Clinical outcomes after Ex-PRESS glaucoma shunt versus non-penetrating deep sclerectomy: two-year follow-up.

PURPOSE: To compare the two-year outcomes of non-penetrating deep sclerectomy (NPDS) and Ex-PRESS glaucoma shunt. METHODS: A retrospective chart review of patients who had undergone NPDS or Ex-PRESS since 2012 was conducted. Patients were excluded if they had undergone eye surgery other than cataract extraction, were diagnosed with ocular pathology other than glaucoma or had less than two-year follow-up. Pre- and postoperative visual acuity, intraocular pressure (IOP), number of hypotensive drugs and visual fields were recorded, as well as intra- and postoperative complications. RESULTS: Thirty-nine eyes were included in the NPDS and twenty-three eyes in the Ex-PRESS group. There were no differences in baseline IOP and hypotensive drugs, IOP reduction or postoperative IOP-lowering medications between groups. Two years after surgery, IOP decrease compared to baseline was 23.5% with NPDS and 24.8% with Ex-PRESS. Qualified success (a 20% IOP reduction, with IOP ≤ 18 mmHg with or without medication) rates were similar: 53.8 and 69.6% for NPDS and Ex-PRESS. Visual fields progressed in four eyes of the NPDS (10.2%) and in three eyes (8.7%) of the Ex-PRESS group. As regards complications, early hypotony was more frequent after NPDS (9 eyes, 23.1%) than Ex-PRESS (2 eyes, 8.7%), although the difference was not statistically significant. CONCLUSIONS: Both NPDS and Ex-PRESS produce an IOP-lowering effect of approximately 25%. Success rates are similar after both procedures, and both seem to lead to a stabilization of visual loss.

Rate of sclerotomy suturing in 23-gauge primary vitrectomy.

PURPOSE: To evaluate the rate of sclerotomy suturing in a large series of primary 23-gauge vitrectomies. METHODS: Retrospective chart review of 23-gauge transconjunctival pars plana vitrectomies performed between 2008 and 2012 in a multisurgeon retina practice. Patients with a history of retinal surgery, combination of vitrectomy and scleral buckling surgery, or intraoperative conversion of a sclerotomy to 20-gauge were excluded from the study. Vitrectomies were divided into two types according to their degree of complexity and intraoperative use of instrumentation. Demographic and clinical data were gathered from the chart. Location and number of sutured sclerotomies were obtained from the operative report. RESULTS: A total of 589 eyes from 569 patients were included in this study. At least 1 sclerotomy was sutured in 227 eyes (38.5%): 69 (30.4%) had 1 sutured sclerotomy, 52 (22.9%) had 2 sutured sclerotomies, and 106 (46.7%) had 3 sutured sclerotomies. Sclerotomy suturing was significantly related to the surgical technique (P < 0.001), type of tamponade agent (P = 0.048), and complexity of the vitrectomy (P < 0.001). The incidence of postoperative hypotony at Day 1 was 2.2% and all cases returned to normal intraocular pressure at 1 week. There were no recognized complications related to sclerotomies regardless of suturing. CONCLUSION: The factors that increased the rate of sclerotomy suturing were the absence of tamponade agent and higher complexity of the procedure. There was a high variability in the rate of suturing between the surgeons.

Efficacy and safety of deep sclerectomy and phacoemulsification and deep sclerectomy in clinical material of Military Health Service Institute--yearly observations.

PURPOSE: Comparison of the effectiveness of nonpenetrated deep sclerectomy (DS) as the only procedure in relation to operation combined with phacoemulsification (FDS) in treatment of patients with open-angle glaucoma based on yearly observation. MATERIAL AND METHODS: 67 eyes with open-angle glaucoma were retrospectively analyzed. Applying layer-systematic criteria 21 eyes after deep sclerectomy with scleral implant (SKGEL/Corneal or T-flux/I-Tech) were selected into group I (DS implant) and 23 eyes after phacoemulsification with simultaneously performed deep sclerectomy and scleral implants were selected into group II (FDS implant). In control studies best corrected visual acuity (BCVA), intraocular pressure (IOP), anterior chamber and fundus, were examined. Postoperative complications and applied procedures were analyzed especially controlling hypotensive effect (goniopuncture, antimetabolites), as well as number of glaucoma medications used. Tests were performed in 1 and 7 days after surgery, and later after 1, 3, 6, 12 months. Statistically test U Mann-Whitney was used as well as pair sequence Wilcoxon test. Survival analysis was done with Kaplan-Meier method with the use of log rank test. RESULTS: After 360 days of observation mean values of IOP in group I was 14.3 +/- 3.6 mmHg, and in group II--12.9 +/- 3.0 mmHg. It was a decrease of mean IOP by 29.6% (p = .000) and 41.4% (p = .000) in comparison to preoperative IOP in particular groups. In both groups fewer glaucoma medications were used after surgery and the results were statistically significant (p < .05). As a complete success rate was considered IOP of < or =18 mmHg without glaucoma medications, and qualified success rate was IOP of < or =18 mmHg without medications or with the most of two glaucoma medications. Complete and qualified success rate were achieved respectively in group I (72.6% and 88.4%) and in group II (74.3% and 86.9%) at the end of observation. In the entire observation there were no statistically significant differences between group I and 2 (p > .05). After 360 days of observation there was no statistically significant difference between mean BCVA in group I and II (p > .05). CONCLUSIONS: DS with scleral implant performed as a single procedure or FDS is effective treatment in open-angle glaucoma.

Outcomes of combined phacoemulsification and deep sclerectomy: a 10-year UK single-centre study.

PURPOSE: To report the outcomes of combined phacoemulsification and -deep sclerectomy (phaco-DS) from a single UK centre over a 10-year period. METHODS: Retrospective analysis of phaco-DS data extracted from an ongoing glaucoma surgery database within Calderdale and Huddersfield NHS Trust. Two hundred and ninety-six eyes of 282 patients were included. Data included patient demographics, pre- and postoperative intraocular pressure (IOP), use of mitomycin C (MMC), spacer device implantation, and follow-up details including surgical success rates. IOP success criteria were: (A) IOP <19 mm Hg and/or 20% decrease from baseline and (B) IOP <16 mm Hg and/or 30% drop from baseline. RESULTS: Mean follow-up was 63.5 ± 35.3 months. MMC was applied in 145 eyes (49%). Kaplan-Meier success rates in all eyes for criteria A were 89.1% and 80% with glaucoma medications (qualified success) and 81.2% and 68.3% without medications (unqualified success) at 2 and 5 years, respectively. Qualified success for criteria B was 72.4 and 61.4% and unqualified rates were 67.2 and 55.2% for the same time periods. Repeated-measures ANOVA showed significantly lower IOP in the phaco-DS with MMC group up to 3 years postoperatively (P = 0.002). Cox's proportional hazards for criteria B, however, showed no significant effect of MMC application in the long term (P = 0.2). Increasing age and laser goniopuncture were positively associated with success, whereas the absence of spacer devices was negatively associated. At last follow-up, 20% of eyes were on glaucoma medications. Complication rates were low with hypotony rates of 0.68%. CONCLUSIONS: This study confirms the long-term safety and efficacy of phaco-DS as a primary glaucoma procedure.

Incidence of sclerotomy-related retinal breaks.

PURPOSE: To estimate the incidence of sclerotomy-related retinal breaks (SRRBs) and identify possible associated risk factors. METHODS: Medical records of patients who underwent pars plana vitrectomy (PPV) from January 1994 to January 1999 at the King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia, were reviewed. The diagnosis, procedure, and possible associated risk factors were documented, in addition to the presence of SRRBs and time of discovery. RESULTS: Of the 441 eyes, 3.1% developed early SRRBs, while 2.9% of 350 eyes developed late SRRBs. Most of the eyes that developed SRRBs were phakic, and penetrating trauma was found statistically to increase the risk of SRRBs. CONCLUSIONS: SRRBs are an uncommon complication of PPV. Early detection and proper management can prevent serious sequelae of such complications.