Crosslinked sodium hyaluronate implant in deep sclerectomy for the surgical treatment of glaucoma

PURPOSE. To evaluate the efficacy and safety profile of a new crosslinked sodium hyaluronate drainage implant in nonpenetrating glaucoma surgery. METHODS. From July 2008 until January 2010, 55 eyes from 55 patients with glaucoma were operated upon. After a standard deep sclerectomy was performed, a crosslinked sodium hyaluronate (HEALAflow (R)) was injected under the superficial sclera, flap and underneath the conjunctiva. The main outcomes measured were mean intraocular pressure (IOP), mean number of antiglaucoma medications, presence of postoperative complications, and clinical aspect of the filtering bleb. RESULTS. For the 55 eyes, the mean follow-up was 12.0 +/- 5.1 months, the mean preoperative IOP was 21.6 +/- 7.2 mmHg, and the mean number of antiglaucoma medications before surgery was 2.4 +/- 1.2. At final follow-up visits, the mean IOP went down to 11.5 +/- 3.0 mmHg; the mean number of antiglaucoma medications was reduced to 0.5 +/- 0.9. The filtering bleb was visible on 49 eyes (89%). There were 5 hypotonies (IOP < 6 mmHg) and 3 iris incarcerations. Complete success rate (IOP <= 18 mmHg without antiglaucoma medication) was 70% and the overall success rate (IOP <= 18 mmHg with and without antiglaucoma medication) was 91%. CONCLUSIONS. The slow resorbable highly crosslinked sodium hyaluronate drainage implant fills up the intrascleral and subconjunctival space, preventing postoperative scarring and fibrosis of the filtering site and helping to maintain a functional filtration after nonpenetrating glaucoma surgery. The IOP was significantly lowered with few numbers of postoperative complications and less medication.