Post-operative inflammation following deep sclerectomy with collagen implant versus standard trabeculectomy

Background: An investigation was carried out to compare post-operative inflammation following deep sclerectomy with collagen implant (DSCI) versus standard trabeculectomy. Methods: In this prospective randomized study, 46 eyes of 46 Caucasian patients with medically uncontrolled chronic open-angle glaucoma and without previous glaucoma surgery underwent filtering surgery. Twenty-four eyes underwent DSCI. Twenty-two eyes underwent standard trabeculectomy. Pre- and post-operative flare, measured using laser flare photometry, were compared between the two groups. Results: In both groups, the mean anterior chamber flare increased on the first post-operative day, then decreased progressively. DSCI was associated with lower flare measurements post-operatively. The difference was statistically significant up to 1 month post-operatively: 16.3+/-7.8 vs 72.5+/-38.9 (P < 0.001) at 1 day, 7.8+/-4.6 vs 44.7+/-29.2 (P < 0.001) at 1 week, 5.9+/-1.6 vs 7.0+/-2.8 (P = 0.012) at 1 month, 6.4+/-1.8 vs 6.5+/-1.9 (P = 0.77) at 2 months, 5.9+/-1.8 vs 6.1+/-1.6 (P = 0.65) at 3 months. Conclusion: Surgically induced inflammation can be reduced with DSCI. This may be due to the lack of iridectomy, irrigation, and penetration of the anterior chamber. Eyes at increased risk of post-operative inflammation, such as those with uveitic or traumatic glaucoma, may benefit from this procedure. Further studies are needed to evaluate the long-term functional and anatomical outcomes of DSCI.