First Author: H.Magdy EGYPT
Co Author(s):
Purpose:
The aim of this work is to assess deep sclerectomy assisted whenever required with goniopuncture compared to standard trabeculectomy. Assessment will include various parameters in glaucoma, in addition to studying the effects on optic nerve head, field of vision and OCT changes.
Setting:
: randomized interventional case-controlled study was conducted on 40 eyes of 25 patients with open angle glaucoma.
Methods:
Inclusion criteria:
• Open angle glaucoma patients, whether medically uncontrolled or intolerable to medical therapy.
• Open angle glaucoma patients with progressive cupping in spite of maximally tolerated medical treatment.
• Open angle glaucoma patients with progressive visual field defects in spite of maximally tolerated medical treatment.
Exclusion criteria:
• Angle closure glaucoma.
• Congenital glaucoma.
• Uveitic glaucoma.
• Media opacities interfering with OCT or optic nerve head photography.
• Neovascular glaucoma.
These patients were selected from the outpatient ophthalmology clinic of Kasr El-Aini Hospital – Cairo University from June 2009 to June 2010.
Patients were randomly divided between groups A and B:
Group A: 20 Open angle glaucoma eyes of 15 patients were operated for deep sclerectomy with mitomycin C (MMC) 0.2 mg/ml with subsequent Nd:YAG goniopuncture. (If IOP was above 21 mmHg during post operative follow up)
Group B: 20 Open angle glaucoma eyes of 14 patients were operated for subscleral trabeculectomy with MMC 0.2 mg/ml. (Control)
Results:
The complete success rate (IOP below 21 mmHg without medications) after 1 year in controlling the IOP was 80% in both groups, and the qualified success rate (IOP below 21 mmHg with one or more medication) in both groups was 20%.
visual gain in deep sclerectomy was found in 4 eyes (20%). Visual loss was found in 1 eye (5%). In trabeculectomy, visual gain was not found in any eye. Visual loss was found in 5 eyes (25%).
laser goniopuncture was done in 7 eyes after deep sclerectomy (35%) to reach the target IOP. the mean IOP was recorded after 1 month to be11.45±4.7 mmHg with % of IOP reduction of 50.7%.
In both groups there were no progressive visual field defects.
The change in the C/D area ratio after 1 year of surgery by OCT of ONH was statstically insignificant between both groups
There was decline in the average thickness of RNFL in both groups with no statistical significant difference
UBM was done to test the bleb and filtration in both groups also to confirm the success of goniopunctue in restoration of filtration.
Conclusions:
deep sclerectomy is as effective as the trabeculectomy in lowering the IOP to reach the target IOP, but it is not just lowering the IOP. laser goniopuncture can be applied to increase filtration to achieve target pressure. deep sclerectomy can avoid of the sight threatening postoperative complications.
Neuroprotective effect of both surgeries is almost the same. Also there were no progressive visual field changes in both groups. There was stable C/D area ratio in both groups evidenced by OCT on the ONH.
What is against the deep sclerectomy, is the long learning curve and the longer duration of the surgical procedure.
Financial Disclosure:
No
