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S. A. Gandolfi, N. Ungaro, C. Sangermani, M. Tardini, G. Bacchi; Deep Sclerectomy 10 Years Later: A Retrospective Chart Review. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4175.
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to evaluate the longterm outcome of deep sclerectomy in several glaucoma phenotypes
retrospective chart review. The charts of 124 patients scheduled for primary deep sclerectomy and operated in the period January 1999 - December 2004 were analyzed. Main outcomes (a) complete success = % of patients showing IOP <,16 mmHg, w/out therapy, on Goldmann applanation tonometry performed at similar daytime, (b) post-operative medications, (c) number of further glaucoma surgical procedures. Surgery was performed by the same surgeon. Goniopuncture was considered as a part of the procedure. Peeling of internal TM was recorded from the OP reports.
27 / 124 patients were either lost-to-follow up or ineligible because of intra-operative complications (i.e. micro or macroperforations). 97 patients were still followed by our Glaucoma Clinic. Mean follow up time was 5.3 + 2.6 years (range 3 - 8 years). The glaucoma phenotypes were the following: (a) POAG n = 31, (b) PEX n = 34, (c) PG n = 9, (d) uveitic n = 11, (e) AC IOLs = 12,, Mean (SD) pre-op IOP was 24.3 (2.6). Mean (SD) IOP dropped to 14.3 (2.1) at the end of follow up. Goniopuncture was performed in 64 / 97 patients. Complete success was obtained in 24/97 patients. Complete succes was significantly associated with (a) immediate post-op IOP < 8 mmHg , (b) reported peeling of the TM, 14 / 97 were scheduled for further glaucoma surgery. Cataract extraction was performed in 9 / 58 phakic patients. Previous 360° laser trabeculoplasty, PG and PEX phenotype, further cataract surgery and number of pre-op medications were independent risk factors for failure. 2 patients developed a post-operative delayed suprachoroidal hemorrage. Both of them showed high myopia and were apakic.
In the long-term, deep sclerectomy proved moderately effective in this uncontrolled case series. Peeling of the internal TM seems mandatory to obtain clinically relevant success.
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