Gonioscopic view of the trabeculo-Descemet's membrane after deep sclerectomy

Purpose: To study the appearance of the trabeculo-Descemet's membrane (TDM) after deep sclerectomy with collagen implant (DSCI). Methods: All patients who underwent a successful DSCI for open-angle glaucoma were included in a non-randomized clinical study. Gonioscopy was performed between 6 and 12 months postoperatively in all patients. Results: Gonioscopy was performed in 42 eyes of 38 patients after a mean follow-up time of 8.3 +/- 2.5 months after DSCI. The diagnosis was chronic open-angle glaucoma in 16 eyes and exfoliative glaucoma in 24 eyes. One patient had pigmentary glaucoma and one had normal tension glaucoma. None of the patients were on glaucoma medication postoperatively. Synechias to the TDM were seen in five eyes. Pigment accumulation to the TDM was seen in nine eyes, four of which had capsular glaucoma, three had primary open-angle glaucoma, one had pigmentary glaucoma and one had normal tension glaucoma. Puncture holes at the TDM were seen in all eight eyes in which Nd:YAG laser goniopuncture had been performed. Conclusion: Postoperative changes, which may go unnoticed without routine gonioscopy, occur at the TDM after deep sclerectomy with collagen implant. Pigment accumulates relatively shortly after surgery. Whether or not these changes are progressive remains unknown. Careful follow-up after deep sclerectomy is necessary and should include routine gonioscopy.