was the mean between-group difference in the reduction in diurnal IOP from baseline to the 6-or 12-month follow-up evaluation. We also considered the incidence of complications, expressed as relative risk. RESULTS Eighteen articles, accounting for 20 comparisons, were selected for data extraction and analysis. Analysis of the 6-month follow-up data showed that the pooled estimate of the mean between-group difference was −2.15 mm Hg (95% CI, −2.85 to −1.44) in favor of TE. There was no difference between the NPS subgroups. In the subgroup antimetabolite analysis, the addition of mitomycin C to TE and DS decreased the difference in the reduction in IOP (TE and DS without mitomycin C: −2.65 mm Hg [95% CI, −3.90 to −1.39]; TE and DS with mitomycin C: −0.83 mm Hg [95% CI, −2.40 to 0.74]). In the subgroup analysis by implant addition, no significant difference induced by DS with or without drainage devices was detected (test for subgroup differences: χ 2 1 = 0.24; P = .62). The absolute risk of hypotony, choroidal effusion, cataract, and flat or shallow anterior chamber was higher in the TE group than in the NPS group. CONCLUSIONS AND RELEVANCE Trabeculectomy seems to be the most effective surgical procedure for reducing IOP in patients with open-angle glaucoma. However, as expected, it was associated with a higher incidence of complications when compared with NPS.
Graefe's Archive for …, 2010
Background To evaluate and compare the results and complications after uneventful phaco-deep sclerectomy in one eye with intended phaco-deep sclerectomy converted to phaco-trabeculectomy in the fellow eye. Methods In this retrospective study, we analyzed thirty-two eyes of sixteen patients in which bilateral phaco-deep sclerectomy was planned but one eye was converted to phaco-trabeculectomy after perforation of the trabeculo-Descemet's membrane. Visual acuity (VA), slit-lamp examinations, intraocular pressure (IOP), and the number of glaucoma medications were recorded preoperatively and postoperatively at 1 day, 1 week, and 1, 3, 6, 12, 18, and 24 months. The postoperative complications were recorded. Comparisons between the two groups were performed. Results The IOP was significantly lower in both groups at every postoperative visit. The postoperative IOP and VA levels did not differ significantly between the groups. However, at the last postoperative visit, eyes that underwent uneventful phaco-deep sclerectomy required fewer glaucoma medications than eyes converted to phaco-trabeculectomy (P =0.04). At 24 months, the group that underwent uneventful phaco-deep sclerectomy had a higher complete success rate (P =0.01). Immediate postoperative complications such as hyphema, a shallow anterior chamber, or a choroidal detachment occurred more frequently in eyes converted to phaco-trabeculectomy, although the difference did not reach significance. Conclusions There were no differences in VA or IOP control between uneventful phaco-deep sclerectomy and phaco-deep sclerectomy converted to phaco-trabeculectomy. However, fewer drugs were needed to successfully control IOP and the rate of complications was lower if phaco-deep sclerectomy was completed uneventfully.
Eye, 2022
BACKGROUND/OBJECTIVES: To evaluate current routine trabeculectomy technique preferences among Australian and New Zealand Glaucoma Society surgeons regularly performing trabeculectomy surgery. SUBJECTS/METHODS: Survey of experienced surgeons who perform trabeculectomy. RESULTS: Forty-nine surgeons (33 male:16 female) participated in the survey. Trabeculectomy was performed as day surgery (39/ 47, 83.0%) under local anesthesia (44/47, 93.6%). The surgical techniques most commonly used were a corneal traction suture (44/ 47, 93.6%), fornix-based conjunctival flap (43/47, 91.5%) and half-thickness scleral flap (38/47, 81.0%). Mitomycin C antifibrotic agent was used in routine cases by 45/46 (97.8%) surgeons. Surgeons applied the antifibrotic agent under the Tenon layer with a pledget (36/46, 78.2%) with a concentration of 0.02% (37/46, 80.4%) for 2 (11/46, 23.9%) or 3 min (30/46, 65.2%). The Kelly (26/46, 56.5%) and the Khaw Descemet (19/46, 41.3%) punches were used to perform the sclerostomy. Most surgeons performed a peripheral iridectomy in all phakic patients (46/47, 97.9%), but less commonly in pseudophakic patients (34/47, 72.3%). Techniques for closure of the limbal conjunctival edge were quite varied with a combination of suturing including purse string (21/47, 57.4%), wing (20/47, 42.6%) and horizontal mattress sutures (33/47, 70.2%). Surgeons reviewed their routine patients four times in the first month (29/47, 61.7%) and continued the postoperative topical steroids for 3-4 months (28/47, 59.6%). CONCLUSIONS: Although a wide range of techniques for trabeculectomy exists among surgeons, there are consistent procedures currently in use to optimize patient outcomes. This report will assist surgeons in choosing which surgical techniques fit their best practice.
A modified deep sclerectomy with or without external trabeculectomy: a comparative study
Clinical Ophthalmology
To determine whether the removal of the inner wall of Schlemm's canal (external trabeculectomy) improves the effectiveness of a modified method of deep sclerectomy (DS), which we will call "reversed" deep sclerectomy (RDS). We conducted a prospective study of two groups of patients. Group A included 22 eyes of 18 patients with open angle glaucoma (OAG) under maximum medical treatment, which underwent RDS - a modified method of performing DS - with the removal of the inner wall of Schlemm's canal (external trabeculectomy) and without using any implant. Group B included 20 eyes of 17 patients which had undergone RDS alone. Demographic and tonometric data of patients of Group A revealed no significant difference from data of patients in Group B. A mean follow up period for Group A was 22.8 months and for Group B was 23.4 months. The outcome of the operations was termed a total success when intraocular pressure (IOP) was <21 mmHg postoperatively, without additional ...
Combined phacoemulsification and deep sclerectomy vs phacoemulsification and trabeculectomy
Acta Ophthalmologica Scandinavica, 2000
Aim To report the safety and efficacy of intraoperative mitomycin (MMC) augmentation of combined phacoemulsification and deep sclerectomy (PDS). Methods Retrospective, non-randomized, comparative, interventional case series of 119 eyes (63 with and 56 without MMC augmentation) of 119 patients who had PDS between September 2001 and April 2004. Results The mean follow-up was 23 months (range 12-41 months). There were no differences in the baseline characteristics of the two groups except that patients from the phacoemulsification and deep sclerectomy with mitomycin C (PDS-MMC) group were on average, younger by 3 years (P ¼ 0.01). Two years after surgery, the probability of maintaining an IOP below 19 and 15 mmHg without glaucoma medications or needle revision was 76 and 62% in the PDS-MMC group and 62 and 45% in the PDS-no MMC group (P ¼ 0.02 and 0.04, respectively). Nd:YAG laser goniopuncture was performed in 71.4% of eyes in the PDS-no MMC and 61.9% of the PD-MMC group (P ¼ 0.33). Needle revision was performed in 21.4% of the PDS-no MMC and 17.4% of the PDS-MMC group (P ¼ 0.65). Ten patients (8.4%) lost more than two lines of Snellen's visual acuity during follow-up, with no difference between the groups. There were few serious complications related to MMC use (hypotony in one eye after laser goniopuncture). The overall incidence of transconjunctival oozing in the PDS-MMC group was 9.5% compared with 5.4% in the PDS-no MMC group. Conclusion This study demonstrates that augmentation of PDS with MMC is safe. MMC augmentation appears to increase the probability of achieving lower target intraocular pressures after combined PDS.
International Ophthalmology, 2014
The aim of this study was to compare the outcome and complications of sutureless trabeculectomy with conventional trabeculectomy. A total of 52 eyes were randomly assigned to two groups. One group received standard conventional trabeculectomy and the other group received sutureless trabeculectomy. The patients were evaluated at 1, 3, 6 and 12 months after surgery. Patient data such as sex, age, intraocular pressure (IOP), logMAR visual acuity, antiglaucoma medications, and intraoperative and postoperative complications were collected and statistically analyzed. The mean age of the conventional and sutureless groups was 48.5 ± 15.4 and 57.3 ± 13.9 years, respectively. All patients achieved IOP levels \21 mmHg with a mean IOP of 13.4 ± 5.3 mmHg in the conventional group and 12.8 ± 2.6 mmHg in the sutureless group at 6 months and 11.00 ± 1.3 and 12.4 ± 3.2 mmHg at 12 months post surgery, respectively. These results showed a significant decrease compared to preoperative measures but did not show a significant difference between the two groups (p = 0.659). The number of antigalucoma medications used postoperatively showed a significant decline from preoperative status of 0.7 ± 0.58 in the conventional group and 0.4 ± 0.4 in the sutureless trabeculectomy group after 6 months and 0.68 ± 0.8 and 0.78 ± 0.9 after 12 months, respectively; however, there was no significant difference between the two groups (p = 0.112). No intraoperative complications were encountered in any of the groups. One patient in the sutureless trabeculectomy group developed mild hyphema which was managed medically. In the conventional group, two patients had failed trabeculectomy which was successfully revised, two patients showed hypotony 2 days after surgery which was managed medically and normal pressure was achieved within 5 days. Sutureless trabeculectomy appears to be a safe and easy method with results comparable to conventional trabeculectomy.
Saudi medical journal, 2013
الصلبة إختراق جراحة تطبيق وسالمة فعالية حتقيق األهداف: الزاوية املفتوح الزرق بداء املصابني السعوديني املرضى على العميق والثانوى. األولى عدد إدراج مت اإلسترجاعية اجليلية الدراسة هذه في الطريقة: مفتوح الزرق مرض مبعاناة مشخصني مريض 152 لعدد عني 194 إضافة مع العميق الصلبة إختراق جلراحة إخضاعهم ومت ، الزاوية اجلامعى العزيز عبد امللك مستشفى فى سى -املايتومايسني مادة بيانات جمعت 0102م. سبتمبر وحتى 2002م يناير من الفترة خالل اجلراحة، وقت العمر تشمل املرضى عن وإكلينيكية دميوجرافية والتعرض األدوية، وعدد العني، وضغط الدقيق، والتشخيص ، والنوع البصرى، العصب لقرص الكأس مقياس ونسبة ، سابقة جلراحات األمد. والبعيدة القريبة املضاعفات سجلت كما شهر، )49.7±( 60.9 متوسط إلى احلاالت متابعة متت النتائج: قبل )10.3±( 25.6 متوسط من العني ضغط إنخفاض خاللها لوحظ متوسط إنخفض حني فى زيارة، آخر فى )4±( 13.5 إلى اجلراحة 0.22 إلى اجلراحة قبل )0.93±( 2.95 من املستخدمة الزرق أدوية معنوية داللة ذو اإلنخفاضني كال وكان زيارة، آخر فى )0.63±( 159/194 فى الكامل اجلراحى النجاح حتقق كما .)p<0.0001( .)90.2%( 175/194 بنسبة الشامل والنجاح )82%( بنسبة عني من أقل سن فى املرضى ورود هى املعنوية الفشل محددات كانت مم )p=0.003( 21 عن العني ضغط إرتفاع ، )p=0.039( سنة 50 كان بينما سابقة. جلراحات التعرض إلى باإلضافة احلضور، عند زئبق والتحول ،)p=0.047( واجللوكوما البيضاء املياه جراحة بني اجلمع بشكل النجاح زيادة عوامل من اجلراحة أثناء اإلختراقية اجلراحة إلى .)p=0.037) ملحوظ وآمنة فعالة جراحة العميق الصلبة إختراق جراحة تعتبر خامتة: بندرة تتميز كما ، الطبيعى املستوى إلى العني ضغط إرتفاع خلفض الزرق مرضى بني اإلبصار حدة تهديد إلى تؤدى التى املضاعفات الزاوية. املفتوح Objectives: To investigate the efficacy and safety of deep sclerectomy (DS) in Saudi patients with primary and secondary open-angle glaucoma (OAG). Methods: In this retrospective cohort study, a total of 194 eyes of 152 patients with OAG were consecutively enrolled to undergo DS with Mitomycin-C (MMC) at King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia between January 2002 and September 2010. Age at surgery, gender, type of glaucoma, operated eye, previous ocular surgery, type of implant, pre and final visit visual acuities, intraocular pressure (IOP), number of anti-glaucoma medications, optic nerve cup/ disc ratio, and complications were recorded.