ABSTRACT
PURPOSE: To evaluate the safety and effectiveness of reverse meridional cyclodialysis (RMC) ab interno with implantation of a metallic implant into the supraciliary space for decreasing intraocular pressure in glaucoma patients. MATERIAL AND METHODS: RMC was performed ab interno in 51 patients, among which 30 patients had a metallic implant inserted into the supraciliary space (implant group). Twenty-one patients who underwent RMC ab interno without implant comprised the control group. The outcomes were evaluated after 12 months. RMC was performed through a clear corneal incision using a special spatula at 4-5 o'clock reaching 5-6 mm deep, width of the cleft was 11-12o of the iridocorneal angle. The evaluation criteria included adverse events, postoperative IOP changes, need for hypotensive medications and repeat surgery. The results were analyzed using variational statistics. RESULTS: Baseline mean IOP was 28.8±4.7 mmHg and 30.2±7.2 mmHg in implant and control groups, respectively, and at 12 months it decreased by 28.7±12.0% and 29.1±17.1%. Baseline mean medication usage was 2.7±0.8 and 2.6±0.9 in respective groups, at 12 months it decreased to 1.1±0.9 and 0.8±0.9. In the implant group, overall success was achieved in 93.3% of cases (complete success - 33.3%, partial success - 60.0%), while in the control group it was 66.7% (complete success - 28.6%, partial success - 38.1%) (p=0.03). In terms of IOP decrease, medication usage and adverse events the difference between the groups was statistically insignificant. Repeat surgery was required 5 times more frequently in the control group (33.3% vs 6.7%, p=3E-05). CONCLUSION: Implantation of a metallic implant into the supraciliary space to keep the cyclodialysis cleft open is safe and effective and substantially decreases the need for repeat surgery.
