Reticulated hyaluronic acid implant in nonperforating trabecular surgery

Purpose: To evaluate experimentally and clinically the tolerance and effica cy of a reticulated hyaluronic acid implant in nonperforating trabecular su rgery (NPTS). Setting: Bascom Palmer Eye Institute, Miami, Florida, USA, and Clinique Sou rdille and Clinique Ophtalmologique Universitaire, Nantes, France. Methods: In experimental surgery, NPTS was performed with and without a hya luronic acid implant in 25 rabbit eyes. In a pilot study, the results of NP TS with a hyaluronic acid implant in 72 human eyes were retrospectively ana lyzed in terms of visual acuity, intraocular pressure (IOP), external filtr ation, postoperative inflammation, and gonioscopy. Mean follow-up was 13.8 months (range 6 to 24 months). Results: In the experimental surgery, the rabbit eyes with the implant show ed a different healing process than the eyes without the implant. The impla nt was slowly bioabsorbed and remnants were seen at the operative site (whe re the tissue was removed) up to day 56 postoperatively. This site was dete ctable at ail histology study periods. Intraocular pressure reduction was l onger in the implant group: greater than 5 months versus 3 weeks (P < .05). In the pilot study, visual acuity remained stable, IOP decreased from a me an preoperative level of 26.3 mm Hg ir 5.22 (SD) to a mean postoperative le vel without treatment of 15.4 +/- 3.1 mm Hg (P< .0001). No external filtrat ion was detected in 60 eyes; a slightly elevated conjunctiva was noted in 1 2 eyes. Postoperative inflammation (laser flare and cell measurements) was low. Gonioscopy consistently demonstrated the persistence of a decompressio n space behind the trabeculum. Conclusion: Comparative experimental surgery results showed excellent toler ance and efficacy in the rabbit eyes with a hyaluronic acid implant. Clinic al results, to be confirmed by a randomized comparative study, also showed excellent biocompatibility and encouraging efficacy.