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Trabeculotome-guided deep sclerectomy. A pilot Study.

Ahmed M Abdelrahman
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Abstract

PURPOSE: To describe and evaluate a new technique that helps identification and unroofing of Schlemm's canal during deep sclerectomy. DESIGN: A prospective, interventional case series. METHODS: This pilot study was conducted on 15 eyes with various types of glaucoma. After dissecting the superficial scleral flap, the trabeculotome was inserted inside the Schlemm's canal. During deep flap dissection, a direct incision was made over the trabeculotomy to open and unroof Schlemm's canal. Five of the excised deep flaps were submitted for histologic examination. RESULTS: In 13 of the 15 eyes, the Schlemm's canal was properly identified and unroofed. Schlemm's canal endothelium was identified in all the examined specimens. The mean intraocular pressure was reduced from 26.66 +/- 4.54 mm Hg to 12.2 +/- 3.5 mm Hg at the end of a mean follow-up of 9.4 +/- 2.9 months. CONCLUSION: The insertion of the trabeculotome inside Schlemm's canal before dissection of the deep flap helped Schlemm's canal unroofing.

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GlaucomaHumansMiddle AgedPhacoemulsificationPilot ProjectsProspective StudiesScleraSclerostomySurgical FlapsTrabecular MeshworkTrabeculectomyJournal Article

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BibTeXRIS

Ahmed M Abdelrahman. 2005. Trabeculotome-guided deep sclerectomy. A pilot Study.. https://doi.org/10.1016/j.ajo.2004.12.089

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PubMed2006

Do scleral flap dimensions influence reliability of intraocular pressure control in experimental trabeculectomy?

AIM: To compare the effect on intraocular pressure (IOP) of large vs small scleral flap size during trabeculectomy using adjustable sutures. METHODS: Trabeculectomy operations were performed on nine donor human eyes connected to a constant flow infusion with real-time IOP monitoring. Large scleral flaps (4 x 4 mm, 16 mm(2), n=12) or small scleral flaps (3 x 2 mm, 6 mm(2), n=9) were constructed over 0.76 mm(2) sclerostomies. For each procedure, equilibrium IOP was measured following tight closure with two four-throw adjustable 10-0 nylon sutures. RESULTS: Five scleral flaps were thin or poorly constructed; four of these were in the initial seven procedures, implying learning effect. These had a mean absolute IOP of 7.6 mmHg (range 2.7-12.4 mmHg) and mean relative IOP of 28.3% of baseline (range 10-45.8%) after closure. In the remaining 16 good quality procedures, mean IOP was 1.3 mmHg (range 0-3.4 mmHg) after sclerostomy, confirming minimal outflow resistance before closure. Following flap closure mean IOP was 20 mmHg (SD 4.4, range 15.5-29.3 mmHg) for large (n=8), and 18.7 mmHg (SD 3.6, 15.9-25.8 mmHg) for small (n=8) flaps (unpaired t-test, P=0.26). Mean IOP (% baseline) was 71.6% (SD 8.4, range 60.6-86.6%) and 66% (SD=12.7, 46.8-86.6%) for large and small flap groups, respectively (unpaired t-test, P=0.2). CONCLUSIONS: Well-constructed scleral flaps of both sizes were able to support an average IOP at least two-thirds of baseline, and both had similar absolute IOP levels. Errors in flap construction resulted in loss of IOP control. Smaller flap size does not appear to compromise control of early postoperative IOP using adjustable sutures.

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