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R.K. Pinheiro, A. Betinjane, V.R. Castanheiras, C. Mandia, N. Kasahara, M. Della Paollera, R. Eliezer, R. Cohen, F. Crosta; "Internal Revision of Simmons": First Analysis of His Clinical Results . Invest. Ophthalmol. Vis. Sci. 2005;46(13):97.
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Purpose: to determine the efficacy and the rate of complications of this procedure. Methods: in a prospective study we selected 29 patients with uncontrolled open angle glaucoma although previous trabeculectomy. We compared the IOP, the visual acuity, the visual field, the number of endothelial cells lost and the amount of eye drops before and after the surgery. All patients underwent the internal revision with MMC 0,02% subconjuntivally. Under local anesthesia a beveled corneal incision was done 3mm from the limbus with 1mm of width. Wile the sclerostomy is viewed with a Zeiss goniolens, a Castroveijo cyclodialysis spatula is passed into the anterior chamber through the incision. After the tip of the spatula is observed in the subconjuntival space, dissection of the scarred episcleral tissue is performed. Balanced salt solution is injected toward the sclerostomy to inflate the bleb. The success rate was decreasing the intra ocular pressure in 30% after 6 months of follow up. Results: The pressure dropped from 24 ± 4mmHg to 15 ± 4 mmHg(p<0,005), and the number of eye drops decreased from 2,1 ± 0,8 to 1,2 ± 1 (p<0,005). 18 patients (62%) lower the IOP equally or more than 30%. There was no statistically change in the vision nor in the visual field, but there was a lost of 2% in the number of endothelial cells.(p<0,005) and 14% of the patients needed another surgery to control the IOP. Conclusions: There are few alternatives for glaucoma surgery failure. Neddling can be a choice, but we need more options with better results in a long period. The Simmons Revision, showed a significant change of the pressure that was sustained, for the period of this study.
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