Valve cyclodialysis with implantation of a non‐absorbable collagen implant in the cyclodialysis tunnel in surgical management of open‐angle glaucoma: long‐term results

Abstract

AbstractPurposeTo assess long‐term efficacy and safety of valve cyclodialysis (VC) with implantation of a non‐absorbable collagen implant (NCI) in cyclodialysis tunnel (CT) in decreasing intraocular pressure (IOP) in open‐angle glaucoma patients.MethodsSixty‐one patients (25 male, 36 females; average age ‐ 73.4±8.8 years; 61 eyes) were included in this study. Surgical technique included dissection of a superficial scleral flap, creation of a scleral valve (2*1mm) out of deep scleral layers 4 mm away from limbus, creation of a CT (2*4mm) and implantation of a NCI in the CT. The scleral valve helped to minimize trauma to ciliary body while inserting NCI. Among other patients, 20 patients (32.8%) with failed filtering surgeries and 45 patients (73.8%) with cataract were included. Thirty‐three patients (54.1%) had advanced stage of glaucoma. Post‐operative follow‐up was up to 24 months. Outcome measures were: IOP change, reduction in hypotensive medication use, need for repeat surgery and intra‐ and postoperative complications. The data were processed by the method of variation statistics.ResultsBaseline mean IOP was 28.0±5.5 mmHg [95% confidence interval (CI) 24.8‐29.2]. At 18 and 24 months, mean IOP decreased to 19.2±1.8 mmHg (n=61, 95% CI 18.1‐19.0) and 18.9±1.8 mmHg (n=30, 95% CI 18.2‐19.5), making a decrease by 29.5±11.4% and 28.0±12.4% respectively. The hypotensive drugs use was reduced from 2.6±0.9 to 0.5±1.0 and 0.5±1.0 respectively. Repeat surgery was required in 2 cases at 18 months. Intraoperative hemorrhage while creating the CT was observed in 6 patients (9.8%). In the early postoperative period hyphema was prevalent in 1 patient, shallow AC – in 2 patients, hypotony – in 1 patient, and some exudative reaction in 3 patients. No complication was noticed in any of the cases in the late postoperative period.ConclusionsLong‐term results showed that VC with implantation of a NCI in the CT is an effective and safe surgical glaucoma procedure.