Five year results of viscocanalostomy

Abstract

Aim: To prospectively study the success rate and complications of viscocanalostomy, a non-penetrating glaucoma surgery.

Methods: Prospective non-randomised consecutive case series of 57 eyes (57 patients) with medically uncontrolled primary and secondary open angle glaucoma. Viscocanalostomy was performed on all participants with injection of viscoelastic in the surgically created ostia of Schlemm's canal as well as in the scleral bed, the superficial scleral flap was loosely sutured. Intraocular pressure, visual acuity, and number of goniopunctures were measured.

Results: The mean follow up period was 34.1 months. The mean preoperative intraocular pressure (IOP) was 24.6 mm Hg; while the mean postoperative IOP was 5.6 mm Hg at day 1 and 13.9 mm Hg at 36 month. Patients who achieved IOP below 21 mm Hg with or without medication were 90% at 60 months, complete success rate (IOP<21 mm Hg without medication) was 60% at 60 months. 21 patients (37%) needed Nd:YAG goniopuncture postoperatively to control raised IOP, mean time for goniopuncture application was 9.4 months, mean pre-goniopuncture IOP was 20.4 mm Hg and mean postgoniopuncture IOP was 12.6 mm Hg (p <0.0001).

Conclusion: Viscocanalostomy appears to be a promising modification of filtering surgery.

Figure 1

Superficial scleral flap dissection.

Figure 2

Deep scleral flap dissection.

Figure 3

Trabeculo-Descemet’s membrane.

Figure 4

Injection of viscoelastic in the surgically created ostia of Schlemm’s canal.

Figure 5

Intraocular pressure before and after viscocanalostomy. Vertical error bars represent ±1 SD.

Figure 6

Evolution of the mean visual acuity after viscocanalostomy. Vertical error bars represent ±1 SD.

Figure 7

Postoperative complications.