Deep sclerectomy with collagen implant: initial experience

Objective: To evaluate complications of deep sclerectomy with collagen implant (DSCI), a recently introduced nonpenetrating glaucoma-filtering surgical technique.

Patients and methods: 30 eyes of 23 patients with open-angle glaucoma were included in this prospective, noncomparative, interventional case series. In all eyes, preoperative intraocular pressure (IOP) was lowered inadequately by topical antiglaucomatous medications. After undergoing DSCI, the patients were followed prospectively. If necessary, the procedure was combined with cataract surgery or mitomycin C application.

Results: In 27 (90%) of 30 eyes, DSCI could be performed. In 3 (10%) of 30 eyes, DSCI had to be transformed intraoperatively into a trabeculectomy because of a large trabecular penetration. Microperforations without further consequences occurred in 2 (7%) of 30 eyes. The mean follow-up was 6.6 +/- 3.8 months. IOP dropped from 26.0 +/- 6.7 to 13.6 +/- 4.7 mm Hg (p < 0.05). Medical glaucomatous treatment was reduced from 2.3 +/- 3.8 to 0.3 +/- 0.6 (p < 0.05). In cases without cataract, visual acuity decreased from 0.7 +/- 0.3 to 0.66 +/- 0.4 at the last visit (p > 0.1). Postoperative complications included Seidel (1/27, 4%), encapsulated bleb (4/27, 15%), astigmatism (1/27, 4%), iris capture (2/27, 7%), microhyphema (3/27, 11%) and peripheral anterior synechiae (4/27, 15%). Fifteen (56%) of the 27 eyes needed the following postoperative procedures: laser goniopuncture (8/27, 30%), needling of the filtering bleb (4/27, 15%), surgical revision in the operating theater (3/27, 11%). All 3 eyes where trabeculectomy was performed instead of DSCI had a favorable course.

Conclusions: During the evaluation period, complications occurred in about half of the cases. None of the complications was severe or irreversible. Target pressure and a reduction in drug treatment could be achieved in all of the patients.