Non penetrating deep sclerectomy (NPDS) with SKGEL implant and/or 5-fluorouracile (5-FU).

Abstract

PURPOSE: To assess effectiveness and safety of DS with reticulated hyaluronic acid implant (SKGEL) and/or 5-Fluorouracile (5-FU). MATERIAL-METHODS: 61 eyes (48 patients) (mean age: 64.5 +/- 10.5 years) with medically uncontrolled open angle glaucoma and comparable surgical risk failure were included in this retrospective non randomized study and were categorized into DS + SKGEL (10 eyes), DS + 5-FU (25 eyes) and DS + SKGEL + 5-FU simultaneously (26 eyes). The 3 groups were comparable in respect of age of patients, diagnosis, severity of VF defects, and bleb failure risk factors. All procedures were performed according to the Kozlov's and Mermoud's technique. Complete ocular examination was carried out preoperatively and at day 1, 7, at 1, 2 and 3 months and every three months thereafter. RESULTS: Mean follow up was 11 +/- 4.9 months and was significantly shorter in group C. For all 61 eyes, mean IOP was significantly decreased from 27.8 +/- 8.6 mm Hg to 15.1 +/- 3.5 mm Hg. Complete (target IOP reached without medication or YAG laser goniopuncture) and qualified (target IOP reached with medication and/or YAG laser goniopuncture) final success rates were respectively of 54% and 90%. Complete success probability was 95% at 6 months and 72% at 12 months. Qualified success probability increased to 89.5% at 12 months. The IOP results, the distribution of success rates and complications were similar within the first postoperative year whatever using SKGEL or intra-operative 5-FU application or both. The need for additional glaucoma medication and the percentage of YAG goniopuncture appeared to be lower in the SKGEL group. Success probability appeared to be improved in SKGEL group comparatively with the other 2 groups. CONCLUSIONS: NPDS is a valid, effective and relatively safe alternative to trabeculectomy although adjunctive medications and/or Nd:YAG goniopuncture are frequently needed. Considering the limitations of our study, we can conclude that the IOP results, success rates and complications are similar within the 1st postoperative year whatever using peroperative 5-FU or SKGEL implant. A longer follow up is needed to confirm that SKGEL implant seems to improve the IOP control and the long term patency of the sclerectomy site by comparison with intra-operative application of 5-FU