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First Author: V.Kumar RUSSIA
Co Author(s): M. Frolov E. Bozhok G. Dushina
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To evaluate the efficacy of a new intracanalicular device (ICD) in decreasing intraocular pressure (IOP) in patients with open-angle glaucoma (OAG).
Ophthalmic unit of Skhodnya city hospital, Moscow region; Department of Ophthalmology, Peoples Friendship University of Russia, Moscow, Russian Federation.
Between October 2012 and December 2012, 10 eyes (10 patients) with OAG had implantation of ICD into Schlemm"s canal (SC) and follow-up through 3 months. In 5 cases (50%) ICD was implanted with concurrent cataract surgery. The ICD was made from 50 micron thick medical grade soft vanadium stainless steel wire by winding it on a 200 micron thick stainless steel microprobe, having curvature as of SC. Surgical technique included- dissection of 8 mm fornix based conjunctival flap, 1/2 thickness superficial (5X5 mm) and deep (3X3 mm) scleral flap upto ciliary body, deroofing of SC, dilation of 5-6 mm of SC with viscoelastic device and microprobes of varying diameters from 0.2 mm to 0.3 mm. The ICD on the microprobe was inserted into dilated SC and held there with second instrument and microprobe was removed. The flaps were sutured back. Efficacy measures were IOP changes, complication rate, additional medication and need for surgical revision. Cases of perforation of trabecular meshwork during deroofing of SC were excluded. Decrease in IOP >25% or IOP 18 mmHg or less without medication was considered as a complete success, with medication partial success.
Mean preoperative IOP was 23.3mmHg. Mean number of topical medication was 2.5. Complete success was achieved in 70% cases, partial-30% cases. Repeat surgery was not required in any of the case. All surgical steps to implant ICD into SC were easy to perform. Mean IOP decrease was 10.6 mmHg (44.1%; range- from 4.7 to 16.8 mmHg; p<0.05). Decrease in mean number of medication was 2.2 (88%; from 2.5 to 0.3; p<0.05). Intra-operatively micro-perforation of trabecular meshwork in areas other than exposed SC occurred in 2 cases. Complete insertion of the device into SC could be achieved in 5 cases, partial insertion - in 5 cases. Water tight closer of scleral flaps was achieved in only half of the cases. In early postoperative period in 50% cases a diffuse low bleb was observed, transitory increase in IOP was noticed in 2 cases, out of these in 1 case a YAG laser goniopuncture of trabecular meshwork in ICD area decreased IOP significantly. Gonioscopically, ICD was located in SC in 9 cases without any inflammation, in 1 case the device ruptured trabecular meshwork and its body was lying in the anterior chamber and ends in the lumen of SC.
In eyes with OAG, ICD decreases IOP significantly by keeping the SC open. The technique of ICD implantation is simple, learning curve is short, and complications are few and easily manageable.