Abstract
Abstract: :
Purpose: To study prospectively the success rate and complications of a modified deep sclerectomy (DS) with Ex–PRESS LR–50 version glaucoma implant (Optonol Ltd, Israel) in glaucoma and combined surgery with phacoemulsification and IOL implantation. Material and methods: A prospective non consecutive randomized study of 45 eyes of 45 patients with medically uncontrolled mild to moderate glaucoma. All patients underwent a new technique of DS : after fornix or limbal based opening of the conjunctiva and dissection of the superficial scleral flap, a 4x3 mm DS was performed just behind Schlemm’s canal (SC), a LR–50 glaucoma implant was inserted into the AC at the level of SC and the superficial scleral flap was sutured back to place over the implant. Viscoelastic was left into the anterior chamber. Phacoemulsification and IOL implantation was done after dissection of the superficial scleral flap in 33 patients. Complete success rate was defined as IOP ≤ 18mmHg without medication and overall success rate was defined as IOP ≤ 18mmHg with or without medications. Complete eye examination was done before surgery, at days 1 and 7, at months 1, 3, 6 after surgery. When the bleb showed signs of inflammation or cystic fibrosis, one or more sub–conjunctival injections of Mitomycin 0.02% (MMC) were performed. Results: Mean follow–up was 12.4±8.7 weeks. Pre–operatively, mean IOP was 21 ±9.1mmHg with a mean number of medications of 2.3 ± 1.1. At 3 months, the mean post–operative IOP was reduced to 12.6±3.2 mmHg (p< 0.02 Wilcoxon sign rank test) with a complete success rate of 70%. Overall success rate according to Kaplan Meier was 82%. Mean number of medications was 0.2±0.5 at the last visit (p< 0.02 Wilcoxon sign rank test). Immediate temporary complications were mainly IOP spikes (4 cases) and IOP of 0 mmHg (4 cases); in 8 cases, MMC injections were performed. No conjunctival erosion over the implant was seen. Conclusion: Ex–Press LR–50 glaucoma implant inserted into the anterior chamber with a modified DS significantly lowers IOP in glaucoma and combined surgery with phacoemulsification and IOL implantation; this modified technique of DS prevents conjunctival erosion, the major complication after insertion of this implant with no superficial scleral flap.
Keywords: clinical (human) or epidemiologic studies: outcomes/complications • intraocular pressure • anterior chamber