Comparative study between deep sclerectomy with and without collagen implant: long term follow up

Aim: To identify the value of using collagen implant in deep sclerectomy. Methods: A prospective randomised trial of 104 eyes ( 104 patients) with medically uncontrolled primary and secondary open angle glaucoma. All patients had deep sclerectomy (DS), half of them with and the other half without a collagen implant (CI) sutured in the scleral bed. The main outcome measures were intraocular pressure (IOP), visual acuity, number of treatments preoperative and postoperative, and Nd: YAG goniopunctures. Results: Mean follow up period was 44.5 (SD 21) months for the DS group and 43.9 ( SD 14) months for the deep sclerectomy with a collagen implant (DSCI) group. The mean preoperative IOP was 23.3 ( SD 7.2) mm Hg for the DS group and 25.6 ( SD 4.9) mm Hg for the DSCI group. The mean IOP at the first postoperative day was 6.1 ( SD 4.21) mm Hg for the DS group and 5.1 ( SD 3.3) mm Hg for the DSCI group. At 48 months IOP was reduced by 40% ( 14 versus 23.3 mm Hg) for the DS group and by 50% ( 12.7 versus 25.6 mm Hg) for the DSCI group. Complete success rate, defined as IOP lower than 21 mm Hg without medication, was 34.6% (18/52 patients) at 48 months for the DS group, and 63.4% (33/52 patients) for the DSCI group. Qualified success rate; patients who achieved IOP below 21 mm Hg with or without medication, was 78.8% (41/52 patients) at 48 months and 94% (49/52 patients) for the DSCI group. The mean number of medications was reduced from 2.1 ( SD 0.8) to 1.0 ( SD 1) after DS, and was reduced from 2.2 ( SD 0.7) to 0.4 ( SD 0.6) in the DSCI group ( p = 0.001) Conclusion: The use of a collagen implant in DS enhances the success rates and lowers the need for postoperative medication.