Deep Sclerectomy With a New Nonabsorbable Uveoscleral Implant (Esnoper-Clip): 1-Year Outcomes

Abstract

Purpose: To report the safety and the effectiveness of deep sclerectomy (DS) with a new nonabsorbable uveoscleral hema implant (Esnoper-Clip) designed to increase trabecular and uveoscleral outflow and to achieve higher intrascleral blebs.

Materials and methods: Twenty-seven eyes of 27 patients with open-angle glaucoma, who underwent DS with an Esnoper-Clip implant, were included in this study. All patients were followed up after 12 months.

Results: A significant decrease in intraocular pressure was observed after surgery, changing from a preoperative mean of 26.6±5.2 mm Hg to a postoperative mean of 15.3±5 mm Hg (P<0.001) at 12 months. There was also a significant reduction in the number of glaucoma drugs needed, varying from 2.5 per patient to 0.3 (P<0.001) 1 year after surgery. The main intrascleral lake height and volume at 12 months was 0.7±0.1 mm and 3.9±1.3 mm, respectively. No intraoperative complications occurred. The main postoperative complications were a positive Seidel test result at 24 hours in 2 eyes (7.4%), hyphema in 2 eyes (7.4%), and choroidal detachment in 1 eye (3.7%). All these complications resolved successfully. The need for additional mitomycin-C injections was recorded in 4 eyes (14.8%), twice in 2 of them. Twelve eyes (44.4%) underwent postsurgical Nd:YAG laser goniopuncture with a mean time between surgery and this procedure of 4.3 months. Mean intraocular pressure after Nd:YAG laser goniopuncture decreased from 19.2 to 15.5 mm Hg (P<0.001).

Conclusion: DS with an uveoscleral hema implant (Esnoper-Clip) is a safe and effective technique for the management of open-angle glaucoma.

FIGURE 1

The new foldable uveoscleral hema implant (Esnoper-Clip) designed and developed at the Glaucoma Unit of the Hospital Universitari Germans Trias i Pujol, Barcelona (Universitat Autonoma of Barcelona), Spain.

FIGURE 2

Surgical technique. A, Superficial scleral flap (5×5 mm²) of one third of the scleral depth, reaching 2 mm of clear cornea. B, Deep 4×4 mm² scleral flap is dissected and removed, and Schlemm canal was deroofed with a capsulorhexis forceps. The implant has 2 plates; one was placed in a full-thickness suprachoroidal bag 2 mm behind the scleral spur. C, After folding the implant the other foot was placed into the intrascleral lake. It can be fixed without suturing because it has 2 lateral notches that do not allow anterior displacement. D, To achieve higher intrascleral blebs, an intrascleral pocket was created at the posterior limit of the intrascleral bed to fix the posterior edge of the implant, thereby helping to keep the scleral lips apart.

FIGURE 3

A, Mean changes in intraocular pressure (IOP) and number of medications (treatment). B, Mean changes in volume and height of the intrascleral lake.

FIGURE 4

Anterior segment optical coherence tomography. The intrascleral lake and supraciliary space after the implantation with transcleral outflow (arrows) can be observed.