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Study calls deep sclerectomy with collagen implant reasonable for exfoliative glaucoma

J Glaucoma. 2009;18(5):361-367.

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Deep sclerectomy with collagen implant provides long-term control of IOP and reduces medication dependence in patients with exfoliative glaucoma, according to a study.

In 22 eyes of 22 patients with uncontrolled exfoliative glaucoma and a mean follow-up of 48.5 months, mean IOP was significantly reduced from 29.9 mm Hg at baseline to 13.2 mm Hg, and IOP was significantly reduced from baseline at all time points. For 18 eyes followed to 54 months, IOP was 12.2 mm Hg.

By the end of the follow-up period, IOP was 18 mm Hg or lower without antiglaucoma medications in 54.5% of eyes; IOP was 18 mm Hg or lower in 90.9% of eyes overall with or without the addition of antiglaucoma medication. Medication dependence was also significantly reduced, from a mean 2.4 per patient at baseline to 0.59 per patient at the end of the study.

Mean best corrected visual acuity did not change at 48.5 months compared with baseline; both measured 0.26 logMAR. For patients completing the full 54 months of follow-up, mean BCVA was 0.21 logMAR.

Goniopuncture with Nd:YAG laser was performed on 14 eyes a mean 16.6 months after deep sclerectomy, and mean IOP was reduced from 21.8 mm Hg before the procedure to 9 mm Hg after.

"In our experience, the long-term success rate was satisfactory, the postoperative complication rate was low and visual acuity was unaffected in a majority of cases," the study authors said.