Minimally Invasive Glaucoma Surgery

Introduction

In the last 15 years glaucoma surgery has evolved greatly with the emergence of several new and less invasive surgical techniques. The major innovation after trabeculectomy was deep sclerectomy, which has been proved safe and efÞcacious after more than a decade of clinical experience.

With the advent of minimally invasive glaucoma surgery, the number of complications has been signiÞcantly reduced compared to classic trabeculectomy and Seton technique. Based on long-time results, we can now assume that these new non-invasive techniques will ensure that patients undergo safe glaucoma surgery even in early the stages of the disease.

Dr Roy and Dr Mermoud will present the deep sclerectomy technique, the mechanisms of Þltration, and the results and management of complications. Dr De Smedt will present in the attached CD-ROM several videos on deep sclerectomy.

More recently, the Ex-PRESSª tube has been proposed as a means to simplify glaucoma surgery. It can make trabeculectomy as well as deep sclerectomy easier. The Ex-PRESSª tube offers a reproducible and stable resistance to aqueous humor outßow. This advantage provides safer surgery and a quieter postoperative follow-up. Dr Dahan will present the chapter on Ex-PRESSª implant describing in detail the surgical technique, the clinical results, the indications, and the mechanisms.

Dr Pajic will present the sclerothalamotomy ab interno and comment on the results from his clinical experience with this procedure. This new technique allows opening of the trabeculum and SchlemmÕs canal from the anterior chamber using a very atraumatic method.

The i-stent¨ technique is a surgery very similar to sclerothalamotomy ab interno. Dr Julian Garcia Feijoo and Dr JosŽ Maria Martinez de la Casa will present this novel procedure with comments on the results from their clinical experience with this method. Using this new device, SchlemmÕs canal is opened directly through the anterior chamber by means of a micro-tube.

In the past few years more innovations and ideas have been developed and proposed by several authors. Due to space constraint they will not be detailed in this chapter. Nevertheless, it would be unfair not to mention viscocanaloplasty, which dilates the lumen of SchlemmÕs canal using a micro-catheter. Similarly, the trabectome, developed by George Baerveldt and his colleagues, also permits comfortable enlargement of SchlemmÕs canal and to perform an ab interno trabeculotomy, just like the PajicÕs technique reported in this chapter. Another minimally invasive glaucoma surgery has been proposed with the Golden shuntª. The subchoro•dal space is connected to the anterior chamber using a gold plate made of multiple micro-tubes set in parallel.

8.1Deep Sclerectomy:

A Nonpenetrating Filtering Surgery

S. Roy ( )

Centre du Glaucome Clinique de Montchoisi

Ch. des Allinges 10 CH-1006 Lausanne Switzerland e-mail:sylvain.roy@epß.ch

8.1.1 Introduction to Deep Sclerectomy

The goal of deep sclerectomy, a nonpenetrating Þltering surgery, is to lower the outßow resistance of the aqueous humor while respecting the anatomy and