Visante Anterior Segment Optical Coherence Tomography Analysis of Morphologic Changes After Deep Sclerectomy With Intraoperative Mitomycin-C and No Implant Use

Pérez-Rico, C.; Gutiérrez-Ortiz, C.; Moreno‐Salgueiro, Agustín; González-Mesa, Ana; Teus, Miguel A.

doi:10.1097/ijg.0b013e31829ea2c8

Cited by 18 publications

(19 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It informs us that the greater the dimension of intrascleral space the lower the IOP, as depicted in the scatter plots in figure 3 (The scatter plot B of figure 3 in the article seems to be wrongly labeled). 1 Their finding is consistent with a report by Mavrakanas et al 7 having a stronger correlation (Pr0.001, r = 0.626) compared with the current study (P = 0.006, r = À0.389, for maximum intrascleral space height) who stated that "A positive inverse correlation was found between the IOP and the height of the intrascleral filtration bleb (Pr0.001, r = 0.626)." These findings are important to note, because intrascleral space dimensions would be larger with implant placement.…”

Section: To the Editorsupporting

confidence: 95%

See 1 more Smart Citation

Visante Anterior Segment Optical Coherence Tomography Analysis of Morphologic Changes After Deep Sclerectomy With Intraoperative Mitomycin-C and No Implant Use

Sangtam

Mermoud²

2015

Journal of Glaucoma

View full text Add to dashboard Cite

on "Visante anterior segment optical coherence tomography analysis of morphologic changes after deep sclerectomy with intraoperative mitomycin-C and no implant use." We would like to make a few comments:(1) The authors wrote that "All these data suggested that the use of scleral implants after NPDS may not be necessary to maintain an open intrascleral space over a long time." However, we need to ask the right question of why implant is used after nonpenetrating deep sclerectomy? The use of implant in deep sclerectomy (DS) is not primarily to maintain an open intrascleral space over a long time, but to enhance its success rates by serving as a space maintainer 2 during the time of maximal healing that occurs in the early months after surgery. During the period of its existence in the intrascleral space, the implant bridges the maximum period of scarring postoperatively. 3 Furthermore, Shaarawy et al 4 showed that DS with collagen implant (DSCI) had a better complete success rate (< 21 mm Hg without medication) than DS alone (63.4% in DSCI vs. 34.6% in DS; P = 0.003). The mean number of medication per patient was reduced from 2.1 (SD = 0.8) to 0.4 (SD = 0.6) in the DSCI group (P = 0.001). This is corroborated by another report from Sanchez et al, 5 where complete and qualified success rates were better when the collagen implant was used (Log-Rank test: P = 0.0002 and 0.033 for complete and qualified success, respectively). The need for postoperative glaucoma medications was significantly lower when the collagen implant was used (0.2 ± 0.5 vs. 0.5 ± 0.7 medication per patient in the DSCI and DS respectively, Student t test: P = 0.0038). They also reported that there was significantly less bleb fibrosis when the collagen implant was used (2% and 11% in DSCI and DS, respectively, P = 0.029). Moreover, use of implant such as collagen decreases the risk of adhesion between the trabeculoDescemetic membrane and the scleral tissue by virtue of its space-occupying property and its presence (usually for 6 to 9mo 6 ) creates an inward indentation of the scleral bed providing more room. This reduction in adhesion and provision of extra room makes goniopuncture more feasible in the postoperative period.(2) The very fact that they "found a significant negative correlation between the IOP level at the time of AS-OCT examinations and the maximum anteroposterior length, maximum height, and volume of that intrascleral space" is telling. It informs us that the greater the dimension of intrascleral space the lower the IOP, as depicted in the scatter plots in figure 3 (The scatter plot B of figure 3 in the article seems to be wrongly labeled). 1 Their finding is consistent with a report by Mavrakanas et al 7 having a stronger correlation (Pr0.001, r = 0.626) compared with the current study (P = 0.006, r = À0.389, for maximum intrascleral space height) who stated that "A positive inverse correlation was found between the IOP and the height of the intrascleral filtration bleb (Pr0.001, r = 0.626)." These findings are important to note, b...

show abstract

Section: To the Editorsupporting

confidence: 95%

“…We would like to make a few comments: (1) The authors wrote that "All these data suggested that the use of scleral implants after NPDS may not be necessary to maintain an open intrascleral space over a long time." However, we need to ask the right question of why implant is used after nonpenetrating deep sclerectomy?…”

Section: To the Editormentioning

confidence: 97%

Visante Anterior Segment Optical Coherence Tomography Analysis of Morphologic Changes After Deep Sclerectomy With Intraoperative Mitomycin-C and No Implant Use

Sangtam

Mermoud²

2015

Journal of Glaucoma

View full text Add to dashboard Cite

show abstract

“…However, we need to ask the right question of why implant is used after nonpenetrating deep sclerectomy? 1 Their finding is consistent with a report by Mavrakanas et al 7 having a stronger correlation (Pr0.001, r = 0.626) compared with the current study (P = 0.006, r = À0.389, for maximum intrascleral space height) who stated that "A positive inverse correlation was found between the IOP and the height of the intrascleral filtration bleb (Pr0.001, r = 0.626)." During the period of its existence in the intrascleral space, the implant bridges the maximum period of scarring postoperatively.…”

Section: To the Editorsupporting

confidence: 92%

“…We would like to make a few comments: (1) The authors wrote that "All these data suggested that the use of scleral implants after NPDS may not be necessary to maintain an open intrascleral space over a long time." We would like to make a few comments: (1) The authors wrote that "All these data suggested that the use of scleral implants after NPDS may not be necessary to maintain an open intrascleral space over a long time."…”

Section: To the Editormentioning

confidence: 99%

Reply to “Visante Anterior Segment Optical Coherence Tomography Analysis of Morphologic Changes After Deep Sclerectomy With Intraoperative Mitomycin-C and No Implant Use”

&NA;

2015

Journal of Glaucoma

View full text Add to dashboard Cite

on "Visante anterior segment optical coherence tomography analysis of morphologic changes after deep sclerectomy with intraoperative mitomycin-C and no implant use." We would like to make a few comments:(1) The authors wrote that "All these data suggested that the use of scleral implants after NPDS may not be necessary to maintain an open intrascleral space over a long time." However, we need to ask the right question of why implant is used after nonpenetrating deep sclerectomy? The use of implant in deep sclerectomy (DS) is not primarily to maintain an open intrascleral space over a long time, but to enhance its success rates by serving as a space maintainer 2 during the time of maximal healing that occurs in the early months after surgery. During the period of its existence in the intrascleral space, the implant bridges the maximum period of scarring postoperatively. 3 Furthermore, Shaarawy et al 4 showed that DS with collagen implant (DSCI) had a better complete success rate (< 21 mm Hg without medication) than DS alone (63.4% in DSCI vs. 34.6% in DS; P = 0.003). The mean number of medication per patient was reduced from 2.1 (SD = 0.8) to 0.4 (SD = 0.6) in the DSCI group (P = 0.001). This is corroborated by another report from Sanchez et al, 5 where complete and qualified success rates were better when the collagen implant was used (Log-Rank test: P = 0.0002 and 0.033 for complete and qualified success, respectively). The need for postoperative glaucoma medications was significantly lower when the collagen implant was used (0.2 ± 0.5 vs. 0.5 ± 0.7 medication per patient in the DSCI and DS respectively, Student t test: P = 0.0038). They also reported that there was significantly less bleb fibrosis when the collagen implant was used (2% and 11% in DSCI and DS, respectively, P = 0.029). Moreover, use of implant such as collagen decreases the risk of adhesion between the trabeculo-Descemetic membrane and the scleral tissue by virtue of its space-occupying property and its presence (usually for 6 to 9mo 6 ) creates an inward indentation of the scleral bed providing more room. This reduction in adhesion and provision of extra room makes goniopuncture more feasible in the postoperative period.(2) The very fact that they "found a significant negative correlation between the IOP level at the time of AS-OCT examinations and the maximum anteroposterior length, maximum height, and volume of that intrascleral space" is telling. It informs us that the greater the dimension of intrascleral space the lower the IOP, as depicted in the scatter plots in figure 3 (The scatter plot B of figure 3 in the article seems to be wrongly labeled). 1 Their finding is consistent with a report by Mavrakanas et al 7 having a stronger correlation (Pr0.001, r = 0.626) compared with the current study (P = 0.006, r = À0.389, for maximum intrascleral space height) who stated that "A positive inverse correlation was found between the IOP and the height of the intrascleral filtration bleb (Pr0.001, r = 0.626)." These findings are important to note, ...

show abstract

“…The absence of correlation between AS-OCT variables and IOP differs from data reported by other authors [23,46] . The lack of an inverse correlation between filtering bleb wall thickness and IOP could be due to the spacer effect of the PRGF clot.…”

Section: Discussioncontrasting

confidence: 56%

Subconjunctival PRGF Fibrin Membrane as an Adjuvant to Nonpenetrating Deep Sclerectomy: A 2-Year Pilot Study

Rodríguez-Agirretxe

Freire²,

Muruzábal

et al. 2017

Ophthalmic Res

View full text Add to dashboard Cite

Purpose: To evaluate the potential role of the autologous PRGF (plasma rich in growth factors) fibrin membrane in tissue regeneration after glaucoma filtering surgery. Materials and Methods: Ten patients with medically uncontrolled primary open-angle glaucoma underwent nonpenetrating deep sclerectomy and were treated with PRGF fibrin membrane as adjuvant. Intraocular pressure reduction was the primary outcome. This variable was measured preoperatively and also at each follow-up visit. Secondary outcomes included the number of antiglaucoma medications, anterior segment optical coherence tomography bleb examination, photographic bleb evaluation, and subjective clinical symptomatology evaluation. Results: The surgical technique showed a significant reduction (p < 0.05) in intraocular pressure in relation to preoperative values at each time of the study, decreasing from 23.3 ± 6.4 to 15.2 ± 4.6 mm Hg at 2 years. Furthermore, the number of antiglaucoma medications consumed showed a significant reduction at the end point of the study compared with the preoperative situation. Optical coherence tomography and photographic filtering bleb variables experienced a progressive reduction during the follow-up. Subjective symptoms showed a reduction from 8.3 ± 4.5 to 4.2 ± 5.3 at 2 years. Conclusions: PRGF-Endoret treatment could promote ocular surface regeneration after glaucoma surgery, enhancing the surgery success rates and reducing the need for postoperative medications. It is important to highlight that this is a preliminary study and some large clinical studies are necessary to verify these results.

show abstract

Visante Anterior Segment Optical Coherence Tomography Analysis of Morphologic Changes After Deep Sclerectomy With Intraoperative Mitomycin-C and No Implant Use

Abstract: NPDS without implant placement and with intraoperative mitomycin C application seems to be an effective and well-tolerated method to reduce IOP with long-term effectiveness, casting doubt on the mandatory use of intrascleral implants in nonpenetrating glaucoma surgery.

Cited by 18 publications

References 24 publications

Visante Anterior Segment Optical Coherence Tomography Analysis of Morphologic Changes After Deep Sclerectomy With Intraoperative Mitomycin-C and No Implant Use

Visante Anterior Segment Optical Coherence Tomography Analysis of Morphologic Changes After Deep Sclerectomy With Intraoperative Mitomycin-C and No Implant Use

Reply to “Visante Anterior Segment Optical Coherence Tomography Analysis of Morphologic Changes After Deep Sclerectomy With Intraoperative Mitomycin-C and No Implant Use”

Subconjunctival PRGF Fibrin Membrane as an Adjuvant to Nonpenetrating Deep Sclerectomy: A 2-Year Pilot Study

Contact Info

Product

Resources

About