Nonpenetrating very deep sclerectomy with hyaluronic acid implant vs trabeculectomy--a 2-year follow-up.

OBJECTIVE

To study and compare the efficacy and safety of nonpenetrating very deep sclerectomy (NPVDS) with the use of hyaluronic acid implant (SKGEL) to trabeculectomy (TB) in patients with with medically uncontrolled glaucoma.

METHODS

Prospective, controlled study of patients with open-angle glaucoma was designed. Seventy-eight eyes of 68 patients with medically uncontrolled glaucoma were assigned either to the NPVDS or to the TB group of trial. Examinations were applied before and 7 days, 1, 3, 6, 12, 18, and 24 months after surgery.

MAIN OUTCOME MEASURE: Best-corrected logMAR visual acuity, intraocular pressure, number of additional procedures, antiglaucoma medications, number of complications.

RESULTS

At 24 months, success rate defined as IOP ≤ 21 mmHg with medication and additional procedures in NPVDS group was 92.31 %, and 94.88 % in control group (p = 0.64). There was no statistically significant difference between intraocular pressure in NPVDS (14.56 ± 4.07 mmHg ) and control (TB) (15.38 ± 3.38 mmHg) group (p = 0.34). Number of glaucoma mediations decreased from 2.18 ± 0.56 to 0.54 ± 0.56 in NPVDS and from 2.28 ± 1.41 to 0.61 ± 0.03 in TB group (p = 0.71). Early and late postoperative complications included two cases of hyphema, two of choroidal detachment, two of filtering bleb fibrosis, four of cataract progression in the NPVDS group; and five cases of hyphema, four of choroidal detachment, one of filtering bleb fibrosis, one of blebitis, and 12 of cataract progression in the control group.

CONCLUSIONS

NPVDS is an effective surgical option for patients with medically uncontrolled glaucoma. NPVDS is associated with a lower risk of complications, and in particular cataract progression, compared to TB.

APPLICATION TO CLINICAL PRACTICE: NPVDS is a modification of NPDS devised for patients with medically uncontrolled open-angle glaucoma.