Outcomes of modified deep scleral trabeculectomy surgery under anterior chamber maintainer

Abstract

Objective: To evaluate patients monitored for glaucoma and operated with trabeculectomy combined with deep sclerectomy under an anterior chamber maintainer. Methods: In this retrospective study, fifteen eyes of 15 patients diagnosed with primary open angle glaucoma (POAG) who show up regularly for follow-up examinations between April 2006 and May 2010 were included in this study. Pre-operative/post-operative intraocular pressure (IOP) and the number of antiglaucomatous medications were evaluated. Results: The mean age was 64.6 ± 11.4 (33-80) years and the mean follow-up period was 22.4 ± 16.2 months (6-55). The mean pre-operative IOP was 24.6 ± 8.0 (12-40 mmHg), and the mean cup/disc (c/d) ratio was 0.71 ± 0. 25. According to the Hodapp classification, the mean damage in the visual field was 2.1 ± 0.9. Mean post-operative IOP at months 1, 12, and 24 was 13.2 ± 3.4, 13.6 ± 4.6 and 13.8 ± 2.8 mmHg, respectively. The average number of pre-operative antiglaucomatous medications was 3.1 whereas the average numbers of post-operative antiglaucomatous medications were 1.8, 0.6 and 0.8 respectively. Conclusion: Modified trabeculectomy has low rates of complication and results in a significant decrease in postoperative IOP, as well as the number of antiglaucomatous medications used. J Clin Exp Invest 2014; 5 (4): 544-547

Keywords

• Anterior chamber maintainer, deep sclerectomy, trabeculectomy

Outcomes of modified deep scleral trabeculectomy surgery under anterior chamber maintainer

Öz

Amaç: Glokom tanısı ile takip edilen ve ön kamara koruyucu altında derin skleral trabekülektomi operasyonu geçiren hastaların değerlendirilmesi. Yöntemler: Bu çalışmaya Nisan 2006 – Mayıs 2010 tarihleri arasında primer açık açılı glokom (PAAG) tanısı almış, düzenli olarak kontrollere gelen 15 hastanın 15 gözü dahil edildi. Çalışmada preoperatif ve postoperatif göz içi basıncı (GİB), kullanılan ilaç etken madde sayıları değerlendirildi. Bulgular: Yaş ortalaması 64,6 ± 11,4 (33-80) yıl, ortalama takip süresi 22,4 ± 16,2 ay (6-55) idi. Preoperatif ortalama GİB\'ları 24,6 ± 8,0 mmHg (12-40), ortalama cup/disk (c/d) oranı 0,71 ± 0,25 saptandı. Hastaların görme alanlarındaki hasar Hodapp sınıflamasına göre ortalama 2,1 ± 0,9 idi. Postoperatif 1. ay, 12. ay ve 24. ay ortalama GİB\'ları sırasıyla 13,2 ± 3,4, 13,6 ± 4,6 ve 13,8 ± 2,8 mmHg ölçüldü. Preoperatif kullanılan antiglokomatöz etken madde sayısı ortalama 3,1 iken, postoperatif ortalama sırasıyla 1,8, 0,6 ve 0,8 bulundu. Sonuçlar: Çalışmamızda modifiye trabekülektomi cerrahisi düşük komplikasyon oranları ile hastaların postoperatif GİB\'ında belirgin bir düşme sağlanmakta ve kullanılan ilaç sayısında belirgin bir azalmaya neden olmaktadır.

Anahtar Kelimeler

• Ön kamara koruyucu, derin sklerektomi, trabekülektomi

References

1. Mermoud A, Schnyder CC. Nonpenetrating filtering sur- gery in glaucoma. Curr Opin Ophthalmol 200;11:151– 157.
2. Ambresin A, Shaarawy T, Mermoud A. Deep sclerec- tomy with collagen implant in one eye compared with trabeculectomy in the other eye of the same patient. J Glaucoma 2002;11:214–220.
3. Molteno AC, Bosma NJ, Kittelson JM. Otago glau- coma surgery outcome study: long-term results of trabeculectomy-1976 to 1995. Ophthalmology 1999;106:1742–1750.
4. Chen TC, Wilensky JT, Viana MA. Long-term follow-up of initially successful trabeculectomy. Ophthalmology 1997;104:1120–1125.
5. Crandall AS. Nonpenetrating filtering procedures: vis- cocanalostomy and collagen wick. Semin Ophthalmol 1999;14:189–195.
6. Sarodia U, Shaarawy T, Barton K. Nonpenetrating glaucoma surgery: a critical evaluation. Curr Opin Ophthalmol. 2007;18:152–158.
7. Lachkar Y, Neverauskiene J, Jeanteur-Lunel MN, et al. Nonpenetrating deep sclerectomy: a 6-year retro- spective study. Eur J Ophthalmol 2004;14:26–36.
8. Jones E, Clarke J, Khaw PT. Recent advances in trabeculectomy technique. Curr Opin Ophthalmol 2005;16:107–113.

9. Wells AP, Bunce C, Khaw PT. Flap and suture manipu- lation after trabeculectomy with adjustable sutures: titration of flow and intraocular pressure in guarded filtration surgery. J Glaucoma 2004;13:400–406.
10. Wanner JB, Katz LJ. Releasable suture techniques for trabeculectomy: an illustrative review. Ophthalmic Surg Lasers Imaging 2004;35:465–474.
11. El Sayyad F, Helal M, El-Kholify H, et al. Nonpenetrat- ing deep sclerectomy versus trabeculectomy in bilat- eral primary open-angle glaucoma. Ophthalmology 2000;107:1671–1674.
12. Yalvac IS, Sahin M, Eksioglu U, et al. Primary visco- canalostomy versus trabeculectomy for primary open angle glaucoma: three-year prospective randomized clinical trial. J Cataract Refract Surg 2004;30:2050– 2057.
13. Stegmann RC, Pienaar A, Miller D. Viscocanalostomy for open-angle glaucoma in black African patients. J Cataract Refract Surg 1999;25:316–321.
14. Karlen M, Sanchez E, Schnyder CC et al. Deep scle- rectomy with collagen implant: medium term results. Br J Ophthalmol 1999;83:6–11.
15. Demailly P, Lavat P, Kretz G, et al. Non penetrating deep sclerectomy (NPDS) with or without collagen devices in primary open angle glaucoma: middle term retrospective study. Int Ophthalmol 1999:20:131–134.
16. Krasnov MM. Externalization of Schlemm’s canal (si- nusotomy) in glaucoma. Br J Ophthal 1968;52:157– 161.
17. Mermoud A, Karlen ME, Schnyder C, et al. Nd:Yag goniopuncture after deep sclerectomy with collagen implant. Ophthalmic Surg Lasers 1999;30:120–125.
18. Devloo S, Deghislage C, Van Malderen L, et al. Non- penetrating deep sclerectomy without or with autolo- gous scleral implant in open -angle glaucoma: medi- umterm results. Graefes Arch Clin Exp Ophthalmol 2005;243:1206–1212.
19. Mousa AS. Preliminary evaluation of nonpenetrating deep sclerectomy with autologous scleral implant in open-angle glaucoma. Eye 2007;21:1234–1238.
20. Shaarawy T, Mansouri K, Schnyder C et al. Longterm results of deep sclerectomy with collagen implant. J Cataract Refract Surg 2007;30:1225–1231.
21. Sihota R, Gupta V, Agarwal HC. Long-term evalua- tion of trabeculectomy in primary open angle glau- coma and chronic primary angle closure glaucoma in an Asian population. Clin Experiment Ophthalmol 2004;32:23–28.
22. Cillino S, Di Pace F, Casuccio A, et al. Deep scle- rectomy versus punch trabeculectomy with or with- out phacoemulsification: a randomized clinical trial. J Glaucoma 2004;13:500–506.
23. Feusier M, Roy S, Mermoud A. Deep sclerectomy combined with trabeculectomy in pediatric glaucoma. Ophthalmology 2009;116:30–38.
24. Bayoumi NH. Deep sclerectomy in pediatric glaucoma filtering surgery. Eye (Lond) 2012;26:1548-1553.
25. Munteanu M, Munteanu G, Zolog I, et al. Ocular de- compression retinopathy after combined deep scle- rectomy and trabeculotomy. Klin Monbl Augenheilkd 2012;229:830-831.