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PubMed · 6585067

Visco elastic glaucoma surgery.

J Draeger·R Winter·H Wirt
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Abstract

Hyaluronic acid facilitates and maintains separation of dissected structures in glaucoma microsurgery, thus preventing complications during surgery and in the immediate postoperative phase. Goniotomy is more easily controlled and is safer. Hyaluronic acid can therefore be used in glaucoma microsurgery to keep prepared layers of tissue separated for longer and can enlarge newly created space and almost eliminate the adhesive forces between the layers. Using hyaluronic acid the safety of glaucoma microsurgery is enhanced and the complication rate reduced. High elastic viscous substances offer better technical possibilities in microsurgery. Further experience is necessary before a final judgement can be made on the advantages.

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GlaucomaHumansHyaluronic AcidIntraoperative ComplicationsMethodsMicrosurgeryJournal Article

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J Draeger, R Winter, H Wirt. 1983. Visco elastic glaucoma surgery.. https://pubmed.ncbi.nlm.nih.gov/6585067/

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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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