První klinické zkušenosti s hlubokousklerektomií v ambulantní chirurgiiglaukomů

Initial Clinical Experience with Deep Sclerectomy in Ambulatory Surgery ofGlaucoma

Deep sclerectomy is a non-perforating filtering operation used in surgical treat-ment of open angle glaucomas. The advantage of the operation is the creation ofgradual filtration due to the thin trabecular Descemet membrane which reducesmarkedly the risk of development of postoperative complications typical forperforating antiglaucomatous operations. The authors operated at the out-patientdepartment 10 eyes of 8 patients (age 46-81 years). Indication for deep sclerectomywas seven times primary open angle glaucoma (POAG), once capsular glaucomaand twice normotensive glaucoma (NTG). In all eyes deep sclerectomy was indi-cated because of decompensation of the intraocular pressure with maxium tole-rated therapy before surgery. None of the eyes were operated previously. Themean value of intraocular pressure before surgery was 25.1 ± 6.5 mm Hg. Fromthe results ensues that in nine operated eyes the intraocular pressure at the endof the 6-month follow-up period was compensated without supplementary therapy,only in one eye beta-blockers were prescribed one month after surgery. The cause of failure of filtration was the development of superficial adherence at the site ofmicroperforatiion of the trabecular Descemet membrane which developed duringoperation. The mean intraocular pressure values at the end of the investigationperiod were 14.3 ± 2.8 mm Hg. In two eyes haemorrhage into the anterior chamberwas observed on the first day after surgery, the blood was absorbed within 24hours. Hypotonia in two eyes was only transient and was not associated witha change in the depth of the anterior chamber or other complications. In none ofthe patients a decline of visual acuity was observed.In three operated eyes a chan-ge of refraction was necessary due to discontinuation of miotics after surgery.Deep sclerectomy is a delicate microsurgical technique which calls for experienceand skill of the surgeon. The most complicated task is to prevent perforation ofthe trabecular Descemet membrane during surgery. Provided the surgical tech-nique is perfect, it burdens the patient less than commonly performed perforatingantiglaucomatous operations and it can be implemented in the out-patient depar-tment.

Key words:
deep sclerectomy, trabecular Descemet memmbrane, ambulatorysurgery of glaucomas