Intracorneal Inclusion of High-molecular-weight Sodium Hyaluronate Following Detachment of Descemet's Membrane During Viscocanalostomy

Dietlein

Graefes Arch Clin Exp Ophthalmol

et al. 2008

Section: Discussioncontrasting

confidence: 48%

Section: Introductionmentioning

confidence: 99%

A prospective trial of phaco-trabeculotomy combined with deep sclerectomy versus phaco-trabeculectomy

Dietlein

Graefes Arch Clin Exp Ophthalmol

et al. 2008

“…Detachment of Descemet's membrane has been reported as an occasional complication following viscocanalostomy and other non-penetrating techniques [18][19][20], however, did not occur in our series.…”

Section: Discussioncontrasting

confidence: 64%

Viscocanalostomy Versus Trabeculectomy in Patients with Bilateral High-tension Glaucoma

Yarangümeli¹,

Güreser

Köz

et al. 2004

Int Ophthalmol

Results of trabeculectomy (TE) and viscocanalostomy (VCO) were compared in a prospective randomised study in two fellow eyes of 22 consecutive patients with bilateral symmetrical high-tension glaucoma. Rates of overall surgical success with intraocular pressures (IOP) < or = 18 mm Hg with or without medications were 91 for the TE, and 95 for the VCO group after a mean follow-up of 18 months. Complete success rates without medications were 64 and 59 for TE and VCO groups, respectively (p = 0.750). Both procedures significantly reduced IOP, however, IOP course following trabeculectomy was significantly lower (p = 0.026). Rates of complications were not found to be different between the two groups of eyes, except for an apparent--though not significant (p = 0.066)--increase in cataract progression with TE. Various types of conjunctival blebs were detected in all eyes with surgical success in both groups, however, diffuse, elevated or multi-cystic functional blebs appeared to be more predominant in eyes with TE, compared to the VCO group in which low-lying, localised blebs had a higher incidence (p = 0.015). Viscocanalostomy was found to be a safe and effective filtration technique in patients with uncomplicated high-tension glaucoma, though IOP decrease was more pronounced with trabeculectomy.

British Journal of Ophthalmology

“…30 UBM is a useful method for assessing the anatomical changes in eyes undergoing viscocanalostomy, which may allow an understanding of the outflow mechanisms. In spite of many variations observed, it may be stated that nonpenetrating viscocanalostomy works best when ultrasound biomicroscopic observations are similar to those observed after filtration surgery.…”

Section: Non-penetrating Surgery Was First Introduced In 1984 Bymentioning

confidence: 99%

Ultrasound biomicroscopy and its value in predicting the long term outcome of viscocanalostomy

Roters

2002

Aims: To examine whether the early postoperative morphology at the site of sclerectomy, as visualised by ultrasound biomicroscopy (UBM), is an indicator of the mechanisms that lower intraocular pressure (IOP) and/or predictors of the long term outcome of viscocanalostomy. Methods: 15 eyes of 14 patients with medically uncontrolled open angle glaucoma and no history of surgery underwent viscocanalostomy according to Stegmann's technique. Ultrasound biomicroscopy was performed during the first month after surgery. The following parameters were assessed: dimensions of the intrascleral "lake," presence of a filtering bleb, presence of a subconjunctival cavity or a suprachoroidal hypoechoic area, and the thickness of the residual trabeculocorneal membrane. A complete ophthalmological examination was performed the day before and the day after surgery. Follow up visits were scheduled 1 week, 4 weeks, 6 months, and 12 months after surgery. Results: At 1 year successful control of IOP (<20 mm Hg) was achieved without further manipulation or medication in six of 15 eyes. The size of the intrascleral "lake" (average 0.62 mm 3 ) did not correlate with later IOP; however, a visible route under the scleral flap and accidental perforation of the trabeculocorneal membrane were associated with long term lowering of IOP. Normal thickness of the trabeculocorneal membrane (0.10-0.15 mm) was indicative of IOP control with and without medication. When UBM showed an early collapse of the intrascleral cavity, control of IOP was not achieved. Other UBM findings did not predict long term function. Conclusion: In accordance with previous studies, the authors found that UBM examination is a useful method to evaluate outflow mechanisms after glaucoma surgery. This study shows that UBM imaging of external filtration during the early postoperative period can be used to predict the success of viscocanalostomy. However, to establish conclusively what parameters of UBM predict successful viscocanalostomy a larger number of patients must be studied. Several investigators have shown renewed interest in surgical reduction of intraocular pressure (IOP) by nonperforating glaucoma surgery. Non-perforating glaucoma surgery avoids opening the anterior chamber and decompressing the eye, thus circumventing many serious complications associated with standard trabeculectomy.1 In open angle glaucoma, the endothelium of Schlemm's canal and the immediately adjacent trabecular meshwork show increased resistance to aqueous outflow, 2 resulting in increased IOP. Recently, a new technique of non-penetrating glaucoma surgery, viscocanalostomy, has been described; it results in better outflow in open angle glaucoma.3 4 In this procedure Schlemm's canal is unroofed and Descemet's membrane is separated 1-2 mm from the corneoscleral junction, resulting in a thinner but intact window to the anterior chamber, through which aqueous humour diffuses into a subscleral lake created by the removal of an inner scleral flap. Filtration is improved when the diameter of Schlemm's ...