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Clinical Trial
. 1999 Jan;83(1):6-11.
doi: 10.1136/bjo.83.1.6.

Deep sclerectomy with collagen implant: medium term results

M E Karlen  1 , E Sanchez, C C Schnyder, M Sickenberg, A Mermoud
Affiliations
Clinical Trial

Deep sclerectomy with collagen implant: medium term results

M E Karlen et al. Br J Ophthalmol. 1999 Jan.

Abstract

Aims: To study prospectively the success rate and complications of deep sclerectomy with collagen implant (DSCI), a new non-penetrating filtration procedure.

Methods: Non-randomised prospective trial involving consecutive patients. 100 eyes of 100 patients with medically uncontrolled primary and secondary open angle glaucoma. A superficial scleral flap was raised and a deep sclerectomy was performed in the scleral bed. Schlemm's canal was opened and dissection of the cornea was performed up to Descemet's membrane, at which point aqueous percolated through the remaining trabeculo-Descemet's membrane. A collagen implant was sutured radially in the scleral bed. Visual acuity, intraocular pressure (IOP) measurements, and slit lamp examinations were performed before surgery and after surgery at 1 and 7 days, and 1, 3, 6, 9, 12, 18, 24, 30, and 36 months.

Results: The mean follow up period was 17.8 (SD 8.7) months. The mean preoperative IOP was 27.8 (8.6) mm Hg; the mean postoperative IOP was 5.7 (4.0) at day 1, 11.2 (4.6) at month 1, 14.0 (3.5) at month 12, and 13.0 (3.8) at month 36. Complete success rate, defined as an IOP lower than 21 mm Hg without medication, was 44.6% at 36 months. Qualified success rate, defined as an IOP lower than 21 mm Hg with medication, was 97.7% at 36 months. Early postoperative complications included hyphaema in seven patients, would leak in 10 patients, and subtle choroidal detachment in 11 patients. Goniopuncture was performed in 41 of the patients, and 5-fluorouracil injections were made in 23 patients; cataract progression occurred in seven patients. When comparing the different types of open angle glaucoma, no difference was found in terms of reduction in IOP, number of patients requiring antiglaucoma medications, or success rate.

Conclusions: Deep sclerectomy with collagen implant appears to provide reasonable control of IOP at medium term follow up, with few immediate postoperative complications.

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Figures

Figure 1
Figure 1
(A) Schematic representation if the irido-corneal angle before deep sclerectomy with collagen implant. (B) Schematic representation of the irido-corneal angle after deep sclerectomy with collagen implant. The aqueous humour flows out of the anterior chamber through the trabeculo-Descemet's membrane, fills the scleral space (the pathway of which is maintained with the collagen implant), and then flows to the subconjunctival space.
Figure 2
Figure 2
Photograph of collagen implant being placed after deep sclerectomy dissection. Schlemm's canal has been opened, anterior trabeculum and Descemet's membrane are exposed, and aqueous is filtering through the remaining membrane.
Figure 3
Figure 3
Dry lyophilised collagen implant and collagen implant after hydration.
Figure 4
Figure 4
Intraocular pressure before and after deep sclerectomy with collagen implant.
Figure 5
Figure 5
Long term cumulative complete success probability and qualified success probability of deep sclerectomy with collagen implant, using Kaplan-Meier life table analysis.
Figure 6
Figure 6
Evolution of the mean visual acuity after DSCI.
Figure 7
Figure 7
Postoperative complications.
See this image and copyright information in PMC

Comment in

  • "New" surgical treatments for glaucoma.
    Khaw PT, Siriwardena D. Khaw PT, et al. Br J Ophthalmol. 1999 Jan;83(1):1-2. doi: 10.1136/bjo.83.1.1. Br J Ophthalmol. 1999. PMID: 10209423 Free PMC article. No abstract available.

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