[Nonperforating trabecular surgery with reticulated hyaluronic acid implant]

To evaluate the clinical results of nonperforating trabecular surgery (NPTS) with reticulated hyaluronic acid implant.

Twenty cases (28 eyes) of advanced open angle glaucoma (C/D = 0.86 +/- 0.14) underwent NPTS with reticulated hyaluronic acid implant. Postoperatively, the intraocular pressure (IOP), intraocular reactions and the bleb appearance were recorded, gonioscopy and ultrasound biomicroscopy were performed.

The mean follow-up was (9.2 +/- 3.4) months. The mean IOP was (28.1 +/- 10.2) mm Hg preoperatively and (17.5 +/- 4.1) mm Hg postoperatively, the difference being significant (t = 5.776, P < 0.001). The number of drugs used for anti-glaucoma was (2.04 +/- 0.74) preoperatively, and (0.71 +/- 0.71) postoperatively (t = 8.103, P < 0.001). On the last visit, in 27 eyes (96.4%) the IOP was < or = 21 mm Hg, and among them, there were 12 eyes (42.8%) without anti-glaucoma medicine and 15 eyes with anti-glaucoma medicine. In 13 eyes (46.4%) the IOP was decreased > or = 10 mm Hg in which 6 eyes did not take any anti-glaucoma medicine and 7 eyes used anti-glaucoma medicine. There were no flare and cells in the anterior chamber in 14 eyes. In 10 eyes there was only slight flare that disappeared in 2-6 days. In 4 eyes there was a small amount of hyphema that was absorbed in 3-7 days. After operation, there was an obvious diffuse bleb in each eye, at the last visit, there were functional blebs in 19 eyes, the successful filtration was ceased in 9 eyes within 1.5-3 months. Intra-operatively, in 5 eyes microperforations occurred in the trabecular meshwork without iris prolapse, and after operation, under the gonioscope, the perforation could be observed in 3 eyes. In another 4 eyes, there was no intra-operative perforation, but a small fissure was seen by gonioscopy. In the post-operative 1-8 months, ultrasound biomicroscopy was performed, and it was shown that the implant was not degraded.

The elevated IOP in patients with open angle glaucoma can be effectively reduced by NPTS, and the number of drugs used for anti-glaucoma was decreased. The post-operative complications were much less because of no intra-operative penetration of the anterior chamber. Therefore, NPTS is a very hopeful and practicable new anti-glaucoma surgery.