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Clarisa Esther Del Hierro, Luis Laneri Pusineri, Carolina Prado-Larrea, Rafael Castañeda, Jesus Jimenez Roman; Sutureless scleral tunnel trabeculectomy, case series report.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):485.
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To determine the effectivity of reducing postoperative IOP measurements with combined sutureless scleral tunnel technique and phacoemulsification on Primary Open Angle Glaucoma (POAG) patients at six-months follow up visit.
A retrospective observational study was carried out. We included 12 eyes from 12 POAG patients that underwent combined glaucoma and cataract surgery. After phacoemulsification with intraocular lens implantation, the trabeculectomy was performed as follows: Superior conjunctiva was slid downwards over the cornea and a 2.2 mm bevel-up metal keratome was introduced 2.5 mm behind the limbus. The keratome was passed through the conjunctiva into the sclera. A superficial lamellar scleral tunnel was done. The blade was then introduced 1 mm into clear cornea to enter the anterior chamber (AC), viscoelastic instilled into the AC through tunnel and a Kelly Descemet’s punch was then introduced along the tunnel into the AC and with the punch facing downwards, the internal lip of the corneal section was punched. The conjunctival wound was sutured with a 10-0 nylon suture. Main outcome measures were Intraocular Pressure (IOP) and number of glaucoma medications at baseline, first and seventh day postoperatively (PO), and first, third and sixth month PO.
Mean patient age was 73.83±6.07 years, 66.66% of patients were female. At baseline mean IOP was 17.08±3.58 mmHg with 2.17±0.83 medications. At 6 months mean IOP was 13.33±1.67 mmHg with 0.083±0.28 medications, that represents a 21.95% IOP reduction (3.75 mmHg, p=0.029). Some adverse events was reported, 3 patients (25%) with shallow chamber, 1 patient (8.33%) with ostium occlusion that resolved with topical 2% pilocarpine, 1 patient (8.33%) with a 1.5 mm hiphema that resolved spontaneously and 1 patient (8.33%) with a wound leakage that resolved with an occlusive patch for 48 hrs. 9 patients (75%) required a mean of 1.67±0.87 bleb needle revision with 5-fluorouracil (5-FU) in the first month PO.
The scleral tunnel technique shows a good IOP reduction and safety profile in patients with POAG who underwent cataract and glaucoma surgery, that we can use it routinely in those patients. A longer follow-up is necessary to determine the long-term results of this technique. This study showed a comparable IOP reduction with the conventional trabeculectomy.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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