Viscocanalastomy with deep sklerectomy and external trabeculectomy: An alternative in glaucoma surgeryT?
M.R. Tetz, V. Jovleska, Ch. Nimsgern, G.U. Auffarth, H.E. Völcker
Background: Viscocanalostomy with deep sklerectomy has been advocated to become a new alternative to traditional filtering glaucoma surgical procedums.
Patients and Methods: Fifty eyes of 40 patients with an average age of 57 years were evaluated 6 months after viscocanalostomy. The patients suffered from following types of glaucoma. PCOAG (35%), secondary OAG in PEX (45%), juvenile glaucoma (18%), buphthalmus (5%), narrow angle glaucoma (5%), aphakic glaucoma (2%). More than 50 % of patients had undergone at least one type of antiglaucomatous surgery: Cyclophotocoagulation, gonioexcision, iridectomy.
Results: On average there was a lowering of IOP from 23.4±5,2mmHg to 14,0±4,4mmHg. The antiglaucomatous medication was reduced from 3,4±1,1 to 0.9±1.1 generics. In >50% of patients IOP levels remained <17mmHg. Complications included 2 temporary hyphema and 3 temporary IOP rises for maximal 2 days. Ten cooperative patients were evaluated with 30º visual field testing (Octopus, Program 38). In all patients Mean Defect (MD) values were lower 6 months postoperatively. In individual cases the MD-value was reduced by 8 to 70% compared to preoperative defects.
Conclusions: The surgical technique of viscocanalostomy was initially developed by Stegmann. It includes elements of the Sinusotomy of Krasnov and the deep sclerectomy by Kozlov, Fyodorov, Demailly. Based on these first experiences there is a lot of evidence that viscocanaostomy with deep sklerectomy represents a new alternative to traditional filtering glaucoma surgery procedure. This may be of special interest in patients with compromised conjunctiva for example after prolonged medical treatment or previous surgery.
Department of Ophthalmology, University of Heidelberg, INF 400, 69120 Heidelberg