Deep Sclerectomy with Porous Collagen in Open-angle Glaucoma, Short-term Study

Abstract

AimTo assess the role of porous collagen in deep sclerectomy (DS), with and without trabeculo-Descemet membrane (TDM) rupture.Patients and methodsForty-six eyes with different types of open-angle glaucoma and medically uncontrolled intraocular pressure (IOP) were selected. DS was performed in all cases. Ologen was implanted as a single large piece in the scleral lake and subconjunctival space in all cases with and without TDM rupture.ResultsA total sample of 46 open-angle glaucoma patients were included in the study. The mean ± standard deviation (SD) IOP was 25.6 mm Hg ± 10.6 (range 12-58 mm Hg) pre-operatively. On follow-up, the mean ± SD IOP was 6.1 mm Hg ± 3.7 (range 2-20 mm Hg) 1 day postoperatively and 9.3 mm Hg ± 4.0 (range 4-23 mm Hg) after 1 month of follow-up, at 12 months the IOP was at 12.1 mm Hg ± 3 (range 8-18 mm Hg). The overall mean ± SD IOP reduction percentage was 48.3% ± 21.3 (range 0.0-86.2). Comparing mean IOP reductions at last follow-up between TDM rupture cases and non-TDM cases (Mann-Whitney test), the mean ± SD IOP reduction in TDM rupture patients was 12.1 ± 8.0 mm Hg (range 2-27) meanwhile, in non-TDM rupture patients it was 14.3 ± 11.4 mm Hg (range 0-50). However, the difference in IOP reduction between the two groups was not significant. (p = 0.689)ConclusionPorous collagen can enhance the results of DS; also, it helps to proceed with DS in cases of TDM rupture without converting to trabeculectomy.How to cite this article: Elbably A, Othman TM, Mousa A, Elridy M, Badawy W, Elbably M. Deep Sclerectomy with Porous Collagen in Open-angle Glaucoma, Short-term Study. J Curr Glaucoma Pract 2018;12(2):85-89.

Efficacy and Safety of Deep Sclerectomy With the Esnoper Clip Implant for Uncontrolled Primary Open Angle Glaucoma: A 1 Year Prospective Study

“…Despite the fact that TE is an effective treatment to decrease IOP, most surgeons prefer to delay surgery and to perform it only in the advanced stages of glaucoma, due to the high rate of complications occurring perioperatively and postoperatively. 5 , 10 , 12 , 23 …”

“… 26 , 37 – 40 Its primary drawback is that it is not as widely undertaken by surgeons due to the difficulty of the technique and the long learning curve it requires. 10 , 28 , 38 The safety of the procedure is strengthened by the outflow dynamics through the TDM. Thus, Mermoud and Vaudaux 45 experimentally demonstrated that outflow resistance through the TDM was low but sufficient to avoid over-filtration and postoperative hypotony.…”

“… 28 , 41 , 44 The relatively high degree of difficulty in carrying out this procedure, which requires great skill in lamellar microdissection and also lengthy experience on the surgeon’s part, leads to the incidence of this complication. 7 , 10 Varga and Shaarawy 7 noted that TDM perforation is significantly more common during the learning phase of a surgeon’s personal experience with DS, defined as the first 20 DS performed. In our study, we encountered only 3 cases of TDM perforation followed by conversion to TE, and these were automatically excluded from the statistical evaluation.…”

“…14 The first space-maintaining device developed was a purified porcine collagen AquaFlow implant (Staar Surgical AG), which was absorbed within 6–9 months. 10 , 15 According to Shaarawy et al 12 and Sanchez et al, 15 the IOP levels, the need for postoperative antiglaucoma therapies, and postoperative bleb fibrosis were all significantly lower with the use of a collagen implant at both short-term and long-term follow-ups. The next generation of implants focused on the use of the various rheological properties of sodium hyaluronate derivates to preserve the intrascleral filtering space postoperatively.…”