Session Title: Special Issues
Session Date/Time: Friday 15/02/2013 | 08:30-10:00
Paper Time: 08:54
Venue: Hall 2
First Author: : K.Lewczuk POLAND
Co Author(s): : J. Sobczak J. Rudowicz M. Rękas
Purpose:
To show that cataract surgery and nonpenetrating deep sclerectomy with SK-gel implantation allows to achieve efficient lowering of intraocular pressure (IOP) in intermediate follow-up. Performing a nonpenetrating deep sclerectomy (NPDS) should avoid a full-thickness perforation of the anterior chamber, and therefore minimize the risk of complications after a classical trabeculectomy. After de-roofing of Schlemm's channel, aqueous humor can percolate through the semi-permeable trabeculo-Descemet membrane (TDM). TDM can minimize the risk of hypotony and subsequent complications. A very important part of NPDS is the intrascleral decompression space which is created during the operation. To preserve this space, implants are inserted.
Setting:
Ophthalmology Department, Military Institute Of Medicine, Warsaw, Poland.
Methods:
A prospective case series study comprised of 219 surgeries performed on 176 patients, with a mean age of 77,39. All eyes underwent NPDS with cataract surgery and SK-gel was used as the intrascleral implant. Mean observation time was 48,27 ± 12,84 months (9 – 82). The indication for surgical treatment was primary open angle glaucoma treated with maximally tolerated antiglaucoma medication without satisfying IOP control or progression of visual field changes and coexisting cataracts.
In the follow-up examinations best corrected visual acuity (BCVA), IOP, anterior and posterior segments of the eye were checked. The amount of antiglaucoma medications used, postoperative complications and procedures applied to preserve hypotensive effects were analyzed.
To preserve hypotensive effects a laser Nd:YAG goniopuncture, 5-FU administration, laser suturolysis, superficial and deep needling was done.
A complete surgical success was defined as IOP ≤ 18mmHg without antiglaucoma medications, whereas a qualified surgical success as IOP ≤ 18 mmHg with or without antiglaucoma medications. Readings of >18mmHg with antiglaucoma drugs, reoperation, atrophy of the eye, or loss of light perception were considered a failure.
Wilcoxon’s matched pair tests and ANOVA Friedman’s tests were applied. Survival analysis was carried out with the Kaplan-Meier method using a log rank test.
Results:
Mean IOP presurgery values were 19,9±5,0 mmHg and reduced to 12,7±3,5mmHg after 360 days of follow-up and 13,4±3,1mmHg after 720 days. Mean IOP decreased by 35,4% (p<0,001) and 31,8% (p<0,001) respectively. At the end of the follow-up (60 months), mean IOP was 13,3±2,7mmHg (p=0,003346). The mean number of antiglaucoma medications before surgery was 2,34±0,78 and was reduced to 0,34±0,72 after 360 days and to 0,62±0,88 after 720 days.
A complete success rate (IOP≤ 18 mmHg) was achieved in 97,3% after 360, 70,1% after 720 days. For IOP ≤ 12 mmHg was respectively 71,2% and 43,7%. A qualified success rate (IOP≤ 18 mmHg) was achieved in 90,5% after 360, 93,0% after 720 days. For IOP ≤ 12 mmHg was respectively 73,8% and 43,7%. After surgery the mean BCVA dropped slightly from 0,30±0,27 to 0,37±0,27 on the first day after surgery and improved to 0,27±0,26 after 7 days. Mean BCVA stabilized after 30 days at the value of 0,11±0,20.
5-FU injections were performed in 38,89%, goniopunctures were in 23,74%, suturolysis in 20,1% and needling in 18,26%.
The most frequent early postoperative complication was transient hypotony (36,1%). The most frequent late complications were bleb fibrosis (21,9%), and corneal epithelial (11,4%).
Conclusions:
Cataract surgery and nonpenetrating deep sclerectomy with SK-gel implantation allows to achieve efficient lowering of IOP in intermediate follow-up. This effect decreases with time as a result of progressive repair effects inside the sclera and espisclera. The applied procedure of preserving the hypotensive effect are an integral element of postoperative proceedings when progressive scarring limits the postoperative effect. In cases when intraocular pressure was not normalized after surgery, the amount of antiglaucoma medications supporting the regulation of intraocular pressure is lower than before surgery. The profile of observed complications and the significant improvement of visual acuity in most of the operated eyes, show cataract surgery with nonpenetrating deep sclerectomy to be a safe procedure for patients with glaucoma and cataracts.
Financial Disclosure:
None
