[Covered sclerotomy for fistulating glaucoma surgery].
BACKGROUND
Covered sclerotomy was developed as a minimally invasive modification of filtering glaucoma surgery. In this prospective study the clinical results are compared after one year.


METHODS
58 eyes with advanced glaucoma were studied. 32 eyes had a covered sclerotomy (ST) and 26 had an ST with viscoelastic filling of the anterior chamber in order to reduce the postoperative hypotony rate (ST+H). The ST procedure consisted in the preparation of a 4-mm corneoscleral tunnel incision with a T-shaped 1.75-mm wide perforation and radial transection of the tunnel floor.


RESULTS
The preoperative intraocular pressure (IOP) was on average 30 +/- 8.5 mmHg (ST) and 26 +/- 8.3 mmHg (ST+H). After 1 year the IOP decreased significantly (P < 0.05) to 17 +/- 3.7 mmHg (ST) and 17 +/- 2.9 mmHg (ST+H). The mean IOP reduction was 37 % (ST) and 30 % (ST+H). Revisions were required in 37 % (ST) and 15 % (ST+H) of the cases. The postoperative hypotony rate was 34 % in both groups. The number of morphologically functional filtering blebs was 60 % (ST) and 70 % (ST+H) after one year.


CONCLUSIONS
The covered sclerotomy required minimal surgical manipulations of the conjunctiva and sclera. After 1 year a significant reduction of the IOP was achieved. However, the occurrence of bleb scarring could not be lowered compared to trabeculectomy. Therefore further modifications with the primary application of antimetabolites are planned.
Klinik für Augenheilkunde, Vivantes Klinikum Neukölln, Berlin. christopher.wirbelauer@vivantes.de
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Wirbelauer
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Fischer-Schiessl
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Zöllner
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Pham
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D020127:Recovery of Function; D012599:Sclerostomy / Q000379:methods*; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome