Deep sclerectomy with collagen implant: medium term results

Karlen, M. E.; Sanchez, Enrique; Schnyder, C; Sickenberg, Michel; Mermoud, André

doi:10.1136/bjo.83.1.6

Cited by 164 publications

(151 citation statements)

References 14 publications

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“…Others reported 5-FU injection rates between 6 and 50%. 8,13,14,16 The number of YAG-goniopunctures performed in our study is lower compared to published data, 16,19,24 which might be owing to the exact dissection with the laser, resulting in a very thin TDM.…”

Section: Discussioncontrasting

confidence: 64%

“…Our long-term results indicate, that Erbium YAG-laser dissection in DS provides similar long-term results as mechanical dissection, 9,16,19 while greatly facilitating the surgery. This is of particular interest to surgeons with a lower case load, who wish to have the advantage of less early postoperative complications that DS offers.…”

Section: Discussionsupporting

confidence: 56%

“…24,25 The rate of newly developed cataract is slightly higher in our study compared to published data, but might be biased by our relatively small sample size. 16,23 The main postoperative concern in our study was filtering bleb scarring. All 14 patients developed a filtering bleb, which is in line with other studies.…”

Section: Discussionmentioning

confidence: 96%

“…The main difficulty is the dissection of the deep corneoscleral lamella. Perforation of the thin TDM during dissection is reported to occur in 8-33% of patients 16,17 First trials encouraged us to dissect the TDM with an Erbium YAG-laser to improve safety. 12 When dissecting with a blade, the major problems are either Figure 2 Cumulative complete success after Erbium YAGlaser-assisted deep sclerectomy using Kaplan-Meier table analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Our results of IOP reduction, complete and qualified success, and reduction of antiglaucomatous medication are similar to those after standard DS. 9,16,19 Without using a collagen implant or antimetabolites, DS results in an IOP reduction to the mid to high teens. 9 No comparison of Erbium YAG-laser-assisted DS and trabeculectomy is available yet.…”

Section: Discussionmentioning

confidence: 99%

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Long-term results of Erbium YAG-laser-assisted deep sclerectomy

Klink

Schlunck

Lieb

et al. 2006

Eye

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Purpose To evaluate the long-term results of Erbium YAG-laser-assisted deep sclerectomy (DS). In this procedure, the delicate dissection of a deep corneoscleral lamella is greatly simplified by using the Erbium YAG-laser. Methods Data of 14 consecutive patients (10 male, four female, age 67.7710.4 years), who underwent surgery from 1999 to 2000 were analysed retrospectively. The procedure was begun as a standard DS. The deep corneoscleral lamella was dissected with a pulsed Erbium YAG-laser (energy: 40-100 mJ, frequency: 5-10 Hz). Schlemm's canal was unroofed and the lamella thinned until aqueous percolated continuously through the membrane. Results The mean follow-up time was 50.476.8 months. The mean preoperative intraocular pressure (IOP) was 37.7710.5 mmHg. The mean postoperative IOP was 16.173.9 mmHg at 1 month, 15.174.3 mmHg at 3 months, 16.474.5 mmHg at 12 months, and 17.678.7 mmHg at 50.5 months. The complete success rates (IOPp21 mmHg þ IOP reduction X20% without glaucoma medication) were 83.3% at 3 months and 50% at 12 and 50.5 months. Rates for qualified success (IOPp21 mmHg þ IOP reduction X20% with glaucoma medication) were 91.7% at 3 months, 92.9% at 12 months, and 78.6% at 50.5 months. The number of glaucoma medications was reduced from 3.0770.92 preoperatively to 1.1471.41 at 50.5 months. A single case of anterior-chamber penetration, requiring iridectomy, was the only intraoperative complication. Conclusions Erbium YAG-laser-assisted DS has the advantage of a greatly simplified dissection, while offering a successful long-term IOP control comparable to conventional DS.

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Section: Discussioncontrasting

confidence: 64%

Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Long-term results of Erbium YAG-laser-assisted deep sclerectomy

Klink

Schlunck

Lieb

et al. 2006

Eye

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Glaucoma Surgery and Aqueous Outflow

Johnson

2002

Arch Ophthalmol

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Histopathology of the three implanted degradable biopolymers in rabbit eye

Rönkkö

Rekonen

Sihvola

et al. 2008

J Biomedical Materials Res

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New straightforward applications of new biopolymers are needed in glaucoma surgery. The aim of this study was to compare biocompatibility of three biomaterials in rabbit eyes after deep sclerectomy; a collagen implant (AquaFlow) represented the "gold standard". A blend of 85:15 poly(L-lactide-co-glycolide) and 70:30 poly(L-lactide-co-1,3-trimethylene carbonate) copolymers in a molar ratio of 70:30 (Bio-1 = Inion GTR membrane) and poly(DL-lactide-co-glycolide with molar compositions of 50:50 (Bio-2) and 85:15 (Bio-3) were inserted into rabbits eyes. Bio-1, Bio-2 or Bio-3 caused very mild eye irritation or tissue response which was comparable to that of the collagen implant. The biodegradation time of Bio-1, Bio-2, and Bio-3 implants was over one year, 3 months and 6 months, respectively. Implant mapping by Fourier transform infrared (FTIR) microscopy revealed a heterogeneous distribution of degradation products throughout Bio-1, Bio-2, and Bio-3. All implants were surrounded by a very fine tissue capsule which was not visible after total degradation of the implants. The FTIR spectrum of tissue capsule around Bio-1 was almost identical to that around Bio-2 whereas significant differences were observed in the spectrum of the tissue capsule around Bio-3. Despite some differences in tissue response, all tested implants represent biologically acceptable materials for drainage devices in glaucoma surgery.

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Deep sclerectomy with collagen implant: medium term results

Cited by 164 publications

References 14 publications

Long-term results of Erbium YAG-laser-assisted deep sclerectomy

Long-term results of Erbium YAG-laser-assisted deep sclerectomy

Glaucoma Surgery and Aqueous Outflow

Histopathology of the three implanted degradable biopolymers in rabbit eye

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