Deep Sclerectomy Combined with Trabeculectomy in Pediatric Glaucoma

Feusier, M.; Roy, Sylvain; Mermoud, André

doi:10.1016/j.ophtha.2008.08.039

Cited by 29 publications

(25 citation statements)

References 16 publications

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“…Roche et al 20 reported a success rate of 93% with deep sclerectomy in primary congenital glaucoma, although occasionally with multiple surgeries and with IOPlowering medications. Feusier et al 21 reported a complete and qualified success rate of 52.3% and 70.6%, respectively, with the use of penetrating deep sclerectomy (combined deep sclerectomy and trabeculectomy). To our knowledge, there are no published data about the combination of deep sclerectomy and CTTM.…”

Section: Resultsmentioning

confidence: 99%

Deep sclerectomy in pediatric glaucoma filtering surgery

Bayoumi

2012

Eye

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Purpose To study the additive value of deep sclerectomy to the procedure of combined trabeculotomy-trabeculectomy with mitomycin C (CTTM) for the treatment of primary congenital glaucoma. Study design This study is a prospective, randomized case series. Patients and methods The study was conducted on 20 eyes of 20 children with primary congenital glaucoma presenting to the Department of Ophthalmology of the Alexandria Main University Hospital. Preoperative examination under anesthesia was followed by surgical intervention. Postoperative examinations were conducted immediately after surgery and at 1, 2, 3, 6, 9, and 12 months. Intraoperative and postoperative complications, as well as operative time, were recorded. Results The mean (±SD, range) age of the study patients in the CTTM group and in the combined trabeculotomy-trabeculectomy with mitomycin C with deep sclerectomy (CTTM-DS) group was 4.7 ( ± 2.0, 2-8) and 7.0 ( ± 3.8, 3-13) months, respectively. The mean ( ± SD, range) preoperative intraocular pressure (IOP) in the CTTM and CTTM-DS groups was 16.7 (4.3, 10-26) and 16.4 (8.4, 8-36), respectively, and these dropped at 12 months of follow-up to 4.9 (2.0, 2-8) and 5.6 (3.3, 2-10), respectively. The mean ( ± SD, range) of the duration of the operation in the CTTM and the CTTM-DS was 57 ( ± 8, 50-71) min and 53 ( ± 7, 42-64) min, respectively (P ¼ 0.428). Two eyes (20%) in the CTTM-DS group developed hypotony disc edema at the first 2 months and resolved spontaneously thereafter. No other complications were noted in either of the groups. Conclusion The addition of deep sclerectomy to the procedure of CTTM in pediatric glaucoma surgery facilitates the finding of Schlemm's canal, shortens the duration of surgery, and is not associated with any additional complications. Hence, the author recommends the addition of deep sclerectomy to CTTM surgery for primary congenital glaucoma.

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Section: Resultsmentioning

confidence: 99%

Deep sclerectomy in pediatric glaucoma filtering surgery

Bayoumi

2012

Eye

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“…The combination of trabeculectomy and deep sclerectomy has been reported by Feusier et al [26]. The authors described the technique in pediatric cases with glaucoma.…”

Section: Discussionmentioning

confidence: 99%

Trabeculectomy combined with deep sclerectomy and scleral flap suture tension adjustment under an anterior chamber maintainer: a new modification of trabeculectomy

2009

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The objective of this study was to investigate the efficacy and safety of trabeculectomy combined with deep sclerectomy in patients with primary open angled glaucoma (POAG) and to compare the results with those from conventional trabeculectomy. In the study 12 eyes of 10 patients operated with trabeculectomy combined with deep sclerectomy (Group I) and 16 eyes of 16 patients operated with conventional trabeculectomy surgery (Group II) were included. In the described form of combined deep sclerectomy with the trabeculectomy technique the superficial scleral flap was sutured with 10/0 monofilament, the number and tension of sutures were adjusted according to the outflow dynamics, under the scleral flap, of balanced salt solution (BSS) provided by an anterior chamber maintainer. In groups I and II all the patients were male POAG cases with mean ages of 60.0 +/- 19.4 and 67.0 +/- 7.1 years, respectively. The mean follow-up periods were 8.3 +/- 3.5 months for group I and 16.6 +/- 7.0 months for group II. Preoperative mean IOP were 29.7 +/- 8.3 and 29.1 +/- 12.8 mmHg mmHg, and average topical antiglaucomatous medications were 2.9 +/- 0.7 and 2.7 +/- 1.1 for groups I and II, respectively. Postoperatively mean IOP measurements were reduced in groups I and II to 10.5 +/- 2.9 vs. 9.6 +/- 4.8 mmHg at 1 week, 13.7 +/- 5.6 vs. 16.0 +/- 9.8 at 1st month, 12.3 +/- 6.4 vs. 17.3 +/- 8.0 at 3rd month, 11.0 +/- 4.1 vs. 15.3 +/- 5.8 at 6th month, 10.8 +/- 1.6 vs. 16.1 +/- 4.4 at 12th month, and 11.0 +/- 1.0 vs. 16.7 +/- 5.0 at 18th month. Statistical analysis revealed that mean postoperative IOP measurements for group I were significantly lower than for group II for all measurements except the first week (P < 0.05). At 12th month, the complete (IOP <22 mmHg without medication) and qualified (IOP <22 mmHg with medication) success rates were 83.3 and 100% for group I and 63.6 and 90.9% for group II. Postoperatively at 12th month, the mean number of antiglaucoma medications had fallen to 0.0 +/- 0.0 in group I and 0.81 +/- 1.1 in group II. Trabeculectomy surgery combined with deep sclerectomy and suture adjustment under an anterior chamber maintainer provided sufficient IOP decrease and diffuse bleb morphology. This technique could be used as a safe method for management of glaucoma.

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“…43 More recently, some authors have argued for improved results by combining deep sclerectomy and trabeculectomy. 44 Deep sclerectomy and numerous other techniques described in adults including viscocanalostomy, 45 suprachoroidal shunts (SOLX (SOLX Inc, Waltham, MA, USA), CyPass (Transcend Medical Inc, Menlo Park, CA, USA)), canaloplasty, trabecular meshwork bypass shunts (eg, iStent (Glaukos Corporation, Laguna Hills, CA, USA), Hydrus (Ivantis Inc, Irvine, CA, USA)) and transscleral shunt (AqueSys Xen (AqueSys Inc, Aliso Viejo, CA, USA)) have not been widely adopted in children because they are yet to be proven efficacious or safe in children and because of the technical challenges of buphthalmic eyes with thin sclera. A recent addition to angle surgery, trabectome surgery (trabeculotomy ab interno) uses a disposable, high frequency electrocautery handpiece to remove the inner wall of Sclemm canal and the trabecular meshwork.…”

Section: Historymentioning

confidence: 99%