Posters

Kumar’s 3rd generation stainless steel spiral Schlemm's canal expander implantation in open-angle glaucoma cases refractory to previous glaucoma surgeries

Poster Details

First Author: D. Galina RUSSIAN FEDERATION

Co Author(s):    V. Kumar   M. Frolov   A. Belodedova   A. Shradqa           

Abstract Details

Purpose:

To evaluate the safety and efficacy of Kumar’s 3nd generation stainless steel spiral Schlemm’s canal expander (SCE) implantation in decreasing intraocular pressure (IOP) in patients with open angle glaucoma (OAG) refractory to previous glaucoma surgeries.

Setting:

Ophthalmic unit of Skhodnya city hospital, Moscow province; People’s friendship university of Russia Medical Institute Department of Ophthalmology, Moscow, Russian Federation.

Methods:

Medical records of 15 patients having undergone implantation of Kumar’s 3rd generation SCE between May, 2014 and June, 2015 in OAG cases refractory to previous glaucoma surgeries were retrospectively evaluated. The device (length-5mm; made from 0.05mm thick medical grade stainless steel wire; inner lumen diameter - .15mm, outer - .25mm) was implanted into SC ab externo. Outcome measures were IOP change, number of glaucoma medications pre- and postoperatively and complications. Success rates were evaluated using World Glaucoma Association guidelines. A paired t-test was used for analysis. Results were significant when p less than .05.

Results:

At 3, 6 and 12 months mean IOP reduced from baseline IOP of 23.1+/–6.7mmHg to 15.5+/–5.1(p=.0041), 15.0+/–4.5 (p=.0015) and 25.8+/–6.3 mmHg (p=.01802); use of medications reduced from 3.1+/–1 to .8+/–1.1 (p=3.97E-07), 1.4+/–1.3(p=9.81E-05) and 1.9+/–1.1(p=.005); complete success was achieved in 64.3 (9/14), 35.7 (5/14) and 14.3% (1/7) cases respectively. Failure rate was - 26.7% (1 case each at 3 and 6 months and 2 cases at 12 months). YAG laser trabeculopuncture, tried in 3 cases, was unsuccessful in reducing IOP. Fluorescein canalography showed complete occlusion of collector channels in 7 cases (46.7%).

Conclusions:

It is plausible that in some failed filter cases, there could be patent post-trabecular outflow. Fluorescein canalography in the present study showed patent post-trabecular outflow in 53% cases (8/15) and implantation of device into SC lumen could control IOP with or without medications in 73% cases. The study further showed that it was safe to implant the device in SC lumen in all cases. Hence it can be concluded that implantation of SCE is a safe and effective procedure in reducing IOP in OAG cases refractory to previous filtering glaucoma surgeries.

Financial Disclosure:

NONE