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Influence on Intraocular Pressure following Deep Non-pentrating Sclerectomy and Viscocanalostomy in Combination with Amnion Implant and/or 5 Fluorouracil Application in Glaucoma Patients
1Arend O., 1Kaup M., 1Plange N., 1Remky A., 2Redbrake C.,
1RWTH Aachen, Universitätsaugenklinik (Aachen)
2Praxisgemeinschaft Alsdorf (Aachen)
Purpose: The drainage of aqueous humor after deep non penetrating sclerectomy and viscocanalostomy (VCS) most likely is the result of a dilatation of Schlemm canal, episcleral veins or subconjunctival filtration. Past studies suggested that the intraocular pressure (IOP) lowering effect of VCS in caucasians is less than after trabeculectomy. A modulation of the postsurgical healing seems admirable. In this study, the VCS was modified by adding an amnion implant under the sceral flap, or adding 5 Fluorouracil (5 FU: 35 mg) during surgery, and the combination of both.
Methods: Thirty eight patients with open angle glaucoma underwent conventional VCS as described by R. Stegman (group1). In a prospective, randomized study the technique was modified by adding 5FU (group 2; n=10), adding an amnion implant (group 3; n=9), and the combination of both (group 4; n=11).
Results: During the follow-up period of 6 weeks there were no significant differences among groups and all 4 procedures lowered IOP significantly (p<0.01).
baseline 7 days 6 weeks significance
Group 1 (VCS) 35 ±12 14 ±6 18 ±7 p<0.0001
Group 2 (VCS; 5FU) 36 ±8 12 ±6 14 ±6 p=0.008
Group 3 (VCS; Amnion) 31 ±6 12 ±4 17 ±7 p=0.01
Group 4 (VCS; 5FU, Amnion) 32 ±8 10 ±6 16 ±5 p=0.006
n.s. n.s. n.s.
In group 1 there was a significant difference between patients showing a filtering bleb and those only showing an intrascleral reservoir (p<0.05; 15 ±6 mmHg vs. 20 ±7 mmHg). IOP success criteria are listed below 6 weeks after surgery.
IOP reduction >30% IOP <21mmHg IOP<21 mmHg
no therapy
Group 1 (VCS) 32/38 (84%) 26/38 (68%) 16/38 (42%)
Group 2 (VCS; 5FU) 5/7 (71%) 6/7 (86%) 4/7 (57%)
Group 3 (VCS; Amnion) 9/11 (82%) 8/11 (73%) 6/11 (55%)
Group 4 (VCS; 5FU; Amnion) 7/9 (78%) 8/9 (89%) 8/9 (89%)
Conclusions: Deep non pentrating sclerectomy with viscocanalostomy reduces significantly intraocular pressure. A postsurgical filtering bleb seems beneficial for IOP lowering efficacy. The post surgical healing process can be influenced by amnion implant and application of 5 FU although significance failed in this study with a small number of patients.