DEEP SCLERECTOMY WITH ADEEP SCLERECTOMY WITH ANONREABSORBABLE HEMA NONREABSORBABLE HEMA
IMPLANTIMPLANT
5th IGS 5th IGS April 2005April 2005Cape TownCape Town
Dr. .J LoscosDra. M.A PareraProf. J de la Cámara
H.Universitari Germans Trias i PujolBarcelonaSpain
- Non ionic polymer (2-hydroxietilmetacrilate)Non ionic polymer (2-hydroxietilmetacrilate)- Low tendency to protein adherenceLow tendency to protein adherence- 25% of water25% of water- Not reabsorbableNot reabsorbable
Patients and MethodsPatients and Methods
70 eyes ( 62 patients)70 eyes ( 62 patients) 35 males / 35 females35 males / 35 females Mean Age: 68.5 yearsMean Age: 68.5 years Uncontrolled glaucoma under Uncontrolled glaucoma under
maximal tolerable medical treatmentmaximal tolerable medical treatment
Patients and Patients and Methods:DiagnosisMethods:Diagnosis
POAG 58
Pigmentary glaucoma 5
PSX Glaucoma 4
Uveític glaucoma 2
Keratoplasty 1
Patients and Patients and Methods: Methods:
Preop IOPPreop IOP<16 mmhg…………. 0 eyes<16 mmhg…………. 0 eyes16-21 mmhg……….. 13 eyes 16-21 mmhg……….. 13 eyes >21 mmhg………….. 57 eyes >21 mmhg………….. 57 eyes
Preop MedicationPreop Medication 1 …………………….. 10 eyes1 …………………….. 10 eyes 2……………………… 29 eyes2……………………… 29 eyes 3……………………… 28 eyes3……………………… 28 eyes 3 + diamox ……… 3 eyes3 + diamox ……… 3 eyes
- Fornix- based conjuntival flap
- Superficial escleral flap 5 x 5 mm
- Mitomycin-C : 0,01% ; t = 3’
- Suture HEMA implant in scleral bed with 10/0 nylon sutures
- Suture scleral flap with 1 sutures
- Closure conjunctiva
Surgical techniqueSurgical technique
UBMUBM
Early Early complicationscomplications
Hyphema : 5Hyphema : 5 Seidel : 3Seidel : 3 Coroidal detachment:3Coroidal detachment:3 Anterior chamber shallowing:1Anterior chamber shallowing:1 Hipotony:6Hipotony:6
Late Late complicationscomplications
Subconjunctival fibrosis : 2Subconjunctival fibrosis : 2 Isquemic bleb: 2Isquemic bleb: 2
GoniopunctureGoniopuncture
9 patients ( 18 %)9 patients ( 18 %)
- 1 month : 1 - 1 month : 1 - 6 month: 8 - 6 month: 8
-Mean time : 5.4 monthMean time : 5.4 month-Mean IOP decrease : 4.13 -Mean IOP decrease : 4.13
mmHgmmHg
Postoperative follow-Postoperative follow-upup
Nº IOP < 16 (mmhg)
IOP 16-21 (mmhg)
IOP >21 (mmhg)
Preop 70 0 13 57
Postop. 24 h.
70 56 12 2
1 month 70 43 19 8
3 month 62 36 15 11
6 month 61 28 23 10
12 months 50 15 32 3
Postoperative follow-Postoperative follow-upup
N IOP Medications
Preop. 70 25,35 (SD:4.08) 2,32 (SD: 0,5)
Postop. 24h
70 8,47 (SD: 5,9) 0,01 (SD:0,03)
1 month 70 14,27 (SD: 6,06)
0,12 (SD:0,07)
3 months 62 15,82 (SD: 5,2) 0,16 (SD:0,09)
6 months 61 17,10 (SD: 3,9) 0,21 (SD: 0,07)
12 months 50 17,00 (SD: 3,5) 0,36 (SD: 0,12)
Postoperative follow-up:12 Postoperative follow-up:12 monthsmonths
50 eyes:
IOP preop: 26.2mmhg IOP postop: 17mmhg
Nº preop med:134 Nº postop med: 18
Mean preop med: 2.6 Mean postop med:0.36
ConclusionConclusion
- QUALIFIED SUCCES RATE - QUALIFIED SUCCES RATE ( IOP< 21 mmHg with / without ( IOP< 21 mmHg with / without medication )medication )
- 88%- 88%
- COMPLET SUCCESS RATE - COMPLET SUCCESS RATE (IOP < 21 mmHg without medication)(IOP < 21 mmHg without medication)
- 68%
ConclusionConclusion
- HEMA implant is safety and effective in HEMA implant is safety and effective in control IOPcontrol IOP
- Few postoperative complications- Few postoperative complications
- Further studies to compare efficiencyFurther studies to compare efficiency with other implantswith other implants
Thank youThank you
