Abstract

FR.10.05

10 years experience with covered sclerotomy as filtering glaucoma surgery

Christopher Wirbelauer, Duy-Thoai Pham

Klinik für Augenheilkunde, Vivantes Klinikum Neukölln, Berlin

Background
Covered sclerotomy was developed as a minimally invasive modification of filtering glaucoma surgery. In the last 10 years several clinical studies were conducted to improve this surgical technique.

Methods
In 3 clinical studies a total of 162 patients with advanced glaucoma were operated with this minimally-invasive technique and followed postoperatively for at least 1 year. The covered sclerotomy procedure consisted in the preparation of a 3 mm corneoscleral tunnel incision with a T-shaped 1,75 mm wide perforation and radial transection of the tunnel floor. In the first study (n=59) modifications with and without filling of the anterior chamber with viscoelastic in order to reduce the postoperative hypotony rate were assessed. In the second study (n=63) an additional wound modulation with the primary application of mitomycin-C (MMC) 0,02% for 3 minutes was performed. In the third clinical study (n=40) the influence of surgical revisions to reactivate the fistulation was observed.
Results
Covered sclerotomy allowed a filtering surgery with morphologically functional filtering blebs in 60-70% of the cases. The reduction of intraocular pressure (IOP) was in all studies from 30 to 45% (P<0,05). In the first study the postoperative hypotony rate was below 20%, but the number of surgical revisions was increased. The absolute success rate was 25% higher in the second study with the primary application of MMC. In complicated cases the success rate was 40%. With surgical revisions to reactivate the filtering process the success rate was further improved by 50%.
Conclusions
The covered sclerotomy required less surgical manipulations of the conjuncitva and sclera. Although a significant IOP reduction was achieved, the occurence of bleb scarring could not be lowered compared to trabeculectomy. Further modifications with the primary application of antimetabolites improved the results, also after surgical revisions. The clinical experience of the last 10 years showed, that the complication rate was lowered by modifications of the surgical technique and that an increase of the success rate was achieved with an additional wound modulation.

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