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A Mermoud, CC Schnyder, A Mounier, TM Shaarawy; Mid-term Results Of Deep Sclerectomy With Flat Collagen Implant:one Versus Two Implants . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3338.
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Purpose: To study prospectively the success rate and complications of deep sclerectomy, a nonpenetrating filtering procedure, with a new flat collagen implant, and to compare the results of one versus two implants in order to evaluate if the intrascleral space volume correlates with success. Methods: This nonrandomized prospective trial included 29 eyes of 29 patients with medically uncontrolled primary open-angle glaucoma.16 eyes (group 1) had deep sclerectomy (DS) with one flat collagen implant (FCI), 13 eyes (group 2) had DS with 2 FCI.Visual acuity, intraocular pressure (IOP), and slitlamp examination were performed before and after surgery at 1 and 7 days and 1,2,3,6,9,12 months. A qualified success rate was defined as IOP below 21 mm Hg with or without medication. A complete success rate was defined as an IOP lower than 21 mm Hg without medication. Results: The mean follow up was 10.6 months ± 5.4 (SD) in group 1 and 11.8 months ± 7.3 (SD) in group 2. Preoperatively the mean IOP was 24.1 ± 7.9 mmHg in group 1 and 27.6 ± 8.7 mmHg in group2. One day postoperatively, the mean IOP was 8.3 ± 5.1 mm Hg in group 1 and 12.0 ± 2.7 mmHg in group 2; 6 months postoperatively the mean IOP was 12.0 ± 2.6 mmHg in group 1 and 13.6 ± 3 mmHg in group2. At 6 months,the complete success rate was 100% in group 1 and 92% in group2; at 12 months, the complete success rate was lower in group 1 than in group2 ( 60% versus 74%, , p=0.0015). No patient developed a shallow or flat anterior chamber, endophtalmitis or surgery-induced cataract. Subconjunctival injections of Mitomycin-C (MMC) were given to 8 patients (50%) in group 1 and to 1 patient (7.7%) in group 2 ( p= 0.01) who had encysted blebs. Goniopuncture was performed in 5 patients ( 31%) in group 1 and in 7 patients ( 53%) in group 2 ( p-value non significant) .The mean number of medications per patient was reduced from 2.3 ± 0.9 to 1.3 ± 0.5 in group 1 and from 2.0 ± 1.0 to 1 ± 0 in group 2. Conclusion: DS with one or two FCI provided reasonable IOP over a mid term follow- up with few immediate postoperative complications ; complete success rate is significantly higher at 12 months when the scleral space was bigger.
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