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Postoperative Results of Deep-sclerectomy with Consideration of the Sonographical Morphology

Zeutzius P., Hille K., Ruprecht K. W.,
Universitätskliniken des Saarlandes, Augenklinik und Poliklinik (Homburg/Saar)

Purpose: The aim of this retrospective study is the evaluation of success rates of deep sclerectomy, which is considered as a modern alternative to the classical penetrating procedures in glaucoma surgery.
Method: The study comprised 32 eyes of 26 patients (average age 70,9 years) affected by different types of open angle glaucomas.18 deep sclerectomies and 14 combined operations with phacoemulsification and intraocular lens implantation were carried out. 26 crosslinked sodium hyaluronat implants were used. 29 eyes were treated with mitomycin and 13 eyes received postoperatively 5-fluorouracil. The examinations including functional and morphological results were performed pre- and perioperatively and at a last visit at mean follow-up time 27,6 weeks. Additionally during the last visit an examination with a high resolution ultrasound system was carried out.
Results: The mean preoperative intraocular pressure (IOP) of 21,96±7,71 mm Hg dropped to14,9±3,15 mm Hg (p<0,05). 20(62,5%) eyes showed an IOP lower than 21 mm Hg without drug treatment and 9(28,1%) eyes showed an IOP lower than 21 mmHg with drug treatment. In 3(9,3%) eyes the operation was not successful and they needed a reoperation (twice a penetrating procedure). The mean number of medications per eye was reduced from 2,24±0,95 to 0,41±0,68. The ultrasound examination showed the presence of an intrascleral space in all eyes with regulated IOP(n=29). In the cases of eyes without success (n=3) it showed once an intrascleral space and twice no space.
Conclusions: The success rate favourizes the method as an alternative in glaucoma surgery. Sonography allows us to show the existence of the intrascleral space. The persistence of this space seems to encourage among others the regulation of IOP.