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Marchini G., Morbio R., Marraffa M.
Background. By using ultrabiomicroscopy (UBM), to assess the effects of deep sclerectomy (DS) with reticulated hyaluronic acid implant (SKGEL) on the reduction of intraocular pressure (IOP) and on acqueous humor drainage.
Methods. Thirty patients suffering from GPAA not controlled by medical therapy were subjected to deep sclerectomy with reticulated hyaluronic acid implant in one eye. Complete oculistic and UBM examinations were carried out 1, 3, 6 and 12 months (average follow-up 11.4±4.7) after operation. The effect of DS on the reduction of IOP, with or without the addition of medical therapy, the highlighting with UBM of the implant (SKGEL) and of the anatomic spaces created by the operation were assessed.
Results. The mean percentage reduction in IOP at the last follow-up was 38% (from 26±4.5 mm Hg to 16.2±3.8 mmHg; p=0.0001). Twenty-four patients (80%) presented IOP <21 mmHg; however in seven (23%), one or more drugs had to be added. UBM showed the persistency in all patients of the decompression space up to 6 months after the operation, after which, in 27% of cases, it was partially replaced by scar tissue. In two patients it could no longer be found one year after the operation. At the final control it was possible in 18 patients to evidence a conjunctival eminence, in a further 18 (60%) a supraciliary hypoechogenic area, in 14 (47%) hyporeflectivity of the sclera around the decompression space. The presence in the same patient of all three characteristics was associated with good postoperative control of IOP.
Conclusions. UBM shows that the presence of a conjunctival eminence is not the only sign of surgical success after deep sclerectomy with reticulated hyaluronic acid implant but that for a good control of IOP an increase in uveo-scleral drainage and intrascleral filtration are equally important.