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Deep sclerectomy maintains low IOP over long term
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VIENNA, Austria — Deep sclerectomy with a collagen implant can “effectively lower IOP over the long-term,” said one surgeon speaking here.
Swiss ophthalmologist André Mermoud, MD, PhD, who has performed more than 3,000 deep sclerectomies over the past 12 years, shared his most recent follow-up data with attendees at the World Glaucoma Congress.
With 8 years’ follow-up, he said, patients had a mean IOP of 12 mm Hg. The procedure achieved complete success in 57% of cases and qualified success in 91% of the patients. Qualified success was defined as an IOP of less than 21 mm Hg. Dr. Mermoud also said 45% of the patients had an IOP of under 15 mm Hg at the final follow-up.
Dr. Mermoud uses the AquaFlow (STAAR Surgical) collagen implant, which is implanted in the intrascleral space during deep sclerectomy. The implant dissolves within 6 to 9 months, he said. After years of perfecting his technique, he prefers to remove the inner scleral wall, which he said “helps to dramatically decrease IOP immediately postoperatively and keeps the pressure down long term.”
Dr. Mermoud said the implant helps maintain the intrascleral space, which is important to outflow of aqueous.
“If you don’t use the implant, the space will collapse and you will lose that intrascleral space,” he said.
Because every patient has a different scleral depth, it is crucial that surgeons determine the correct depth early in the procedure when first cutting the scleral flap, he warned.
Dr. Mermoud said that if the patient has an IOP of 19 mm Hg immediately postop, the surgeon probably has not removed the outer wall of Schlemm’s canal, and therefore the IOP will not be lowered over the long term either.
“In the first day, if you did it right, [IOP] should be 3 to 4 mm Hg,” Dr. Mermoud said.