Deep Sclerectomy Versus Punch Trabeculectomy with or without Phacoemulsification

Cillino, Salvatore; Pace, Francesco; Casuccio, Alessandra; Calvaruso, Liborio; Morreale, Daniele; Vadalà, Maria; Lodato, Gaetano

doi:10.1097/01.ijg.0000137869.18156.81

Cited by 117 publications

(133 citation statements)

References 21 publications

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“…The low complication rate with low-dosage MMC in our sample is in agreement with our previous studies. 8,24,35,36 A recent pilot study 20 is not in agreement with our results, since it showed OLO to have a larger amount of complications than simple trabeculectomy. The conjunctival closure with two simple 10-0 nylon sutures at the flap extremities was probably responsible for a higher incidence of positive Seidel test with flat anterior chamber in the study group, and could have reduced the beneficial effect of the implant in bleb development.…”

Section: Discussioncontrasting

confidence: 54%

Biodegradable collagen matrix implant vs mitomycin-C as an adjuvant in trabeculectomy: a 24-month, randomized clinical trial

Cillino

Pace

Cillino

et al. 2011

Eye

106

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Aim To verify the safety and efficacy of Ologen (OLO) implant as adjuvant compared with low-dosage mitomycin-C (MMC) in trabeculectomy. Methods This was a prospective randomized clinical trial with a 24-month follow-up. Forty glaucoma patients (40 eyes) were assigned to trabeculectomy with MMC or OLO. Primary outcome includes target IOP at r21, r17, and r15 mm Hg; complete (target IOP without medications), and qualified success (target IOP regardless of medications). Secondary outcomes include bleb evaluation, according to Moorfields Bleb Grading System (MBGS); spectral domain optical coherence tomography (SD-OCT) examination; number of glaucoma medications; and frequency of postoperative adjunctive procedures and complications. Results The mean preoperative IOP was 26.5 ( ± 5.2) in MMC and 27.3 ( ± 6.0) in OLO eyes, without statistical significance. One-day postoperatively, the IOP dropped to 5.2 ( ± 3.5) and 9.2 ( ± 5.5) mm Hg, respectively (P ¼ 0.009). The IOP reduction was significant at end point in all groups (P ¼ 0.01), with a mean IOP of 16.0 (±2.9) and 16.5 (±2.1) mm Hg in MMC and OLO, respectively. The rates and Kaplan-Meier curves did not differ for both complete and qualified success at any target IOP. The bleb height in OLO group was higher than MMC one (Po0.05). SD-OCT analysis of successful/ unsuccessful bleb in patients with or without complete success at IOP r17 mm Hg indicated a sensitivity of 83% and 73% and a specificity of 75% and 67%, respectively, for MMC and OLO groups. No adverse reaction to OLO was noted. Conclusions Our results suggest that OLO implant could be a new, safe, and effective alternative to MMC, with similar long-term success rate.

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Section: Discussioncontrasting

confidence: 54%

Biodegradable collagen matrix implant vs mitomycin-C as an adjuvant in trabeculectomy: a 24-month, randomized clinical trial

Cillino

Pace

Cillino

et al. 2011

Eye

106

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“…22 Several reports of NPGS describe combined cataract and glaucoma surgery with comparable or even better IOP-lowering outcomes. 14,17 To our knowledge, this case series represents the largest cohort with the longest follow-up of phaco-DS in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…16 Phacoemulsification combined with DS (phaco-DS) has been shown to be as effective as phacoemulsification with trabeculectomy (phaco-trab) in lowering IOP. 14,17 In this large case series, we seek to report the outcomes of phaco-DS from a single UK centre over a 10-year period. To our knowledge, this is the largest cohort to describe this procedure with such long-term follow-up results.…”

Section: Introductionmentioning

confidence: 99%

“…10,11 IOP lowering with DS and postoperative laser goniopuncture (LGP) has been shown to be comparable to trabeculectomy with a lower incidence of complications in the immediate postoperative period according to some reports. [12][13][14][15] In the presence of significant cataract with glaucoma, combined phacoemulsification with trabeculectomy is commonly performed. 16 Phacoemulsification combined with DS (phaco-DS) has been shown to be as effective as phacoemulsification with trabeculectomy (phaco-trab) in lowering IOP.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of combined phacoemulsification and deep sclerectomy: a 10-year UK single-centre study

Mercieca

Shevade

Anand

2015

Eye

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Purpose To report the outcomes of combined phacoemulsification and -deep sclerectomy (phaco-DS) from a single UK centre over a 10-year period. Methods Retrospective analysis of phaco-DS data extracted from an ongoing glaucoma surgery database within Calderdale and Huddersfield NHS Trust. Two hundred and ninety-six eyes of 282 patients were included. Data included patient demographics, pre-and postoperative intraocular pressure (IOP), use of mitomycin C (MMC), spacer device implantation, and follow-up details including surgical success rates. IOP success criteria were: (A) IOP o19 mm Hg and/or 20% decrease from baseline and (B) IOP o16 mm Hg and/or 30% drop from baseline. Results Mean follow-up was 63.5 ± 35.3 months. MMC was applied in 145 eyes (49%). Kaplan-Meier success rates in all eyes for criteria A were 89.1% and 80% with glaucoma medications (qualified success) and 81.2% and 68.3% without medications (unqualified success) at 2 and 5 years, respectively. Qualified success for criteria B was 72.4 and 61.4% and unqualified rates were 67.2 and 55.2% for the same time periods. Repeatedmeasures ANOVA showed significantly lower IOP in the phaco-DS with MMC group up to 3 years postoperatively (P = 0.002). Cox's proportional hazards for criteria B, however, showed no significant effect of MMC application in the long term (P = 0.2). Increasing age and laser goniopuncture were positively associated with success, whereas the absence of spacer devices was negatively associated. At last follow-up, 20% of eyes were on glaucoma medications. Complication rates were low with hypotony rates of 0.68%. Conclusions This study confirms the longterm safety and efficacy of phaco-DS as a primary glaucoma procedure.

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“…The pressure-reducing effect of penetrating surgery is probably still higher than that of non-penetrating strategies, particularly in the long run. [12][13][14] However, postoperative scarring is a major problem, compromising postoperative surgical success in both groups.…”

Section: Discussionmentioning

confidence: 99%

A prospective randomised trial of trabeculectomy using mitomycin C vs an ologen implant in open angle glaucoma

Rosentreter

Schild

Jordan

et al. 2010

Eye

107

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Deep Sclerectomy Versus Punch Trabeculectomy with or without Phacoemulsification

Cited by 117 publications

References 21 publications

Biodegradable collagen matrix implant vs mitomycin-C as an adjuvant in trabeculectomy: a 24-month, randomized clinical trial

Biodegradable collagen matrix implant vs mitomycin-C as an adjuvant in trabeculectomy: a 24-month, randomized clinical trial

Outcomes of combined phacoemulsification and deep sclerectomy: a 10-year UK single-centre study

A prospective randomised trial of trabeculectomy using mitomycin C vs an ologen implant in open angle glaucoma

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