Kumar VKumar V..1,21,2,, Frolov M.A.Frolov M.A.11 , , Isufaj EIsufaj E22.,.,Makovetskaya I.E.Makovetskaya I.E.22

Long term results of stainless steel Long term results of stainless steel wire micro-drainage device wire micro-drainage device

(SSWMDD) in surgical management of (SSWMDD) in surgical management of refractory primary open-angle refractory primary open-angle

glaucoma (RPOAG)glaucoma (RPOAG)

Innovative educational program of the universityInnovative educational program of the university

Financial disclosure - noneFinancial disclosure - none

Department of ophthalmologyDepartment of ophthalmology

Russian People’s Friendship University Russian People’s Friendship University 11

Moscow, Russian FederationMoscow, Russian Federation

Ophthalmic unit of Skhodnya city hospitalOphthalmic unit of Skhodnya city hospital 22,, Moskovskaya oblastMoskovskaya oblast. .

Metallic shunts in glaucoma Metallic shunts in glaucoma surgerysurgery

SOLX gold shunt, SOLX, Inc.

Ex-PRESS mini glaucoma shunt, Optonol Ltd.

Micro-drainage device made Micro-drainage device made from stainless steel wirefrom stainless steel wire

PurposePurposeTo evaluate long term results of a new To evaluate long term results of a new filtering procedure using SSWMDD in filtering procedure using SSWMDD in surgical management of RPOAG. surgical management of RPOAG.

Department of ophthalmology, Department of ophthalmology, Russian people’s friendship university, Russian people’s friendship university, MoscowMoscow

Ophthalmic unit of Skhodnya city Ophthalmic unit of Skhodnya city hospital, Himki, Moscovskaya oblast hospital, Himki, Moscovskaya oblast

SettingSetting

SSWMDD was made from surgical grade stainless SSWMDD was made from surgical grade stainless steel wire by winding it once on a 2.5 mm wide and steel wire by winding it once on a 2.5 mm wide and 0.5 mm thick metallic spatula. SSWMDD are 0.5 mm thick metallic spatula. SSWMDD are sterilized by autoclavingsterilized by autoclaving

Technique of SSWMDD preparationTechnique of SSWMDD preparation

Total 42 casesTotal 42 cases ( (42 eyes): 42 eyes): male – 22 (52.4ale – 22 (52.4%%); female – 20 (47.6); female – 20 (47.6%%) )

Patient’s age: Patient’s age: avg. age: avg. age: 68.6 +/-7.1 yrs. (55 - 79 yrs. ) yrs. (55 - 79 yrs. )

Study Study period: period: April 2008 – December 2009 April 2008 – December 2009

Exclusion criteria: Exclusion criteria: minimum follow – up period 1 yearminimum follow – up period 1 year

• Cases were admitted for evisceration for painful terminal glaucoma

• Intraocular pressure (IOP) varied from 27 to 41 mmHg (as per Maklakov’s method)

• All patients were instilling not less than 2 eye drops

Methods and materialMethods and material

Methods and materialMethods and material

Criteria for success:Criteria for success: relief from pain,

normal outlook of the eye ball,

decrease in preoperative IOP by 30% or more

with or without glaucoma medication.

Main outcome measures: Main outcome measures: IOP change,

complication rate,

additional glaucoma medication,

need for surgical revision.

41 (97.6%) eyes were saved as an 41 (97.6%) eyes were saved as an organ. organ. 41 patients (97.6%) got relief from 41 patients (97.6%) got relief from pain.pain.All saved eye balls achieved normal All saved eye balls achieved normal outlook.outlook.

Observations during surgery: Observations during surgery:

The operation was technically easy to The operation was technically easy to perform.perform.Easy insertion of micro-drainage through Easy insertion of micro-drainage through

tunnel.tunnel.Controlled filtration of aqueous humour Controlled filtration of aqueous humour

through drainage – no sudden gush of through drainage – no sudden gush of fluid. fluid.

No loss of anterior chamber.No loss of anterior chamber.No case of hemorrhagic choroidal effusion.No case of hemorrhagic choroidal effusion.

ResultsResults

Observations in post-operative period:Observations in post-operative period:

IOP without medication was controlled in 34 patients (80.9%)IOP with medication was controlled in 97.6% cases. The mean IOP decrease was 18.1 +/-2.5 mmHg (range: 11–20 mmHg, 56% decrease, P<0.05). Shallow AC due to choroidal effusion was observed in 11 cases (26.2%). In 2 cases the effusion dissolved spontaneously, in 9 cases a sclerotstomy was required. With in 1 year after operation a swollen cataract was removed by phacoemulsification in 3 cases (7.1%). During follow-up not a single case of ocular hypotony was During follow-up not a single case of ocular hypotony was observed. observed.

ResultsResults

SSWMDD in the anterior chamber SSWMDD in the anterior chamber – – gonioscopic viewgonioscopic view

Outlook of the eye ball after 3 months а

b Marvel B-scan with UBM

(Appasamy medical equipments (P) ltd,

India).

c

Outlook of the eye ball after 6 months

Outlook of the eye ball after 1 year

ConclusionsConclusions

SSWMDD filtration procedure is technically simple and safe to perform and in long terms effectively controls IOP in patients with RPOAG.