Long-term Evaluation of Efficacy and Safety of Deep Sclerectomy in Uveitic Glaucoma

Al-Obeidan, Saleh A.; Osman, Essam; Mousa, Ahmed; Al-Muammar, Abdulrahman; El‐Asrar, Ahmed M. Abu

doi:10.3109/09273948.2013.870213

Cited by 21 publications

(15 citation statements)

References 43 publications

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“…As summarised in Table 3, we identified three case series specific to NPGS in UG after an extensive online search using Medline and EMBASE. [26][27][28][29] The mean follow-up in these case series varied from 12 to 46 months with unqualified success (for IOP o21 mm Hg) ranging from 45 to 85% of cases within those time frames. No cases of bleb-related infection or delayed hypotony were reported in these series.…”

Section: Discussionmentioning

confidence: 99%

“…[23][24][25] In UG, encouraging preliminary results have been reported for both DS and viscocanalostomy. [26][27][28][29][30] Our study highlights the clinical outcomes, complications, and failure rates for augmented deep sclerectomy in UG and compares these to the current published literature on both deep sclerectomy and augmented trabeculectomy.…”

Section: Introductionmentioning

confidence: 99%

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Deep sclerectomy for uveitic glaucoma: long-term outcomes

Mercieca

Steeples

Anand

2017

Eye

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PurposeTo report long-term outcomes of deep sclerectomy (DS) in eyes with raised intraocular pressure (IOP) and glaucoma secondary to uveitis.Patients and methodsRetrospective consecutive case series of 43 eyes of 43 patients with uveitic glaucoma. Mitomycin C (MMC) 0.2-0.4 mg/ml was applied sub-conjunctivally prior to scleral flap dissection for 2-3 min in 35 eyes (81%). Combined phacoemulsification and DS was done in 4 cases (9%).ResultsMean follow-up was 68.5±33.5 months. In total, 23 eyes (53.5%) had previous intraocular surgery. Pre-operative IOP was 33.6±12.0 mm Hg. Mean IOP at one, three and five years after surgery was 15.5±5.0 mm Hg, 16.9±6.7 mm Hg and 16.4±5.2 mm Hg, respectively.The probability of IOP <22 and <19 mm Hg was 69 and 62% at 3 years and 60 and 51% at 5 years, respectively. This included eyes that had undergone needle revision and/or laser goniopuncture within that period but had not needed glaucoma medication or further glaucoma procedures. The overall number of glaucoma medications decreased from 3.0±1.2 to 0.8±1.2 by last follow-up (P<0.001). Serious complications included hypotony with macular folds in two eyes and occlusion of the trabeculo-Descemet's membrane (TDM) by iris in two eyes. Recurrence of uveitis was observed in 16 eyes. Seven eyes (16.3%) had subsequent procedures including trabeculectomy with MMC in one eye, DS with MMC in two eyes and Baerveldt tube implantation in five eyes.ConclusionsDS is a safe and effective procedure to lower IOP in uveitic glaucoma. However, as with other glaucoma procedures, a significant proportion of patients will require another IOP-lowering procedure in the long-term.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Deep sclerectomy for uveitic glaucoma: long-term outcomes

Mercieca

Steeples

Anand

2017

Eye

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“…Studies have shown that deep-sclerectomy is an effective and reliable method in patients with steroidinduced glaucoma in the presence of an accompanying inflammatory eye disease such as uveitis and in patients undergoing penetrating keratoplasty (29)(30)(31).…”

Section: Resultsmentioning

confidence: 99%

Comparison of the clinical efficacy and safety of deep sclerectomy with mitomycin-c and trabeculectomy surgeries

Karakurt¹,

Mesçi²,

Erbil³

et al. 2019

Ann Med Res

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Aim: Comparison of clinical efficacy and safety of trabeculectomy and deep sclerectomy with mitomycin-C (MMC) surgeries. Material and Methods: 58 eyes of 58 patients with glaucoma who underwent trabeculectomy or deep sclerectomy with MMC were evaluated retrospectively. The success criterion was regarded as follows; patients having intraocular pressure (IOP) less than 21 mmHg was regarded as complete success; patients with IOP less than 21 mmHg with medication was regarded as partial success; and patients with IOP higher than 21 mmHg with medication was regarded as un-success. Results: There was no statistically significant difference in IOP lowering effects between the two surgeries. Considering the success of the groups; complete success was achieved in 32 patients (91.4%) and partial success in 3 patients (8.6%) in the trabeculectomy group. Complete success was achieved in 20 patients (86.9%) and partial success in 3 patients (13.1%) in the deep sclerectomy with MMC group. In the deep sclerectomy with MMC group, hypotonia was detected in 2 patients (8.7%). In the trabeculectomy group, 5 patients (14.3%) had hypotonia, 2 patients (5.7%) had shallow anterior chamber and 1 patient (2.85%) had choroidal detachment. Conclusion: When IOP lowering effects of deep sclerectomy with MMC and trabeculectomy operations were compared, it was found that there was no statistically significant difference between the two techniques. When complication rates were compared, less complication was found in deep sclerectomy operations. It can be concluded that deep sclerectomy is safer than trabeculectomy and as effective as it is.

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“…ODR has been shown to occur primarily after a trabeculectomy or glaucoma drainage devices, but rarely after an uncomplicated DS [2]. It is more common in uveitic [3] and exfoliation glaucoma [4]. A multifocal hemorrhagic retinopathy, which is not accounted for by other processes, can also be seen.…”

Section: Discussionmentioning

confidence: 99%

Ocular Decompression Retinopathy with Macular Edema after Deep Sclerectomy with Intrascleral Implantation

Aljaro¹,

Arenas²,

Iturralde³

et al. 2020

Case Rep Ophthalmol

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We report a case of ocular decompression retinopathy (ODR) with macular edema, diagnosed by optical coherence tomography, after a deep sclerectomy (DS) with an intrascleral implant, resolved with medical therapy 6 months later. The medical literature reports that in 14% of patients suffering from ODR, a pars plana vitrectomy was required, and 15% of patients had a poor final visual acuity. An otherwise healthy 75-year-old man with high myopia and a primary open-angle glaucoma, with previous intraocular pressure (IOP) of 24 mm Hg, underwent a DS with intrascleral implant without complications. The patient suffered postoperatively from ODR with macular edema that required medical therapy with nonsteroidal anti-inflammatory eye drops (Nepafenac ® 0.3%) for a period of 6 months. ODR is an infrequent complication that may occur after any surgical or medical procedure that causes a sudden IOP decrease. The presence of macular edema is only reported in 5% of cases and can occur in patients who report a decreased visual acuity, commonly associated with a retinal hemorrhage. We have described a case of ODR with macular edema after DS with intrascleral implant. Although ODR is considered to cause a low level of morbidity, in some patients this may not be the case.

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Long-term Evaluation of Efficacy and Safety of Deep Sclerectomy in Uveitic Glaucoma

Abstract: DS is safe and effective in patients with uveitic open-angle glaucoma. However, laser goniopuncture is frequently needed to improve the outcome.

Cited by 21 publications

References 43 publications

Deep sclerectomy for uveitic glaucoma: long-term outcomes

Deep sclerectomy for uveitic glaucoma: long-term outcomes

Comparison of the clinical efficacy and safety of deep sclerectomy with mitomycin-c and trabeculectomy surgeries

Ocular Decompression Retinopathy with Macular Edema after Deep Sclerectomy with Intrascleral Implantation

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