Viscocanalostomy for primary open-angle glaucoma: the Gross Pankow experience

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Surgical Techniques

Background:

• Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness.
• Medical management of POAG often requires multiple medications and may not achieve target intraocular pressure (IOP).
• Surgical interventions like viscocanalostomy aim to improve aqueous humor outflow and lower IOP.

Purpose of the Study:

• To evaluate the efficacy of viscocanalostomy in lowering IOP.
• To assess the rate of postoperative complications associated with this procedure.
• To determine the long-term pressure-lowering effect and medication reduction after viscocanalostomy.

Main Methods:

• A prospective study involving 41 patients (56 eyes) with medically uncontrolled POAG.
• Viscocanalostomy procedure included superficial scleral flap, deep sclerectomy, Schlemm's canal deroofing, and Healon GV augmentation.
• Postoperative follow-up included IOP measurements and medication assessment at multiple time points up to 1 year.

Main Results:

• Mean preoperative IOP of 28.1 mmHg decreased significantly postoperatively, reaching 17.8 mmHg at 1 year with reduced medication use.
• At 1 year, 36% of patients achieved IOP < 21 mmHg without medication, and 79% achieved it with medication.
• Complications included hyphema (2%), hypotony (2%), positive Seidel test (17%), and need for secondary surgery (9%).

Conclusions:

• Viscocanalostomy demonstrated a pressure-lowering effect and reduced medication requirements in POAG patients.
• The complication rate was generally low, although subconjunctival drainage was noted in 26% of patients.
• The study did not reproduce the high success rates reported in earlier viscocanalostomy literature.