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Long-term results of surgical treatment of refractory glaucoma using an original stainless steel glaucoma device

Poster Details

First Author: V.Kumar RUSSIA

Co Author(s):    M. Frolov   I. Shepelova           

Abstract Details



Purpose:

To analyze long term results of surgical treatment of refractory glaucoma using an original stainless steel glaucoma device.

Setting:

Ophthalmic unit of Skhodnya city hospital,Moscow province; department of ophthalmology, People's friendship university of Russia, Moscow, Russian Federation

Methods:

Between 2008 and 2012, 20 patients (20 eyes) - 10 male and 10 female patients (average age - 68.6 +/-7.1yrs.) operated for refractive glaucoma with implantation of an original stainless steel glaucoma device were under observation. Eight cases (40%) each were operated for painful terminal stage open angle glaucoma and for failed previous glaucoma surgery, 1 (5%) - for postuveal secondary glaucoma and 3 (15%) - for neovascular glaucoma. Surgical technique: Under fornix based conjunctival flap, app. 1.0 -1.5 mm away from limbus and parallel to it, a band of sclera (1.0 X 0.5 mm X 90-95% full sclera thickness) was dissected and excised. Device made from .25mm thick medical grade stainless steel wire was inserted into anterior chamber through 1.0 mm wide parasynthesis at the base of scleral groove and its other end was fixed to the posterior lip of scleral groove with 10-0 suture. Outcome measures were: visual acuity, intraocular pressure (IOP) change, additional hypotensive medication use and need for repeat surgery. IOP was measured by Maklakov's method. Follow-up > 2 years. Success rates were evaluated at each follow-up visit as per the guidelines of World Glaucoma Association for clinical surgical trials.

Results:

Complete success after 2 years was achieved in 11 cases (55%), partial - in 4 (20%), failure - in 5 cases (25%), who required second drainage surgery for IOP control. Second surgery was performed at the site away from the previous one with implantation of another device into anterior chamber angle. IOP was under control in all these cases (mean IOP after second surgery was 21.5+/-2.5 mmHg as per Maklakov's tonometery, range:17-24). In one case (5%), after 2.5 years after first surgery, drainage device eroded through the conjunctiva and was removed. A trabeculectomy was performed in this cases to control IOP. Visual acuity was maintained in all cases with useful vision. Cases with painful eyes were free from pain at long term follow-up.

Conclusions:

From the analysis it is concluded that implantation of an original stainless steel glaucoma device into anterior chamber angle effectively decreases IOP in cases with refractory glaucoma. FINANCIAL INTEREST: NONE

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