International Ophthalmology

, Volume 29, Issue 5, pp 367–372 | Cite as

Efficacy and safety of deep sclerectomy in uveitic glaucoma

  • Saleh A. Al Obeidan
  • Essam A. Osman
  • Abdulrahman M. Al-Muammar
  • Ahmed M. Abu El-Asrar
Original Paper

Abstract

Purpose To evaluate the safety and efficacy of deep sclerectomy with implant and mitomycin C in uveitic glaucoma. Design Prospective, noncomparative case study. Patients and methods Nine patients (13 eyes) with uncontrolled uveitic glaucoma underwent deep sclerectomy with implant from 2002 to 2006. All patients had their uveitis controlled before and after surgery with anti-inflammatory therapy. Main outcome measures Control of intraocular pressure. A secondary outcome measure was the number of antiglaucoma medications required to achieve the desired intraocular pressure. Visual acuity and complication associated with the surgery were monitored. Results Mean follow-up was 21 months (range 12–54 months). Intraocular pressure (IOP) was reduced from a mean preoperative value of 28.7 mmHg to a mean postoperative value of 13.85 mmHg (Wilcoxon signed rank test P = 0.005). At the most recent visit, complete success was obtained in 84.6%, qualified success was obtained in 7.7%, and complete failure in 7.7%. Mean number of antiglaucoma medications was reduced from 3.07 to 0.2 (Wilcoxon signed rank test P = 0.001). Neodymium:YAG goniopuncture was performed in two eyes. Postoperative complications included transient hypotony with maculopathy in one eye, shallow choroidal effusions in two eyes, and progression of cataract in four eyes. Conclusion Deep sclerectomy with implant in uveitic glaucoma appeared to be effective in controlling the IOP at short-term follow-up with no serious postoperative side-effects.

Keywords

Deep sclerectomy Uveitic glaucoma 

References

  1. 1.
    Kok H, Barton K (2002) Uveitic glaucoma. Ophthalmol Clin North Am 15:375–387PubMedCrossRefGoogle Scholar
  2. 2.
    Moorthy RS, Mermoud A, Baerveldt G et al (1997) Glaucoma associated with uveitis. Surv Ophthalmol 41:361–394PubMedCrossRefGoogle Scholar
  3. 3.
    Merayo-Lloves J, Power WJ, Rodriguez A et al (1999) Secondary glaucoma in patients with uveitis. Ophthalmologica 213:300–304PubMedCrossRefGoogle Scholar
  4. 4.
    Panek WC, Holland GN, Lee DA et al (1990) Glaucoma in patients with uveitis. Br J Ophthalmol 74:223–227PubMedCrossRefGoogle Scholar
  5. 5.
    Herbert HM, Viswanathan A, Jackson H et al (2004) Risk factors for elevated intraocular pressure in uveitis. J Glaucoma 13:96–99PubMedCrossRefGoogle Scholar
  6. 6.
    Neri P, Azuara-Blanco A, Forrester JV (2004) Incidence of glaucoma in patients with uveitis. J Glaucoma 13:461–465PubMedCrossRefGoogle Scholar
  7. 7.
    Sung VC, Barton K (2004) Management of inflammatory glaucomas. Curr Opin Ophthalmol 15:136–140PubMedCrossRefGoogle Scholar
  8. 8.
    Auer C, Lehoang P, Herbort C et al (2003) Glaucoma associated with uveitis: review on its appraisal, management, and new surgical prospects. Compr Ophthalmol Update 4:203–210Google Scholar
  9. 9.
    Watson PG, Jakeman C, Ozturk M et al (1990) The complications of trabeculectomy (a 20-year follow-up). Eye 4(Pt 3):425–438PubMedGoogle Scholar
  10. 10.
    Rekonen P, Kannisto T, Puustjarvi T et al (2006) Deep sclerectomy for the treatment of exfoliation and primary open-angle glaucoma. Acta Ophthalmol Scand 84:507–511PubMedCrossRefGoogle Scholar
  11. 11.
    Drolsum L (2006) Longterm follow-up after deep sclerectomy in patients with pseudoexfoliative glaucoma. Acta Ophthalmol Scand 84:502–506PubMedCrossRefGoogle Scholar
  12. 12.
    Mielke C, Dawda VK, Anand N (2006) Deep sclerectomy and low dose mitomycin C: a randomised prospective trial in West Africa. Br J Ophthalmol 90:310–313PubMedCrossRefGoogle Scholar
  13. 13.
    Detry-Morel M, Detry MB (2006) Five-year experience with non penetrating deep sclerectomy. Bull Soc Belge Ophtalmol 299:83–94PubMedGoogle Scholar
  14. 14.
    Goldsmith JA, Ahmed IK, Crall AS (2005) Nonpenetrating glaucoma surgery. Ophthalmol Clin North Am 18:443–460 viiPubMedCrossRefGoogle Scholar
  15. 15.
    Guedes RA, Guedes VM (2005) Nonpenetrating deep sclerectomy in Brazil: a 3-year retrospective study. J Fr Ophtalmol 28:191–196PubMedGoogle Scholar
  16. 16.
    Anand N, Atherley C (2005) Deep sclerectomy augmented with mitomycin C. Eye 19:442–450PubMedCrossRefGoogle Scholar
  17. 17.
    Shaarawy T, Mansouri K, Schnyder C et al (2004) Long-term results of deep sclerectomy with collagen implant. J Cataract Refract Surg 30:1225–1231PubMedCrossRefGoogle Scholar
  18. 18.
    Lachkar Y, Neverauskiene J, Jeanteur-Lunel MN et al (2004) Nonpenetrating deep sclerectomy: a 6-year retrospective study. Eur J Ophthalmol 14:26–36PubMedGoogle Scholar
  19. 19.
    Neudorfer M, Sadetzki S, Anisimova S et al (2004) Nonpenetrating deep sclerectomy with the use of adjunctive mitomycin C. Ophthalmic Surg Lasers Imaging 35:6–12PubMedGoogle Scholar
  20. 20.
    Galassi F, Sodi A, Ucci F et al (2002) Deep sclerectomy in primary open angle glaucoma: comparison among different implants. Acta Ophthalmol Scand Suppl 236:63–64PubMedCrossRefGoogle Scholar
  21. 21.
    Towler HM, McCluskey P, Shaer B et al (2000) Long-term follow-up of trabeculectomy with intraoperative 5-fluorouracil for uveitis-related glaucoma. Ophthalmology 107:1822–1828PubMedCrossRefGoogle Scholar
  22. 22.
    Stavrou P, Murray PI (1999) Long-term follow-up of trabeculectomy without antimetabolites in patients with uveitis. Am J Ophthalmol 128:434–439PubMedCrossRefGoogle Scholar
  23. 23.
    Towler HM, Bates AK, Broadway DC et al (1995) Primary trabeculectomy with 5-fluorouracil for glaucoma secondary to uveitis. Ocul Immunol Inflamm 3:163–170CrossRefGoogle Scholar
  24. 24.
    Patitsas CJ, Rockwood EJ, Meisler DM et al (1992) Glaucoma filtering surgery with postoperative 5-fluorouracil in patients with intraocular inflammatory disease. Ophthalmology 99:594–599PubMedGoogle Scholar
  25. 25.
    Prata JA Jr, Neves RA, Minckler DS et al (1994) Trabeculectomy with mitomycin C in glaucoma associated with uveitis. Ophthalmic Surg 25:616–620PubMedGoogle Scholar
  26. 26.
    Wright MM, McGehee RF, Pederson JE (1997) Intraoperative mitomycin-C for glaucoma associated with ocular inflammation. Ophthalmic Surg Lasers 28:370–376PubMedGoogle Scholar
  27. 27.
    Ceballos EM, Beck AD, Lynn MJ (2002) Trabeculectomy with antiproliferative agents in uveitic glaucoma. J Glaucoma 11:189–196PubMedCrossRefGoogle Scholar
  28. 28.
    Akarsu C, Onol M, Hasanreisoglu B (2003) Postoperative 5-fluorouracil versus intraoperative mitomycin C in high-risk glaucoma filtering surgery: extended follow up. Clin Experiment Ophthalmol 31:199–205PubMedCrossRefGoogle Scholar
  29. 29.
    Katz GJ, Higginbotham EJ, Lichter PR et al (1995) Mitomycin C versus 5-fluorouracil in high-risk glaucoma filtering surgery. Extended follow-up. Ophthalmology 102:1263–1269PubMedGoogle Scholar
  30. 30.
    Da Mata AP, Foster CS (1999) Ahmed valve and uveitic glaucoma. Int Ophthalmol Clin 39:155–167PubMedCrossRefGoogle Scholar
  31. 31.
    Auer C, Mermoud A, Herbort CP (2004) Deep sclerectomy for the management of uncontrolled uveitic glaucoma: preliminary data. Klin Monatsbl Augenheilkd 221:339–342PubMedCrossRefGoogle Scholar
  32. 32.
    Souissi K, El Afrit MA, Trojet S et al (2006) Deep sclerectomy for the management of uveitic glaucoma. J Fr Ophtalmol 29:265–268PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  • Saleh A. Al Obeidan
    • 1
  • Essam A. Osman
    • 1
  • Abdulrahman M. Al-Muammar
    • 1
  • Ahmed M. Abu El-Asrar
    • 1
  1. 1.Department of Ophthalmology, College of MedicineKing Saud UniversityRiyadhSaudi Arabia

Personalised recommendations