Document Detail

Viscocanalostomy for open-angle glaucoma in black African patients.
MedLine Citation:
PMID:  10079435     Owner:  NLM     Status:  MEDLINE    
PURPOSE: To study the clinical effectiveness of viscocanalostomy in a population of black African patients with open-angle glaucoma that was uncontrolled on medical treatment. SETTING: Department of Ophthalmology, Medical University of Southern Africa, Medunsa, South Africa. METHODS: In this prospective study viscocanalostomy was performed in 214 eyes of 157 black African patients with open-angle glaucoma that was poorly controlled by medical therapy. The procedure involves the production of superficial and deep scleral flaps. The deep flap is disserted to the plane of Schlemm's canal. From this plane, an intact window in Descemet's membrane is created by gentle pressure at the level of Schwalbe's line using a cellulose sponge. Aqueous humor diffuses through this window into a subscleral space (lake). Reflection of the inner flap unroofs Schlemm's canal, creating a trough leading to 2 entrances into Schlemm's canal (surgical ostia). A delicate cannula is introduced into the entrance of Schlemm's canal left and right and high-viscosity sodium hyaluronate is gently injected into the canal for 4 to 6 mm. The deeper scleral flap is excised (deep sclerectomy) and the superficial flap is sutured securely using 5, 11-0 polyester fiber (Mersilene) sutures. High-viscosity sodium hyaluronate is then injected into the subscleral lake to act as a physical barrier to fibrinogen migration postoperatively. RESULTS: Postoperative intraocular pressure (IOP) of 22 mm Hg or less was achieved without medical therapy in 82.7% of eyes. If a beta blocker was added to the cases not achieving 22 mm Hg or less postoperatively, the success rate increased to 89.0%. The average follow-up was 35 months (range 6 to 64 months). CONCLUSION: Viscocanalostomy produced an encouraging long-term reduction in the IOP of black African patients with glaucoma who would otherwise have had a poor prognosis.
R Stegmann; A Pienaar; D Miller
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of cataract and refractive surgery     Volume:  25     ISSN:  0886-3350     ISO Abbreviation:  J Cataract Refract Surg     Publication Date:  1999 Mar 
Date Detail:
Created Date:  1999-05-04     Completed Date:  1999-05-04     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8604171     Medline TA:  J Cataract Refract Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  316-22     Citation Subset:  IM    
Medical University of Southern Africa, Medunsa, South Africa.
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MeSH Terms
African Continental Ancestry Group*
Aged, 80 and over
Filtering Surgery / methods*
Follow-Up Studies
Glaucoma, Open-Angle / ethnology,  surgery*
Hyaluronic Acid / administration & dosage
Intraocular Pressure
Middle Aged
Prospective Studies
Sclera / surgery
South Africa
Surgical Flaps
Treatment Outcome
Reg. No./Substance:
9004-61-9/Hyaluronic Acid
Comment In:
J Cataract Refract Surg. 1999 Mar;25(3):297   [PMID:  10079423 ]
J Cataract Refract Surg. 1999 Mar;25(3):298-300   [PMID:  10079424 ]
J Cataract Refract Surg. 1999 Oct;25(10):1309   [PMID:  10511923 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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