Deep sclerectomy with collagen implant in one eye compared with trabeculectomy in the other eye of the same patient

PURPOSE: To study the efficacy and safety of deep sclerectomy with collagen implant in one eye versus trabeculectomy in the other eye of the same patient. METHODS: The authors conducted a nonrandomized prospective trial of 20 patients with medically uncontrolled primary and secondary open-angle glaucoma. Patients with bilateral medically uncontrolled glaucoma who had previously undergone trabeculectomy in one eye were selected for the study, and a deep sclerectomy with collagen implant was performed in the second medically uncontrolled glaucomatous eye. Trabeculectomy was studied retrospectively whereas deep sclerectomy with collagen implant was studied prospectively. Visual acuity, intraocular pressure, and slit-lamp examinations were performed before and after surgery, at 1 and 7 days, and at 1, 3, 6, 9, 12, 18, and 24 months. Visual fields were repeated every 6 months. RESULTS: The mean follow-up period for both groups was 24.3 +/- 19.1 months. The mean intraocular pressure at 24 months was 13.9 +/- 4.5 mm Hg for deep sclerectomy with collagen implant and 12.9 +/- 4.8 mm Hg for trabeculectomy. At 24 months, IOP was reduced by 39.7% in the deep sclerectomy with collagen implant group (13.8 mm Hg vs. 22.9 mm Hg), and by 55.9% in the trabeculectomy group (12.9 mm Hg vs. 29.3 mm Hg). Forty percent of the deep sclerectomy with collagen implant eyes and 45% of the trabeculectomy eyes achieved a pressure of less than 21 mm Hg without treatment (complete success rate). The deep sclerectomy with collagen implant group showed 50% less hyphema and choroidal detachment than the trabeculectomy group. CONCLUSIONS: Deep sclerectomy with collagen implant is another surgical treatment option in the management of glaucoma, showing pressure results comparable with trabeculectomy but with a lower rate of early postoperative complications