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Botella-García J, Balboa M, Romera-Romero P, Stijnen T, Sánchez-Fortún A, Mercieca K, Loscos-Arenas J. Efficacy and safety of deep sclerectomy with uveoscleral implant plus collagen matrix implant overcoming the superficial scleral flap in glaucoma surgery. Int J Ophthalmol 2023; 16:1806-1813. [PMID: 38028507 PMCID: PMC10626349 DOI: 10.18240/ijo.2023.11.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 08/16/2023] [Indexed: 12/01/2023] Open
Abstract
AIM To assess the efficacy and safety of non-penetrating deep sclerectomy (NPDS) with uveoscleral implant plus subconjunctival and intrascleral collagen matrix overcoming the superficial scleral flap lips (modified deep sclerectomy technique, DS) and minimal use of mitomycin C in glaucoma surgery. METHODS A retrospective review of 47 consecutive glaucoma patients who underwent NPDS with DS between January 2017 and May 2018. Best-corrected visual acuity, intraocular pressure (IOP), post-operative need for glaucoma medications, visual field mean deviation (MD), re-interventions, needling revisions and laser goniopuncture were noted. Absolute success was defined as IOP≤18 mm Hg without topical medication. Relative success was defined as the same criteria but with the addition of any antihypertensive medication. IOP over 18 mm Hg on two consecutive follow-up visits was considered as a failure. RESULTS Fifty-two eyes of 47 patients were evaluated. Mean preoperative IOP was 25.37±6.47 mm Hg, and decreased to 15.04±4.73 at 12mo and 12.21±4.1 at 24mo (all P<0.0001). Requirement for topical medications dropped from a mean of 3.06±0.25 per patient to 0.51±0.99 and 1.11±1.23 respectively after 12 and 24mo (all P<0.0001). No medications were required in 45.5% of patients after 24mo. Relative and absolute success rate at 24mo were 85.5%±5% and 48.5%±7.4%, respectively. CONCLUSION DS is a safe and effective non-penetrating glaucoma surgery variation. It aims to retain the patency of all pathways created for aqueous humor drainage: the intrascleral bleb, the supraciliary space and the open communication between intrascleral and subconjunctival compartments.
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Affiliation(s)
- Jéssica Botella-García
- Department of Ophthalmology, Hospital Germans Trias i Pujol, Badalona 08916, Spain
- International University of Catalonia (UIC), Barcelona 08017, Spain
- Department of Surgery, Barcelona Autonomous University (UAB), Barcelona 08035, Spain
| | - Marta Balboa
- Department of Ophthalmology, Hospital Germans Trias i Pujol, Badalona 08916, Spain
| | - Pau Romera-Romero
- Department of Ophthalmology, Hospital Germans Trias i Pujol, Badalona 08916, Spain
- Department of Surgery, Barcelona Autonomous University (UAB), Barcelona 08035, Spain
| | - Theo Stijnen
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden 2333, The Netherlands
| | | | - Karl Mercieca
- University Hospitals Bonn Eye Clinic, Bonn, 53127, Germany
| | - Jordi Loscos-Arenas
- Department of Ophthalmology, Hospital Germans Trias i Pujol, Badalona 08916, Spain
- Department of Surgery, Barcelona Autonomous University (UAB), Barcelona 08035, Spain
- Germans Trias i Pujol Research Institute (IGTP), Badalona 08916, Spain
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Correia Barbosa R, Gonçalves R, Bastos R, Alves Pereira S, Basto R, Viana AR, Tenedório P. Trabeculectomy Vs Non-penetrating Deep Sclerectomy for the Surgical Treatment of Open-Angle Glaucoma: A Long-Term Report of 201 Eyes. Clin Ophthalmol 2023; 17:1619-1627. [PMID: 37304331 PMCID: PMC10257434 DOI: 10.2147/opth.s405837] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 03/17/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction Glaucoma is the second leading cause of vision loss worldwide. The reduction of intraocular pressure remains the backbone of its therapy. Among surgical techniques for its treatment, deep non-penetrating sclerotomy is the most widely practiced non-penetrating surgery. The purpose of this study was to evaluate the long-term efficacy and safety of deep non-penetrating sclerotomy compared to standard trabeculectomy in patients with open-angle glaucoma. Patients and methods Retrospective study including 201 eyes with open-angle glaucoma. Closed-angle and neovascular cases were excluded. Absolute success was considered when intraocular pressure under 18 mmHg, or a reduction of at least 20% in patients with a baseline intraocular pressure below 22 mmHg, was obtained after 24 months, without the use of medication. Qualified success was considered when those targets were met with or without the use of hypotensive medication. Results Deep non-penetrating sclerectomy showed a slightly lower long-term hypotensive effect compared to standard trabeculectomy, with significant differences at 12 months, but not at 24 months of follow-up. The absolute and qualified success rates were 51.85% and 65.43% for the trabeculectomy group and 50.83% and 60.83% for the deep non-penetrating sclerectomy, without significant differences. Regarding postoperative complications, mainly due to postoperative hypotonia, or related to the filtration bleb, they were significantly different between groups, with 10.8% and 24.7%, in deep-nonpenetrating sclerectomy and trabeculectomy groups, respectively. Conclusion Deep non-penetrating sclerectomy seems to be an effective and safe surgical option for patients with open-angle glaucoma unable to be controlled by non-invasive strategies. Data suggests that the intraocular pressure-lowering effect of this technique may be marginally lower than that of trabeculectomy, but the achieved efficacy outcomes were similar, with a significantly lower risk of complications.
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Affiliation(s)
- Renato Correia Barbosa
- Ophthalmology Department, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Rita Gonçalves
- Ophthalmology Department, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Ricardo Bastos
- Ophthalmology Department, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Sara Alves Pereira
- Ophthalmology Department, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Rita Basto
- Ophthalmology Department, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Ana Rita Viana
- Ophthalmology Department, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Paula Tenedório
- Ophthalmology Department, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
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Baxant AD, Klimešová YM, Holubová L, Pluhovský P, Bartošová J, Veselý Ľ, Nemčoková M, Rosina J, Studený P. Efficacy and Safety of Deep Sclerectomy With the Esnoper Clip Implant for Uncontrolled Primary Open Angle Glaucoma: A 1 Year Prospective Study. J Glaucoma 2023; 32:227-235. [PMID: 36256952 PMCID: PMC9981320 DOI: 10.1097/ijg.0000000000002137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 09/29/2022] [Indexed: 03/04/2023]
Abstract
PRCIS Deep sclerectomy (DS) with the Esnoper Clip drainage implant in patients with uncontrolled primary open angle glaucoma (POAG) achieved a complete success rate of 87.2% at the 1-year follow-up. PURPOSE To investigate the efficacy and safety of DS followed by Esnoper Clip implantation in patients with uncontrolled POAG. MATERIALS AND METHODS In a prospective, consecutive, interventional study, we investigated 39 eyes of 35 patients with uncontrolled POAG who underwent DS with Esnoper Clip implantation. Complete ophthalmologic examinations including corrected visual acuity and intraocular pressure (IOP), were performed preoperatively, and at 1 day, at 1 week as well as at 1, 3, 6, 9, and 12 months postoperatively. Moreover, any goniopunctures and glaucoma medications required postoperatively were noted. RESULTS The mean preoperative IOP was 20.8±5.2 mm Hg and it decreased to 13.9±3.1 mm Hg at 1 year postoperatively ( P <0.001). The number of glaucoma medications decreased from 2.9±0.7 preoperatively to 0.3±0.8 after 1 year ( P <0.001). The complete success rate (IOP≤21 mm Hg without glaucoma medication) and the qualified success rate (IOP ≤21 mm Hg with or without glaucoma medication) were 87.2% and 94.9%, respectively. Goniopuncture was performed in 33.3% of cases. No significant corrected visual acuity changes were registered at the final follow-up. Perioperative complications consisted of 3 micro-perforations of the trabeculo-descemet membrane. Postoperative complications included: hyphema (6 eyes), hypotony (6 eyes), shallow anterior chamber (3 eyes), choroidal detachment (4 eyes)-all of which were resolved without surgical intervention during the first postoperative month-and conjunctival dehiscence, which required resuture (2 eyes). CONCLUSION Deep sclerectomy with the Esnoper Clip implant was safe and effectively lowered IOP in patients with uncontrolled POAG.
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Affiliation(s)
- Alina-Dana Baxant
- Department of Ophthalmology, University Hospital Královské Vinohrady
| | - Yun Min Klimešová
- Department of Ophthalmology, University Hospital Královské Vinohrady
| | - Lucie Holubová
- Department of Ophthalmology, University Hospital Královské Vinohrady
| | - Patrik Pluhovský
- Department of Ophthalmology, University Hospital Královské Vinohrady
| | - Jitka Bartošová
- Department of Ophthalmology, University Hospital Královské Vinohrady
| | - Ľudovít Veselý
- Department of Ophthalmology, University Hospital Královské Vinohrady
| | - Martina Nemčoková
- Department of Ophthalmology, University Hospital Královské Vinohrady
| | - Jozef Rosina
- Department of Medical Biophysics and Informatics, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pavel Studený
- Department of Ophthalmology, University Hospital Královské Vinohrady
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Anisimova NS, Arbisser LB, Anisimov SI, Arutyunyan LL, Shilova NF, Bashaeva G, Kirtaev RV, Anisimova SY. Five-year results of non-penetrating deep sclerectomy with demineralized cancellous bone xenogenically derived collagen glaucoma implant. Int Ophthalmol 2021; 41:2041-2052. [PMID: 33655389 DOI: 10.1007/s10792-021-01760-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/06/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate the long-term effectiveness of non-penetrating deep sclerectomy (NPDS) with xenogenically derived cancellous bone collagen glaucoma implant (XCB-CGI) implantation in patients with primary open-angle glaucoma (POAG). MATERIALS AND METHODS Retrospective chart review of patients with POAG stages 2 and 3 was treated with NPDS and XCB-CGI. Follow-up was at 6 months, 1, 2, 3, 4 and 5 years after surgery. Main outcomes were intraocular pressure (IOP) and medication burden. Secondary outcomes were visual acuity, corneal hysteresis (CH), visual field (VF) and optical coherence tomography (OCT) parameter analysis. RESULTS Among 71 patients (71 eyes), the mean age was 72.7 ± 9.8. Average initial IOP was 27.7 ± 7.9 and average initial med load was 2.36 ± 0.99. At 6 months, 1, 2, 3, 4 and 5 years, the average IOP was 14.9 ± 3.3 mm Hg (46.2% reduction), 15.3 ± 4.0 mm Hg (44.7% reduction), 14.2 ± 3.8 mm Hg (48.7% reduction), 15.2 ± 3.3 mm Hg (45.0% reduction), 15.5 ± 3.3 mm Hg (44.0% reduction) and 14.2 ± 2.8 mm Hg (48.7% reduction), respectively. In 5 years, the success rate was 34% and 67%, without, and with medications (1.8 ± 0.8 meds required), respectively. Visual acuity was not significantly different (P > .05) at all follow-up visits from baseline. Mean CH increased by 2.1 ± 0.8 (P = .05). No glaucomatous deterioration of the VF and OCT parameters was detected in 56 eyes at the 5-year follow-up. CONCLUSION NPDS with XCB-CGI implantation is an effective procedure to normalize the level of IOP, stabilize glaucomatous changes and decrease the number of meds needed for glaucoma control.
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Affiliation(s)
- Natalia S Anisimova
- A.I. Yevdokimov, Moscow State University of Medicine and Dentistry, Moscow, Russia. .,Eye Center Vostok-Prozrenie, Moscow, Russia. .,Department of Eye Diseases, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, 127473, Delegatskaya St., 20, p. 1, Moscow, Russia.
| | | | - Sergey I Anisimov
- A.I. Yevdokimov, Moscow State University of Medicine and Dentistry, Moscow, Russia.,Eye Center Vostok-Prozrenie, Moscow, Russia
| | | | | | - Gilyana Bashaeva
- A.I. Yevdokimov, Moscow State University of Medicine and Dentistry, Moscow, Russia.,Eye Center Vostok-Prozrenie, Moscow, Russia
| | - Roman V Kirtaev
- Moscow Institute of Physics and Technology, Dolgoprudny, Russia
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Vila-Mascarell E, Vila-Arteaga J, Suriano MM, Fons Moreno A. Spurectomy: A novel modification of non-penetrating deep sclerectomy. ACTA ACUST UNITED AC 2020; 96:195-201. [PMID: 33298353 DOI: 10.1016/j.oftal.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/09/2020] [Accepted: 09/16/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the outcomes of a novel modification of the non-penetrating deep sclerectomy (NPDS) approach for glaucoma management called spurectomy. METHODS Observational comparative non-randomized retrospective study including 98 glaucomatous eyes of 76 patients operated on with the spurectomy technique consisting of the combination of the excision of the scleral spur with NPDS (groupA). A control group (groupB) including 53 glaucomatous eyes of 43 patients operated on with classical NPDS was also included. Changes in intraocular pressure (IOP) and medications required as well as complications were recorded in a 12-month follow-up. RESULTS Mean IOP decreased from 25.69±8.11 preoperatively to 15.73±4.16mm Hg postoperatively in groupA (p<0.001). In groupB, mean IOP decreased from 26.66±5.93 preoperatively to 18.19±5.93mm Hg postoperatively (P<.001). Differences between groups in postoperative IOP was statistically significant (P<.001). At 12months after surgery, 13.27% and 52.83% of eyes in groupsA andB required topical antihypertensive therapy (P<.001). The rate of absolute success after surgery was 87.5% and 47.17% in groupsA andB, with significantly higher rate of relative success in groupB (P<.001). No significant differences among groups were found in the complication rate (P=.960). The most common postoperative complication was microperforation of the trabeculo-descemetic membrane in both groups. CONCLUSIONS Spurectomy is a safe and effective technique when compared with conventional NPDS and seems a promising alternative in the surgical management of glaucoma, optimizing the efficacy of the treatment and minimizing complications.
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Affiliation(s)
- E Vila-Mascarell
- Clínica Oftalmológica Vila-Innova Ocular, Valencia, España; Hospital La Fe, Valencia, España
| | - J Vila-Arteaga
- Clínica Oftalmológica Vila-Innova Ocular, Valencia, España; Hospital La Fe, Valencia, España
| | - M M Suriano
- Clínica Oftalmológica Vila-Innova Ocular, Valencia, España; Hospital General de Castellón, Castellón, España; Facultad de Medicina, Universidad Jaime I, Castellón, España.
| | - A Fons Moreno
- Facultad de Medicina, Universidad de Valencia, Valencia, España
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Belda JI, Loscos-Arenas J, Mermoud A, Lozano E, D'Alessandro E, Rebolleda G, Rodriguez-Agirretxe I, Canut M, Rodriguez-Calvo PP. Supraciliary versus intrascleral implantation with hema implant (Esnoper V-2000) in deep sclerectomy: a multicenter randomized controlled trial. Acta Ophthalmol 2018; 96:e852-e858. [PMID: 29855167 DOI: 10.1111/aos.13749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 02/08/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare the supraciliary versus intrascleral implantation of the hema implant (Esnoper V-2000) in terms of the efficacy and safety in nonpenetrating deep sclerectomy (NPDS). PATIENTS AND METHODS Prospective, randomized, unmasked, competitive and multicenter clinical trial. Eighty-three eyes from 83 patients suffering from open-angle glaucoma (40 males, 43 females) were enrolled and followed up for 12 months. Main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), perimetry (mean defect, MD and Visual Field Index, VFI), pachymetry, number of antiglaucoma medications and analysis of blebs according Moorfields Bleb Grading. RESULTS The IOP was significantly reduced in both groups from 23.74 ± 6.9 mmHg (implant sutured to the sclera, group 1) and 23.46 ± 6.47 mmHg (implant placed in the suprachoroidal space, group 2) to 15.43 ± 4.27 mmHg (p < 0.001) and 14.62 ± 3.64 mmHg (p < 0.001), respectively. There were no statistically significant differences in mean IOP values between the groups a year after the surgery (p = 0.581). BCVA did not show statistical differences in comparison with baseline (p = 0.09, group 1; p = 0.42, group 2). The mean number of antiglaucoma medications was reduced in both groups from 2.58 ± 0.04 and 2.68 ± 0.02 before the surgery to 0.32 ± 0.76 and 0.24 ± 0.66 after surgery. CONCLUSION Nonpenetrating deep sclerectomy using hema implant (Esnoper V-2000) is safe and effective regardless of the positioning of the implant. We achieved IOP decrease and reduction in antiglaucoma medications during the first year after surgery without significant differences between both techniques.
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Affiliation(s)
- Jose I. Belda
- Department of Ophthalmology; Torrevieja Hospital; Alicante Spain
| | | | | | - Esther Lozano
- Department of Ophthalmology; Torrevieja Hospital; Alicante Spain
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Supraciliary Implant Placement and Postoperative Suprachoroidal Hemorrhage After Nonpenetrating Deep Sclerectomy. J Glaucoma 2018; 27:389-392. [PMID: 29401157 DOI: 10.1097/ijg.0000000000000896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose if this study was to evaluate the clinical characteristics and risk factors of 3 eyes (3 patients), with primary open-angle glaucoma (POAG), in whom a postoperative suprachoroidal hemorrhage (SCH) occurred after a previous nonpenetrating deep sclerectomy (NPDS) augmented with a supraciliary nonabsorbable implant placement. METHODS AND SURGICAL TECHNIQUE This is a report of 3 eyes of the 3 patients who underwent NPDS in 3 different centers, by 3 experienced surgeons, and were the only ones to develop postoperative SCH in the last 18 years. All were operated with a one-third thickness outer scleral flap measuring 5×5 mm dissected until it reached 1 to 2 mm into the clear cornea. Mitomycin C (MMC, 0.02%) was applied for 1 minute and an inner scleral flap measuring 4×4 mm was dissected leaving only 10% of scleral thickness below. Then, the inner wall of Schlemm canal was removed. A supraciliary implant, T-flux (Carl Zeiss Meditec, Zeiss, Spain) in case 2 and Esnoper (AJL Ophthalmics SA, Miñano, Spain) in cases 1 and 3, was placed through a full-thickness escleral incission 2 mm behind the scleral spur. RESULTS Three eyes with uncontrolled primary open-angle glaucoma had a delayed SCH after an uneventful NPDS. Time lapse from filtering surgery to the SCH ranged from 12 hours in case number 1, to 3 weeks in case 3. Several risk factors for DSH were present, but the only common clinical feature for all of them, was the nonabsorbable implant that was placed in the supraciliary space. A Hema implant (Esnoper) was used in 2 eyes (cases 1 and 3), and T-flux, was implanted in the case 2. Case 1 required vitreoretinal surgery and had poor visual outcome, but cases 2 and 3 recovered with conservative treatment. CONCLUSIONS Although taking the potential bias arising from the nature of the current cases report into consideration, supraciliary placement of the implant in NPDS could be a risk factor for SCH. Consequently, it seems reasonable to avoid it, especially in the presence of other best recognized factors.
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Szurman P, Januschowski K, Boden KT, Seuthe AM. Suprachoroidal drainage with collagen sheet implant- a novel technique for non-penetrating glaucoma surgery. Graefes Arch Clin Exp Ophthalmol 2017; 256:381-385. [DOI: 10.1007/s00417-017-3873-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/11/2017] [Accepted: 12/11/2017] [Indexed: 10/18/2022] Open
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Two-year Results After Deep Sclerectomy With Nonabsorbable Uveoscleral Implant (Esnoper-Clip): Surgical Area Analysis Using Anterior Segment Optical Coherence Tomography. J Glaucoma 2017; 26:929-935. [DOI: 10.1097/ijg.0000000000000756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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