Purpose. To study prospectively the success rate and complications of deep
sclerectomy with collagen implant (DSCI), a nonpenetrating filtration proce
dure.
Setting. Glaucoma Unit, Department of Ophthalmology, Hopital Ophtalmique Ju
les Gonin, University of Lausanne, Lausanne, Switzerland.
Methods: This nonrandomized prospective trial comprised 105 eyes of 105 pat
ients with medically uncontrolled primary or secondary open-angle glaucoma.
Visual acuity, intraocular pressure (IOP), and slitlamp examinations were
performed before and after surgery at 1 and 7 days and 1, 3, 6, 9, 12, 18,
24, 30, 36, 48, 54, 60, and 66 months. Visual field examinations were repea
ted every 6 months. A qualified success was defined as IOP below 21 mm Hg w
ith or without medication. A complete success was defined as IOP lower than
21 mm Hg without medication.
Results: The mean follow-up was 43.2 months +/- 14.3 (SID). The mean IOP wa
s 26.8 +/- 7 mm Hg preoperatively, 5.1 +/- 3 mm Hg 1 day postoperatively, a
nd 11.8 +/- 3 mm Hg 60 months postoperatively. At 60 months, the qualified
success rate was 94.8% and the complete success rate, 61.9%. The IOP was lo
wer than 21 mm Hg with medication in 32.1% of patients at 60 months; 48 pat
ients (45.7%) had an IOP of 15 mm Hg or lower without medication. No patien
t developed a shallow or flat anterior chamber, endophthalmitis, or surgery
-induced cataract. However, 23 (21.9%) had progression of a preexisting sen
ile cataract. Injections of 5-fluorouracil were given to 25 patients (23.8%
) who had DSCI to salvage encysted blebs. The mean number of medications pe
r patient was reduced from 2.30 +/- 0.76 to 0.49 +/- 0.72.
Conclusion: Deep sclerectomy with collagen implant provided reasonable IOP
over a long-term follow-up with few immediate postoperative complications.
(C) 2001 ASCRS and ESCRS.