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G. Rebolleda, F. J. Munoz-Negrete, L. Cabrejas; Ultrasound Biomicroscopy Characteristics of Deep Sclerectomy With Reticulated Hyaluronic Acid Implant. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4172. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the anatomical characteristics and the intraocular pressure lowering mechanisms of deep sclerectomy with reticulated hyaluronic acid implant (SK-gel®) by ultrasound biomicroscopy (UBM)
Deep sclerectomy (DS) was performed in 40 consecutive eyes of 38 patients with uncontrolled primary open angle glaucoma. Several variables were evaluated at 1 and 3 months postoperatively; including IOP measurement, presence and size of the intrascleral space (maximum length, maximum height and volume), the thickness of trabeculo-descemet membrane (TDM), presence and characteristics of subconjunctival filtering bleb, supraciliary hypoechoic area, and scleral reflectivity around the decompression space. The possible association between UBM variables and IOP measurement was also determined.
IOP significantly dropped from a mean preoperative value of 24,6 ± 4,2 to 12,3 ± 4,1 mmHg and 13,6 ± 3,5 ,,Hg at 1 and 3 months postoperative (P < 0.01). An intrascleral cavity was observed in all eyes. The mean volume of intrascleral cavity was 11,5 ± 8,7 mm3 and 8,2 ± 6,7 mm³ at 1 and 3 months postoperatively. A significant correlation was found between IOP and intrascleral lake volume (P < 0.05). The mean TDM thickness was 0,12 ± 0,03 mm. At 3 months examination, an hyporeflective bleb was present in 61.1%, a supraciliary hypoechoic area in 80.6% and scleral hyporeflectivity around the scleral lake in 72,2%. These 3 UBM characteristics were detected simultaneously in 38.9% of eyes, and this finding was significantly correlated with lower IOP values.Conclussions: Several studies evaluated UBM after deep sclerectomy, most of them have been performed with collagen implant. Several aqueous humour drainage pathways including, a low-reflective diffuse subconjunctival space, a remaining intrascleral cavity and an additional suprachoroidal outflow have been described. In a similar way, after DS using reticulated hyaluronic acid implant, filtering bleb formation, increased uveoscleral and transscleral filtration are present singly and in various combinations. In this study, the simultaneous presence of all 3 characteristics correlated significantly with a lower IOP
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