Br J Ophthalmol 1999;83:6-11 ( January )
Deep sclerectomy with collagen implant: medium term results
Marc E Karlen,
Enrique Sanchez,
Corinne C Schnyder,
Michel Sickenberg,
André Mermoud
Hôpital
Ophtalmique Jules Gonin, Department of Ophthalmology, University of
Lausanne, Lausanne, Switzerland
Correspondence to: André Mermoud, MD, Hôpital Ophtalmique Jules Gonin, Avenue de
France 15, CH-1004 Lausanne, Switzerland.
Accepted for publication 11 August 1998
AIMS To study
prospectively the success rate and complications of deep sclerectomy
with collagen implant (DSCI), a new non-penetrating filtration procedure.
METHODSNon-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.
RESULTSThe 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.
CONCLUSIONSDeep
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
© 1999 by British Journal of Ophthalmology
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