A Comparison Of the Scleral Lake Height By Anterior Segment OCT Using Several Implants In Deep Sclerectomy

Abstract

Purpose: : To perform an analysis of the relationship between deep-sclerectomy (DS) intrascleral blebs height and IOP with three different types of implants using the Visante^TM anterior segment (AS) OCT.

Methods: : This is a cross sectional study in 61 eyes that underwent uneventful DS with intraescleral implant. Eyes were divided depending on the implant that was used: 19 eyes (31.14%) in the SKGel^TM group, 22 eyes (36.06%) in the Esnoper^TM group and 20 eyes (32.78%) in the Aquaflow^TM group. The intraocular pressure (IOP) measurement and the scan with the Visante^TM AS-OCT were performed by the same operator (RF) on the same day in all the patients. Scans were performed through the scleral bleb at 45º, 90º and 135º.

Results: : The mean follow up after surgery was 15.82 (SD 13.76) months. The mean IOP was 12.94 (SD 3.98) mmHg. The median scleral bleb height at 45º was 0.650 (SKGel^TM), 0.570 (Aquaflow^TM) and 0.660 (Esnoper^TM) (p= 0.297). At 90º the median scleral bleb height was 0.630 (SKGel^TM), 0.630 (Aquaflow^TM) and 0.650 (Esnoper^TM) (p= 0.760). Finally at 135º the sclera bleb height was 0.670 (SKGel^TM), 0.650 (Aquaflow^TM) and 0.670 (Esnoper^TM) (p= 0.611). The correlation between the scleral bleb height and the IOP was statistically significant in all measurements (r = -0.359; p= 0.004 at 45º, r = -0.410; p = 0.001 at 90º and was r = -0.417; p = 0.001 at 135º).

Conclusions: : Recently, Mavrakanas et al reported an inverse correlation between sclera bleb height and IOP in 25 eyes presenting clinically flat blebs following DS with collagen implant. Several resorbable and non-resorbable implants have been implanted to mantain a patent intrascleral space. In the current study, we obtained similar results in a large sample of patients using 3 different implants. Intrascleral bleb height is related to the success of DS, suggesting for intrascleral filtration an important role in lowering IOP. There is an inverse significant correlation between the scleral bleb height at 45º, 90º and 135º and the IOP measurement after uneventful DS with any of the evaluated scleral implants without differences between them.

Keywords: intraocular pressure