Deep Sclerectomy With Intrascleral Versus Suprachoroidal Collagen Implant: A Randomized Control Trial

Abstract

Précis: Deep sclerectomy with intrascleral collagen implant (DSCI) was less effective in lowering intraocular pressure (IOP) than with suprachoroidal implantation. Further studies are needed to establish the potency and safety of deep sclerectomy with suprachoroidal collagen implant (DSSCI). Purpose: The purpose of this study was to analyze the safety and IOP-lowering effect of DSSCI in comparison with DSCI. Setting: Geneva University Hospitals, Geneva, Switzerland. Methods: This is a prospective, randomized, controlled study involving 13 patients (26 phakic eyes) with bilateral medically uncontrolled primary or secondary open-angle glaucoma. Bilateral deep sclerectomy was performed with each patient being randomly assigned to receive a collagen implant in the intrascleral space in one eye, and a suprachoroidal collagen implant in the other. Follow-up visits were performed at day 1; at week 1; and at months 6, 9, 12, 18, 30, 48, 54, and 60. Results: Mean preoperative IOP was 24.1±4.2 mm Hg for DSCI group and 25.3±5.3 mm Hg for DSSCI group (P=0.1). The mean postoperative IOP was 14.8±4.0 mm Hg (DSCI) versus 9.8±3.7 mm Hg (DSSCI) at month 60 (P=0.01). Mean preoperative best-corrected visual acuity for the DSCI group was 0.76±0.22 and 0.74±0.23 for the DSSCI group (P=0.001), while the mean postoperative best-corrected visual acuity was 0.82±0.17 (DSCI) and 0.80±0.17 (DSSCI) at month 60 (P=0.004). Conclusions: DSSCI demonstrated a greater IOP-lowering effect than deep sclerectomy with intrascleral implantation. The safety profile of both methods was similar. More patients with a longer follow-up are required to comprehensively assess the safety and efficacy of this new approach.

Bleb-Independent Glaucoma Surgery to Activate the Uveolymphatic Route of Non-Trabecular Aqueous Humor Outflow: Short-Term Clinical and OCT Results

“…This is indirectly supported by our observations in cases where a classical DS was performed (with the creation of a trabeculo-Descemet’s window without a laser trabeculotomy) with placement of a CI as described above, where LV were observed on slit lamp examinations with a significant decrease in IOP. Mitwally et al [ 23 ] also demonstrated a greater IOP-lowering effect of DS with suprachoroidal CI than with DS and intrascleral implantation. The role of the implantation of a non-absorbable collagen implant (Xenoplast, Dubna-Biofarm, Moscow, Russia) in the SCS in decreasing IOP has been studied by Shradka A.S. et al [ 24 ] and Kumar V. et al [ 25 ].…”

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

“…While the trabecular outflow pathway, which involves a subconjunctival bleb formation, has been studied for several years, lately attention has been directed to the uveoscleral pathway, which involves aqueous bleb-less drainage 47. This has meant a lower risk of DS failure with uveoscleral implants compared with scleral devices, due to increased aqueous outflow through the suprachoroidal pathway and also due to the lower rate of complications related to the subconjunctival bleb 33,47. On the other hand, a significant limiting factor in the long-term success of DS with uveoscleral implants is the inflammatory potential of the suprachoroidal region characterized by significant cell infiltration and fibrosis 33,47,48.…”

“…47 This has meant a lower risk of DS failure with uveoscleral implants compared with scleral devices, due to increased aqueous outflow through the suprachoroidal pathway and also due to the lower rate of complications related to the subconjunctival bleb. 33 , 47 On the other hand, a significant limiting factor in the long-term success of DS with uveoscleral implants is the inflammatory potential of the suprachoroidal region characterized by significant cell infiltration and fibrosis. 33 , 47 , 48 This deficiency could be resolved by using materials with better modulation of biological responses, inducing minimal tissue reaction and scarring, especially in the suprachoroidal region.…”

“… 33 , 47 On the other hand, a significant limiting factor in the long-term success of DS with uveoscleral implants is the inflammatory potential of the suprachoroidal region characterized by significant cell infiltration and fibrosis. 33 , 47 , 48 This deficiency could be resolved by using materials with better modulation of biological responses, inducing minimal tissue reaction and scarring, especially in the suprachoroidal region. 47 According to Loscos-Arenas et al, 31 another important factor in the success rate for this surgery is implant design.…”

Activation of uveolymphatic outflow pathway after non-penetrating glaucoma surgery without filtering bleb: case reports

“…Несмотря на это, во всех 3 случаях мы наблюдали лимфатические сосуды при обследовании на щелевой лампе пациентов со значительным снижением уровня ВГД. R. Mitwally et al [19] продемонстрировали больший эффект снижения ВГД при глубокой склерэктомии с супрахориоидальным коллагеновым имплантатом, чем при глубокой склерэктомии с интрасклеральной имплантацией коллагенового имплантата. Примечательно, что в предложенной методике экспозиция поверхности увеальной ткани для резорбции ВВ была увеличена путем дополнительного удаления полоски глубоких слоев склеры сзади от склерального мостика.…”