Ultrasound biomicroscopy in deep sclerectomy

Abstract

Purpose To evaluate by ultrasound biomicroscopy (UBM) the anatomical characteristics and the intraocular pressure (IOP) lowering mechanisms of deep sclerectomy after long-term follow-up. Methods In all, 22 eyes of 21 consecutive patients who had deep sclerectomy were examined by UBM. Several UBM variables were prospectively evaluated, including the presence and maximum length and height of the intrascleral space, the minimum thickness of residual trabeculo-Descemet membrane (TDM), the presence and type of subconjunctival filtering bleb, and the presence of other possible drainage sites, for example suprachoroidal. Surgical success was considered to be achieved when the IOP was o22 mmHg and the IOP was lowered by more than 20% without the use of any medication. The possible association between UBM variables and the surgical outcome was determined. Results The mean time between surgery and the UBM examination was 12.075.3 months. The mean IOP decreased significantly from a preoperative value of 23.774.0 to 16.073.9 mmHg at the time of UBM (Po0.01). There was a poor correlation between the level of IOP at the time of UBM and the length of intrascleral space (r 2 ¼ 0.0016), the height of the intrascleral space (r 2 ¼ 0.136), or the thickness of remaining TDM (r 2 ¼ 0.0009). The presence and type of filtering bleb were not associated with the success. Conclusions In patients undergoing deep sclerectomy, UBM examination after long-term follow-up showed the presence of an intrascleral space and a filtering bleb in most patients. The surgical outcome was not associated with the UBM variables of the surgical area.

Biomicroscopía ultrasónica en esclerectomía profunda no perforante con un nuevo implante acrílico

“…A partir de este espacio, el humor acuoso puede filtrarse a través de la fina capa de esclera que cubre el cuerpo ciliar y la coroides al espacio supracoroideo, o bien ser reabsorbido por la formación de nuevos vasos de drenaje o drenar por los orificios del canal de Schlemm y a las venas epiesclerales. Aunque en prácticamente el 90% de los casos tras una EPNP se puede detectar una ampolla de filtración, en la mayoría de los casos estas son planas y difusas (8,13,14). Marchini et al (7) encontraron sólo un 60% de ampollas de filtración tras EPNP con implante de colágeno, sin que su ausencia implicase un mal control tensional.…”

Ultrasound Biomicroscopy in Glaucoma: An Update

“…In patients undergoing deep sclerectomy, UBM examination after long-term follow-up shows the presence of an intrascleral space and a filtering bleb. 50 Collagen implants used to augment deep sclerectomy can also be visualized using this technology. A grading of bleb similar to the trabeculectomy bleb has also been used for NPDS blebs.…”

Outcomes of combined phacoemulsification and deep sclerectomy: a 10-year UK single-centre study

“…[3][4][5][6][7][8][9] Papers using modern technology such as ultrasound biomicroscopy and optical coherence tomography have now clearly demonstrated the presence of an 'intrascleral 'bleb' and 'subconjunctival flow'. 10,11 IOP lowering with DS and postoperative laser goniopuncture (LGP) has been shown to be comparable to trabeculectomy with a lower incidence of complications in the immediate postoperative period according to some reports. [12][13][14][15] In the presence of significant cataract with glaucoma, combined phacoemulsification with trabeculectomy is commonly performed.…”