Deep sclerectomy for the management of uncontrolled uveitic glaucoma: preliminary data.

BACKGROUND: If medical treatment fails in uveitic glaucoma a surgical approach should be considered. Classical trabeculectomy is known to have a less favourable outcome in uveitis. Our intention is to report the first series of uveitis patients with glaucoma resistant to medical therapy who were treated with deep sclerectomy (DS). PATIENTS AND METHODS: Fourteen eyes of 13 patients (mean age 39.0 +/- 18.5 years; range 8 to 76 years) with chronic uveitis underwent non-penetrating filtering surgery from 1995 to 2003. All patients had their uveitis controlled before and after surgery by immunomodulatory therapy. Non-penetrating filtering surgery consisted of DS with collagen implant (Staar(R)) in 4 eyes, DS with draining device (T-Flux Ioltech(R)) in 2 patients, DS without implant in 7 patients and with viscocanalostomy in 1 patient. Nine eyes (65 %) received mitomycin C peri-operatively.
RESULTS: Intra-ocular pressure (IOP) was reduced from a mean pre-operative value of 42.8 +/- 13.6 mmHg to a 1-year mean post-operative value of 12.1 +/- 4.0 (71.7 % reduction). Eleven of the 14 eyes completed 12 months of follow-up, resulting in complete success in 5 (45.4 %) and in qualified success in 5 (45 %) and in failure in one patient (9.2 %), later controlled by a second operation. Anti-glaucomatous medication was reduced from a mean of 3.7 +/- 0.5 medications preoperatively to 1.2 +/- 0.8 medications (71.4 % reduction) at the 12 month follow-up. Nine of the 14 patients achieved a 24 month follow-up with a mean IOP of 14.1 +/- 3.8 mmHg and mean of anti-glaucomatous medications of 1.6. Four patients have been examined 4 years after the DS: mean IOP was 13.2 +/- 2.2 mmHg and mean medication 1.7 +/- 1.0. Post-operative complications included one case of lens opacity and 2 cases of hypotony lasting for five months and four weeks after the intervention respectively.
CONCLUSION: Non-penetrating filtering surgery controlled the intra-ocular pressure in 90 % of eyes with uveitic glaucoma resistant to medical therapy at 12 months. Surgical complications were low which may explain the high success rate of the procedure, compared to classical penetrating surgery.