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C Auer, P LeHoang, CP Herbort, A Mermoud; Deep Sclerectomy in Refractory Uveitic Glaucoma . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3336.
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Purpose: It has been reported that non-penetrating filtering surgery lowers the intraocular pressure as much as trabeculectomy with fewer complications in primary open angle glaucoma. The surgical treatment of uveitic glaucoma remains unsatisfactory in many cases to date. The purpose in this study was to analyse retrospectively the success of deep sclerectomy in uveitic glaucoma refractory to medical therapy in an open multicentric study. Methods: Patients with a glaucoma uncontrolled with medical therapy seen in the uveitis clinics at La Source Eye Center or the Pitié-Salpétrière hospital undewent deep sclerectomy. The type of uveitis was recorded as well as the number of medical antiglaucomatous therapies, the visual acuity, the intraocular pressure and the visual fields. The type and number of adjunct procedures to sclerectomy(goniopuncture, mitomycine injections, 5-FU-injections) as well as post-operative complications were recorded. Deep sclerectomy was performed with a 5X5 mm superficial scleral flap , deep sclerectomy measuring 4X4 mm. Schlemm's canal was opened and Descemet's membrane was exposed for at least 1 mm. Results: From 1995 to 2001 11 patients (4male / 7 female, aged 8-58 years, mean age 35.1+/- 18.4) had a deep sclerectomy performed for uveitic glaucoma refractory to maximal medical therapy. The uveitic entities included 4 cases of suspected or proven sarcoidosis, 2 cases of Fuchs' uveitis, two cases of intermediate uveitis of unknown etiology and respectively one case of juvenile arthritis related uveitis, of herpes uveitis and tuberculous uveitis. The preoperative mean intraocular pressure of 40.9 +/- 7.5 mm Hg was reduced to 11.2 +/-3.3 mmHg after a mean follow-up of 20.5 +/19.3 months. Adjunct procedures consisted of a total 4 mitomycin injections in 3 cases and of a goniopuncture in 2 other cases. In seven cases no antiglaucomatous drugs were needed after the operation and all other 4 patients needed only drops combining 2 antiglaucomatous treatments. Conclusion: Nonpenetrating deep sclerectomy used in uveitic glaucoma offers a good alternative to classical glaucoma surgery, allowing to control intraocular pressure without the unwanted complications of penerating surgery such as shallow anterior chamber, hyphema, choroidal detachment often reported in series of uveitic glaucoma.
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