Non-penetrating deep sclerectomy and implantation of collagen drainage in the surgical treatment of glaucoma

Abstract

PURPOSE. Analysis of the results of surgical treatment of glaucoma by non-penetrating deep sclerectomy (NPDS) combined with suprachoroidal implantation of collagen drainage.METHODS. This open prospective study included a total of 98 patients (104 eyes), 45 men and 53 women with primary open-angle glaucoma who were examined and operated on. All patients underwent non-penetrating deep sclerectomy with implantation of the "Xenoplast" drainage. Group I (n=72) consisted of patients without suprachoroidal drainage, and Group II (n=32) — patients who were implanted the drainage. Group I included 15 cases (20.8%) with stage I glaucoma, 17 (23.6%) — stage II, 38 (52.8%) — stage III and 2 (2.8%) — stage IV. Group II patients had stage I glaucoma in 8 cases (25%), stage II in 5 (15.6%), stage III in 17 (53.1%) and stage IV in 2 cases (6.3%). The mean age of study patients was 68.2±7.4 years.RESULTS. All early postoperative complications were transient. There were no significant differences in the frequency of complications between the two groups (p>0.05). In group I patients, Descemet’s goniopuncture was performed significantly more frequently than in group II (p<0.05). No complications were detected in the late postoperative period. Pronounced hypotensive effect wasobserved in both groups on the first day after the operation, IOP in group I was slightly lower and amounted to 15.5±2.3 mm Hg in comparison with 17.3±2.5 mm Hg in group II (p>0.05). Further, after 7 days and 1 month, we observed a slight increase of IOP in group I up to 17.2±2.0 mm Hg, while in Group II it remained practically unchanged. After 1 and 2 years of observation, a respective increase of the mean IOP to 18.5±2.8 and 17.8±2.6 mm Hg was registered in group I. Group II, on the contrary, showed a decrease in IOP in these periods to 16.8±1.9 and 16.2±1.8 mm Hg, respectively (differences between the groups were not statistically significant, p>0.05). In group I, the mean number of instillations used to achieve target IOP was 0.89±0.27; in group II it was 0.83±0.26 (p>0.05). The rate of achieving "complete" success after 6 months and 2 years of observation in groups I and II did not differ significantly and was 94.4% and 90.6%, 65.3% and 59.4%, respectively (p>0.05).CONCLUSION. This paper presents a comparative analysis of the results of non-penetrating deep sclerectomy and collagen drainage implantation depending on the involvement of the suprachoroidal space in the operation with 24 months follow-up. Both groups were comparable in the majority of studied parameters, except for the frequency of laser Descemet’s goniopuncture in the postoperative period (it was significantly lower in the group with suprachoroidal drainage). The proposed technique is effective and safe in the treatment of primary open-angle glaucoma.