1. Hospital Universitari Germans Trias i Pujol
Are there any advantages of the suprachoroidal implants in Deep Sclerectomy ?
Dr. J. Loscos
Hospital Universitari Germans Trias i Pujol
Badalona, Barcelona

2. Conflict of interest: The authors declare no conflict of interest
Dr. P. Romera
Glaucoma Consultant
Dra. N. Romanic
Resident 3rd year
Dra. A. Moll
Resident 4th year
DO J. Castellvi
Optometrist

3. Why is Casablanca one of the best movies in history?

4. _ Ciliary muscle Relaxation (A) / Contraction (B)
How does it work ?
Influye Paqui edad ( % cada década)miopía Metaloproteasas No modelo animal Femeninas
_ Ciliary muscle Relaxation (A) / Contraction (B)
_ Increase (A) / Decrease (B) aqueous humor outflow through muscle bundles

5. How does it work ? Suprachoroidal Supraciliary
˃2.5 mm
<1.5-2mm
Suprachoroidal
Supraciliary
Pero no busacmos solo un aumento de la via uveoscleral sino tb una ciclodialisisEsta es uveoscleral ( Enrique paredes 10/18/ ) y otra supraciliar ( Encarna toro moral 1237)
Uveoscleral outflow increase
Ciliary body detachment
_ Decrease in aqueous humor production
_ Decrease in choroidal resorption

6. How does it work ? Supraciliary Intrascleral
No todas la supraciliar inducen ciclodialisis ni mejoran supraciliar
Supraciliary
Intrascleral

7. How does it work ? Jan 2013 May 2015 Oct 2013 Oct 2015 Oct 2015
Como se comporta lo largo del tiempo Ripoll. La tendencia es a quedar abierta cuando se cierra transescleral ( también tienes Visante de Toro)
Oct 2013
Oct 2015
Oct 2015
Sept 2016

8. Results No implantl Supraciliary Intrasclerall
Author
Implant Nº
Years
Pre IOP
Post IOP
Nº Pre
Nº Post
Bissing
Aquaflow®
105 10
26.8
12.2
2.3
1.3
Galassi
SKGel®
200 3 21
12.85
2.4
0.3
Mousa
Esclera 20 1
33.1
14.6 **
Devloo 24
1.2
25.6
15.7
0.5
Lachkar
258 6
24.4
15.8 2
0.8
Ravinet
T-Flux® 23
28.1
13.2
2.5
0.4
Healon GV®
23.5
2.2
0.2
Studeny
T-FLUX® 40 5
26.7
18.3
1.8
Mansouri
PMMA 30
21.4
13.8
0.6
13.3
0.7
Karlem
100
1.5
27.8 14
Chiselita 17
27.7
20.9
Mermoud 44
25.8
Author Nº
Years
Pre IOP
Post IOP
Med Post.
Med. Post
El-Sayyad 39 1
27.9
15.6
2.4
0.3
Perez-Rico 47
4.8
21.19
12.76
2.06
1.06
No implantl
Antes avalancha de datos aparentemente conbtradictorios se funde en negro y se pregunta
Author
Implant
LOC Nº
Ye ars
Pre IOP
Post IOP
Med Pre
Med Post
Muñoz
T-Flux®
SUPRA 61 1
26.4 14
2.8
0.3
Loscos
Esnoper
Clip®
INTRA 27
26.6
15.3
2.5
Esnoper® 33 2
24.6
16.1
2.7
0.4
Supraciliary
Intrasclerall

9. Is it worth it?
Es una pregunta que el glaucomatologo se hace frecuentementemente desgraciadaamente

10. Results Eyes IOP pre post Nº Preop Medicat Nº Postop Suprachoroidal 41
Eyes
IOP
pre
post
Nº Preop
Medicat
Nº Postop
Suprachoroidal 41
23.46 ± 6.47
14.62 ± 3.64
2.68 ± 0.02
0.24 ± 0.66
Intrascleral 42
23.74 ± 6.9
15.43 ± 4.27
2.58 ± 0.04
0.32 ± 0.76
Comparative Analyses of Two Positioning Variants of The Acrylic Implant Esnoper V-2000 In Deep Sclerectomy: a Multi-Center Randomized Controlled Trial.
Belda JI, Loscos J, Mermoud A, Lozano E, Rebolleda G, Rodriguez-Agirretxe I, Canut M , Rodriguez-Calvo PP and the ESNOPER V-2000 study group.

11. Results : Goniopuncture
Eyes
Days
IOP reduction
Suprachoroidal
15 (36.58%)
165  
Intrascleral
22 (52.38%)
210  
Comparative Analyses of Two Positioning Variants of The Acrylic Implant Esnoper V-2000 In Deep Sclerectomy: a Multi-Center Randomized Controlled Trial.
Belda JI, Loscos J, Mermoud A, Lozano E, Rebolleda G, Rodriguez-Agirretxe I, Canut M , Rodriguez-Calvo PP and the ESNOPER V-2000 study group.

12. Results Supraciliary Intrascleral N 58 27 Pre IOP 27.66 +/- 9.19
Supraciliary
Intrascleral N 58 27
Pre IOP
/- 9.19
24.02+/
Nº Preop Medications
2.91+/- 0.40
3.13 +/- 0.64
Post IOP
13.38+/- 4.88
/- 3.61
Nº Postop Medications
0.14 +/- 0.43
0.35 +/- 0.64
Goniopuncture
41.79%
33.34%
% Reduction
59.68%
32.46%
Poner resultados de Nevena

13. Results : Goniopuncture
Podiamos tener hipotonías marcadas post GP
The eyes with suprachoroidal outflow decreased 5.09 mmHg ± 3.62 (-24.73%) whereas the ones without suprachoroidal outflow decreased 4.36 mm Hg ± 6.86 (-16.86%)

14. Results 12m 40 32 (80%) 15 (37.5%) 6 (15%) 24m 18 15 (83.3%) 9 (50%)N
Conjunctival Bleb
Uveoscleral
Outflow
Cyclodialysis
12m 40
32 (80%)
  15 (37.5%)
6 (15%)
24m 18
15 (83.3%)
  9 (50%)
3 (16.6%)
36m 15
11(73.3%)
8 (53%)
2 (13.3%)
La hipotonía es mas por la ampolla 5++++
_ Cyclodialysis does not exist with high funcional conjunctival blebs
_ High functional conjunctival blebs do not exist with cyclodialysis
_ Uveoscleral outflow can exist in both situations

15. Complications : Hyphema
DS Intrascleral
0.8% %4
DS Supraciliary
6.6% %2
_ Low postoperative IOP at 24 hours
_ Implant in touch with supraciliar vessels
Podria condicionar más fibrosis???
1- Muñoz G, Nonstitch suprachoroidal technique for T-flux implantation in deep sclerectomy.J.Glaucoma 2009; 18:
2- Loscos, Valldeperas, Parera,Camara Deep sclerectomy with supraciliary hema implant: results and complications. Int Ophthalmology 2015 Oct;35(5):693-9.
3- Lachkart Y, Neverauskiene ,Nonpenetrating deep sclerectomy: a 6-year retrospective study. Eur J Opthalmol 2004; 14:26-36.
4- Raviinet E,Bover E, Mermoud T-Flux implant versus Healon GV in deep sclerectomy. J.Glaucoma 2004; 13:

16. Complications : Hypotony
...clinical hypotony may be the variably low pressure that, in an individual eye, leads to lost of function and tissue changes overtime.
OCT y Visante de Boza y Torre bore ( Busca Visante de Boza). Pon foto del articulo de hipotensión ¡¡
_ 34 eyes
_ Maculopathy 25% (32.4 % Spontaneous recovery)
_ No significant difference in the rate of cataract or choroidal effusion

17. Complications : Hypotony
OCT y Visante de Boza y Torre bore ( Busca Visante de Boza). Pon foto del articulo de hipotensión ¡¡

18. Complications : Hypotony
OCT y Visante de Boza y Torre bore ( Busca Visante de Boza). Pon foto del articulo de hipotensión ¡¡

19. Complications : Hypotony1
OCT y Visante de Boza y Torre bore ( Busca Visante de Boza). Pon foto del articulo de hipotensión ¡¡
1- Nadal J, Carreras E, Canut M I, Barraquer R, Vitrectomy and internal limiting membrane peeling for macular foldssecondary to hypotony in miopes Clin Ophthalmol. 2015; 9: 859–864.

20. Conclusions _ Not quantitative
_ Alternative when transcleral outflow is limited
_ Unconventional pathways could be increased
_ Less bleb dependence
_ Avoid the need for suturing
_ Supraciliary / Suprachoroidal
_ Identify risky factors
_ No more complications than MMC

22. Moltes gràcies