Evaluation of the Early to Mid-term Efficacy and Safety of Deep Sclerectomy without an Intrascleral Spacer for Open-angle Glaucoma in an Australian Population.

Radhika Srinivasan,Vanita Suri,Nalini Gupta,Pooja Sikka,Mansi Gupta,Pranab Dey,Rajiv Savala,Arvind Rajwanshi,Sushmita Ghoshal,Seema Chopra,Sc Saha,Bhavana Rai,Renu Madan,Neelam Aggarwal

doi:10.5005/jp-journals-10028-1254

Abstract

ABSTRACTPurposeThis study aims to evaluate the early to the midterm efficacy of deep sclerectomy (DS) without an intra-scleral spacer for open-angle glaucoma (OAG) patients.Materials and methodsRetrospective study of 99 eyes (88 patients) with open-angle glaucoma who underwent DS were recruited in a consecutive order following informed consent. Intraocular pressure (IOP) was collected up to 60 months post operation (mean 19.87 ± 15.13 months). Criteria of success were defined as the qualified success (QS) or complete success (CS) with IOP level less than 21, 18 and 15 mm Hg and a reduction of more than 20% IOP from baseline. QS includes additional medication post-DS, while CS requires no other medications or surgery post-DS. Further analysis includes comparing the criteria of success based on several factors. The data were analyzed using statistical package for social sciences (SPSS version 21) statistical software.ResultsThe QS at 60 months for IOP less than 21, 18 and 15 mm Hg is 71.3% (45.12 ± 2.46), 63.9% (40.41 ± 2.75) and 48.7% (35.62 ± 2.85), respectively. The CS at 60 months for IOP less than 21, 18 and 15 mm Hg are 69.3% (47.51 ± 2.77), 57.9% (40.41 ± 2.75) and 45.2% (35.62 ± 2.85), respectively. There was no significant difference between QS and DS post-DS based on the level of experience of the surgeons; intraoperation complication; age and gender. There was a significant reduction in IOP post operation (p < 0.001).ConclusionDS is observed to be an effective surgical method with a favorable safety profile to manage patients with open-angle glaucoma. It has a better safety profile compared to trabeculectomy (TE) and can be performed by surgeons of different experience safely and successfully.Clinical significanceTo our knowledge, this is the first report of DS in an Australian population with up to 60 months of follow-up. It is an effective procedure for IOP control in patients with OAG and has fewer complications compared to TE. DS is less popular than TE primarily due to a perceived steep learning curve, but most of the literature on DS describe single surgeon results. Our study compared the outcome of five surgeons with a variety of experience and found no significant differences in the rate of success for all levels of IOP.How to cite this articleHui MM, Clement CI. Evaluation of the Early to Mid-term Efficacy and Safety of Deep Sclerectomy without an Intrascleral Spacer for Open-angle Glaucoma in an Australian Population. J Curr Glaucoma Pract 2018;12(3):107-112.

Highlights

Endometrial cancer is the most common gynecologic malignancy in developed countries, and its incidence has more than doubled over the last 10 years
Clear cell carcinoma typically occurs in the ovaries, is rarely seen in the cervix or vagina, and very rarely occurs in the endometrium, accounting for less than 3% of all endometrial cancers
Prevalence rates vary according to studies, clear cell carcinoma represents about 3% of all endometrial carcinomas.[3,4]

Summary

Clinicopathological Conference Report

Clear Cell Endometrial Carcinoma in a Postmenopausal Woman with Rapid Recurrence: A Rare Variant. Tumor Clinic Unit 3 Presenters: Moderator: Gyne Unit 3 Faculty: Cytology & Gyne-Pathology Unit Faculty: Radiotherapy Unit Faculty: Date: 14/2/2017 Dr Mansi Gupta[1] and Dr Rajiv Savala[2] Dr Neelam Aggarwal[3] Dr Vanita Suri[4], Dr SC Saha[5], Dr Seema Chopra[6], Dr Pooja Sikka[7] Dr Arvind Rajwanshi[8], Dr Radhika Srinivasan[9], Dr Pranab Dey[10], Dr Nalini Gupta[11] Dr Sushmita Ghoshal[12], Dr Bhavana Rai[13], Dr Renu Madan[14]

INTRODUCTION

CASE REPORT

Findings

DISCUSSION