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Impressum
Ultrasound Biomicroscopy Shows Outflow Pathways after Deep Sclerectomy with Collagen Implant
1,2Kazakova D., 2Roters S., 1Schnyder C. C., 1Achache F., 1Mermoud A.
1Hôpital Opthalmique Jules Gonin, Department of Ophthalmology, University of Lausanne, Switzerland 2University of Cologne, Centre of Ophthalmology, Germany
Purpose: Deep sclerectomy with collagen implant is a new and safe
glaucoma surgery procedure. To understand the long-term lowering mechanisms
in IOP decrease an ultrasound biomicroscopic imaging - when collagen implant
is completely resorped - was performed.
Methods: As an observational, non randomized, consecutive case
series we studied 42 eyes of 32 patients with medically uncontrolled open
angle glaucoma at least one year after deep sclerectomy with collagen
implant. It was performed by one surgeon (A.M.). Complete ocular examination
and ultrasound biomicroscopy (UBM) of the filtrating site were performed
1-6 year after surgery. The following parameters were assessed: 1. Presence
of a subconjunctival filtering bleb. 2. Presence and volume an intrascleral
caverty. 3. Presence of suprachoroidal hyporeflexive area.
Results: Postoperatively 15 eyes (35.7%) had goniopuncture with
the Nd: Yag laser. Four patients (9.5%) have postoperative subconjunctival
injections of MMC and two patients (4.7%) have postoperative subconjunctival
injection of 5FU, because of IOP increase. IOP decreased significantly
from preoperative 28.1 ±2.5 mmHg to postoperative 12.4 ±3.8
mmHg (mean ± standard deviation) rangeing 7 - 25 mmHg. 40 eyes
showed clinically a diffuse and profile filtering bleb. UBM demonstrated
a subconjunctival hyporeflexive space in all eyes. In 39 eyes (92.8%)
high resolution ultrasonography imaged an intrascleral hyporeflexive caverty.
The mean volume of this caverty was 1.8 mm3 (range 0.11mm3-6.53mm3). In
19 eyes (45.2%) we observed a hypoechoic area in the suprachoroidal space.
Conclusion: After complete resorption of collagen implant several
aqueous humour drainage pathways could be presumed by UBM-examination.
All eyes showed a subconjunctival filtering bleb and 92.8% had a remaining
intrascleral caverty more than one year after surgery. In almost half
of the patients an additional suprachoroidal outflow was observed. Typical
findings will be presented by high resolution ultrasound images.