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Advantages of Mermoud (Gonin Institute) Nonpenetrating Sclerectomy in Post-uveitic Glaucoma
William Sponsel, MD
William Eric Sponsel
Professor of Vision Sciences, UIW, San Antonio, Texas
Director of SEE, Multi-Assistance Center, Morgan's Wonderland, San Antonio, Texas
Executive Committee, International Society for Glaucoma Surgery, Geneva, Switzerland
Purpose: To share with Sonoma Eye delegates the documented advantages of mitomycin-augmented nonpenetrating deep sclerectomy (NPDS). The method, developed at the Gonin Eye Institute in Lausanne by Andre Mermoud, has remarkable demonstrated capacity to achieve statistically significant visual field improvement in patients with a prior history of severe uveitis. This elegant method differs from classic trabeculectomy by conserving the inner trabeculum. Morbidity to the lens, endothelium and macula are dramatically reduced, while still providing substantial, stable and longlasting IOP reduction.
Methods: Published findings from our South Texas clinical population for short and long-term IOP-control and visual field survival will be summarized. The relationship between these NPDS outcomes and our eventual recognition and statistical confirmation of coordinated binocular CNS control of glaucomatous visual field loss will be described.
Results: 5-year follow-up of NPDS outcomes in 106 eyes (Pre-op,3,6,12,24,36,48&60mo): Maintained mean IOP reduction of 7.8mmHg (37%; P<10 -6), 92% with IOP >5<21mmHg at every assessment interval. Topical meds were reduced from pre-op mean 2.7 to 0.5 at 5 years (81%; P<10 -22). Humphrey 30-2 MD and CPSD were stable relative to baseline at all 8 time intervals (R=0.83-0.94; P<0.0001).
Conclusion: NPDS with MMC is a highly effective form of glaucoma management that is particularly suited to post-uveitic patients. Recovery of pre-apoptotic ganglion cellular function, in the absence of iatrogenic macular, lenticular, or corneal perimetric artifact, was a key factor in the elucidation and confirmation of the "Jigsaw Effect," verifying bilateral CNS coordination of functional loss to maximize binocular visual field survival [see TVST 3(3)1; 4(2)8; 4(3)7 &6(6)6].