Comparative study between deep sclerectomy with and without collagen implant: long term follow up

Shaarawy, Tarek; Nguyen, Christophe; Schnyder, C; Mermoud, André

doi:10.1136/bjo.88.1.95

Cited by 102 publications

(101 citation statements)

References 23 publications

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“…A space maintainer (implant) is frequently utilized to enhance the intrascleral lake and to improve long-term success. 9,13 External bleb classifications 10,11 have been described to address the glaucoma surgery functionality and prognosis but they cannot assess the intrascleral bleb. Recently, the AS-OCT has been used to evaluate filtering blebs after trabeculectomy [2][3][4] and DS with collagen scleral implant.…”

Section: Discussionmentioning

confidence: 99%

A comparison of intrascleral bleb height by anterior segment OCT using three different implants in deep sclerectomy

Fernández-Buenaga

Rebolleda

Casas-Llera

et al. 2012

Eye

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Purpose To compare intrascleral blebs characteristics after deep sclerectomy (DS) with three intrascleral implants using the Visante anterior segment optical coherence tomography. Methods This is a cross-sectional study including 60 eyes of 51 patients that underwent DS with Sk-Gel, Esnoper, and Aquaflow implant. Intraocular pressure (IOP) measurement, slit-lamp examination, and Visante scans were performed the same day in all the patients. Visante scans were done through the intrascleral bleb at 451, 901, and 1351 and the bleb height was measured. Results Sk-Gel was used in 19 eyes (31.66%), Esnoper in 22 eyes (36.66%), and Aquaflow in 19 eyes (31.66%). The median time lapsed from the surgery was 15.50 months 25th and 75th percentiles (p 25 8.25; p 75 20). The median IOP was 13 mm Hg (p 25 10; p 75 15), with no significant differences among implants (P ¼ 0.232). Overall, the correlation between the scleral bleb height and the IOP was statistically significant at 451 (r ¼ À0.359; P ¼ 0.004), 901 (r ¼ À0.410; P ¼ 0.001), and 1351 (r ¼ À0.417; P ¼ 0.001). However, Sk-Gel did not show any statistically significant correlation between the scleral height and IOP whereas the other two groups (Esnoper and Aquaflow) showed a significant correlation. There were no differences in the bleb height among implants. Conclusion There was a moderate inverse correlation between the scleral bleb height and the IOP measurement after DS with Esnoper and Aquaflow implants. There were no differences in bleb height among the three implants.

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Section: Discussionmentioning

confidence: 99%

A comparison of intrascleral bleb height by anterior segment OCT using three different implants in deep sclerectomy

Fernández-Buenaga

Rebolleda

Casas-Llera

et al. 2012

Eye

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“…10 The concept of occupying the intrascleral space with a space-occupying device has been proven to improve significantly success rates in DS in the short 17 and long term. 18 Sanchez et al 17 examined the results of DSCI compared to DS in a prospective nonrandomized group 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. The mean follow-up period was about 9 months in both procedures.…”

Section: Discussionmentioning

confidence: 99%

“…After surgery, all the previously mentioned examinations, except for visual field assessment, were conducted on the first and the seventh day as well as in 1,3,6,9,12,18,24,30,36,48,54,60, and 66 months. Visual field examination was repeated every 6 months.…”

Section: Postoperative Follow-upmentioning

confidence: 99%

Deep sclerectomy in one eye vs deep sclerectomy with collagen implant in the contralateral eye of the same patient: long-term follow-up

Shaarawy

Mermoud

2004

Eye

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Purpose To compare prospectively the results of deep sclerectomy (DS) vs deep sclerectomy with collagen implant (DSCI) Methods Randomized prospective trial involving 26 eyes (13 patients) with medically uncontrolled primary and secondary open angle glaucoma. Collagen implant was randomly assigned to one eye of each patient. Results: The mean follow-up period was 49.5 (SD 20) months for the DS-treated eyes, and 56.5 (SD 14) months for the DSCI-treated eyes (P ¼ 0.4). The mean preoperative intraocular pressure (IOP) was 24.1 (SD 7) mmHg for the DS-treated eyes, and 25.3 (SD 6) mmHg for the DSCI-treated eyes (P ¼ 0.5). The mean IOP at the first postoperative day was 6.4 (SD 3) mmHg for the DS-treated eyes, and 3.7 (SD 2) mmHg for the DSCI-treated eyes (P ¼ 0.05). The mean IOP at 12 months postoperative day was 15.4 (SD 3) mmHg for the DS group, and 10.4 (SD 4) mmHg for the DSCI-treated eyes (P ¼ 0.04), while at 48 months it was 16 (SD 3) mmHg for the DS group, and 10 (SD 4) mmHg for the DSCI-treated eyes (P ¼ 0.005). Complete success rate, defined as an IOP lower than 21 mmHg without medication, was 38% (5/13 patients) at 48 months for the DStreated eyes, and 69% (9/13 patients) for the DSCI-treated eyes. Qualified success rate: patients who achieved IOP below 21 mmHg with or without medication, was 69% (9/13 patients) at 48 months and 100% (13/13 patients) for the DSCI group. The mean number of medications was reduced from 2.4 (SD 0.8) to 1.1 (SD 1) after DS, and was reduced from 2.2 (SD 0.7) to 0.4 (SD 0.6) in the DSCI group (P ¼ 0.001). For those eyes treated with DSCI, IOP was 3.21 mmHg lower than for those treated with DS (Po0.0001). ConclusionThe use of a collagen implant in DS seems to enhance the success rates, provides significantly lower IOP levels, and lowers the need for postoperative medications.

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“…[45][46][47][48] There are now seven long-term studies (mean 4 years follow-up) involving more than 1000 eyes that have undergone VC/DS without a single case of endophthalmitis or hypotony being reported. 43,44,[49][50][51][52][53] Few long-term studies exist for MMC trabeculectomy, but with a 23% 5-year incidence of sight-threatening bleb-related complications 3 and 3% per annum hypotony maculopathy, some 300 eyes might be expected to have suffered from these complications had MMC trabeculectomy been performed on these eyes rather than VC.…”

mentioning

confidence: 99%

“…Every VC involves performing a deep sclerectomy (DS) to identify and then de-roof the canal of Schlemm-creating an '-ostomy' in the canal. Those who call the operation a DS tend to use an implant to encourage formation of an intrascleral lake, 43 whereas those calling the procedure a VC use viscoelastic and tight closure of the superficial scleral flap, to encourage aqueous to drain into the cut ends of Schlemm's canal. 44 Published randomized controlled trials show no statistically significant difference in IOP lowering with trabeculectomy compared to VC.…”

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confidence: 99%

Trabeculectomy is not the best surgical option for glaucoma

Wishart

2008

Eye

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The goal of glaucoma surgery should be the preservation of visual function, the avoidance of sight-threatening complications, and the preservation of the quality of life of the patient. Curiously, the majority of glaucoma surgeons still consider trabeculectomy the best surgical option for their patients, despite evidence that trabeculectomy cannot meet these goals.The trabeculectomy operation has already been abandoned in favour of the augmented trabeculectomy with the antimetabolite mitomycin-C (MMC) 1 by the majority of UK and US glaucoma specialists. 2 MMC trabeculectomy, however, is not safe. The risk of bleb-related endophthalmitis (BRE) ranges from 1.5% per patient year 3 to 10% in one year, 4 with 11 recent studies giving an average incidence of 2.8% per year. [5][6][7][8][9][10][11][12][13] As the mean follow-up of these 11 studies was 19 months, the true incidence may be higher, as institutional reviews of BRE show that the mean time of presentation of BRE is 32 months postoperatively. [14][15][16][17][18] Of equal importance as a cause of central visual loss after MMC trabeculectomy is hypotony maculopathy, with a mean incidence of 3.2% per annum reported in 7 recent studies (mean follow-up of 28 months). 4,9,[19][20][21][22][23] The Collaborative Initial Glaucoma Treatment Study (CIGTS) showed that trabeculectomy increases the risk of cataract formation eightfold in the first postoperative year and by fourfold over 5 years. 24 Cataracts can be removed, but bleb failure occurs in 22% of eyes as a consequence of cataract surgery. 25 Numerous papers are published advising techniques for increasing the safety of MMC trabeculectomy, with posterior application of MMC and strategies to avoid early postoperative hypotony using tight sutures that can later be released, lasered, or adjusted. 26 However, these postoperative manipulations can cause serious complications, such as endophthalmitis, bleb leaks, suprachoroidal haemorrhage, flat anterior chambers, 15,27,28 and may reduce the success of the operation. 29 A 2006 study described a 'Safe trabeculectomy technique' that had a 1.5% rate of BRE in the first year. 13 A recent editorial 30 on the Tube vs Trabeculectomy (TVT) study 31 described as 'excellent' the first year's results of MMC trabeculectomy despite persistent hypotony causing 3% of failures, 1% of eyes suffering BRE, and an additional 2% of cases suffering blebitis, 32 a precursor of endophthalmitis. 14 Surely such a high incidence of serious bleb-related complications is at odds with the description of an 'excellent record'?As to efficacy, MMC trabeculectomy in the TVT study had a 13.5% failure rate and a 57% incidence of postoperative complications, including a 10% incidence of shallow or flat anterior chamber, 3% hypotony maculopathy, 3% suprachoroidal haemorrhage, and 19% choroidal effusions. 31,32 There were 85 surgically invasive postoperative interventions including 49% laser suture lysis and 22% needling. 31 Two recent studies of MMC trabeculectomy from Europe showed similar rates of postop...

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Comparative study between deep sclerectomy with and without collagen implant: long term follow up

Cited by 102 publications

References 23 publications

A comparison of intrascleral bleb height by anterior segment OCT using three different implants in deep sclerectomy

A comparison of intrascleral bleb height by anterior segment OCT using three different implants in deep sclerectomy

Deep sclerectomy in one eye vs deep sclerectomy with collagen implant in the contralateral eye of the same patient: long-term follow-up

Trabeculectomy is not the best surgical option for glaucoma

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