Viscocanalostomy for open-angle glaucoma in black African patients

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 dissected 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(R)) 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.