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T.M. Shaarawy, K. Mansouri, A. Mermoud; Long-term Results of Deep Sclerectomy with Collagen Implant . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1208.
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Purpose: To study prospectively the success rate and complications of deep sclerectomy with collagen implant (DSCI). Setting: Glaucoma unit, Department of Ophthalmology, Hôpital Ophtalmique Jules Gonin, University of Lausanne, Lausanne , Switzerland. Methods: Non-randomised prospective trial involving 105 eyes of 105 patients with medically uncontrolled 1ry and 2ry open-angle glaucoma. Visual acuity, intraocular pressure (IOP), and slit lamp examinations were performed before and after surgery at 1 and 7 days, and 1, 3, 6, 9, 12, 18, 24, 30, 36, 48, 54, 60, 66, 72, 78, 84, 90, and 96 months. Visual field examinations were repeated every 6 months. Results: The mean follow-up period was 64 (SD 26.6) months. The mean preoperative IOP was 26.8(SD 7.7) mm Hg; the mean postoperative IOP was 5.2 (SD 3.35) mm Hg at day 1 and 12(SD 3) mm Hg at month 78. At 96 months, qualified success rate; patients who achieved IOP below 21 mm Hg with and without medication, was 91% and complete success rate, defined as IOP lower than 21 mm Hg without medication, was 57%. Patients with an IOP lower than 21 mm Hg with medication were 34 % at 96 months. Fifty one (49%) of our patients achieved an IOP equal to or lower than 15 mm Hg without medication. Nd:YAG goniopuncture was performed in 54 patients (51%), the mean time of goniopuncture performance was 21 months, and the mean IOP before goniopuncture was 20 mm Hg and dropped to 11 mm Hg after goniopuncture. No shallow or flat anterior chamber, endophthalmitis, nor surgery induced cataract were observed. However 26 patients (25 %) showed a progression of pre-existing senile cataract (mean time 26 months, range 18-37 months). Injections of 5-FU were administered on 25 patients (23%) who underwent DSCI to salvage encysted blebs. The mean number of medications per patient was reduced from 2.3(SD 0.7) to 0.5(SD 0.7) (Signed rank p<0.0001). Conclusion: DSCI appears to provide Stable and reasonable control of IOP at long-term follow-up, with few immediate postoperative complications.
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