Abstract
Aim
To study the long-term outcome of deep sclerectomy in patients with open angle glaucoma.
Methods
Prospective consecutive series of 43 eyes (38 patients) with medically uncontrolled open-angle glaucoma undergoing deep sclerectomy. All patients underwent clinical assessment before and after surgery at day 7 and at months 1, 3, 6, 12, 18, 24, 36. Surgical success was considered if the patient's intraocular pressure (IOP)<22 mmHg and the IOP was lowered by more than 20% without the use of any medication. Kaplan–Meier survival curves were used to evaluate the success rate.
Results
The mean follow-up time was 28.1±8.2 months. Mean IOP decreased significantly from a preoperative value of 24.6±5.5 mmHg to a postoperative value of 18.5±4.6 mmHg at 36 months (P<0.001). Microperforation of TDM occurred in three cases (7.0%) and ciliary body prolapse in one case (2.3%) but did not prevent completion of the operation. Postoperatively, hyphaema was detected in one case and shallow anterior chamber in another case and both were treated conservatively. Bleb encapsulation with elevation of IOP occurred in two cases (4.7%) and was treated with 5-fluorouracil subconjunctival injection. Goniopuncture with neodymium : YAG laser was performed in two cases (4.7%). There were no other late complications with the exception of failure of the operation. On the life-table analysis the success rate at 12, 24, and 30 months were 61.4, 36.6, and 18.9%, respectively.
Conclusion
Deep sclerectomy reduced the IOP temporarily while minimising the risk of postoperative complications commonly encountered with standard trabeculectomy. However, after long-term follow-up surgery failed to maintain a low IOP.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Cairns JE . Trabeculectomy: preliminary report of a new method. Am J Ophthalmol 1968; l66: 673–681.
Mermoud A . Sinusotomy and deep sclerectomy. Eye 2000; 14: 531–535.
El-Sayyad F, Helal M, El-Kholify H, Khalil M, El-Maghraby A . Non-penetrating deep sclerectomy versus trabeculectomy in bilateral primary open angle glaucoma. Ophthalmology 2000; 107: 1671–1674.
Kranzov MM . Sinusotomy: foundation, results, prospects. Trans Am Ophthalmol Otolaryngol 1972; 76: 369–374.
Zimmermann TJ, Kooner KS, Ford VJ, Olander KW, Mandjekorn RM, Rawlings EF et al. Trabeculectomy vs non-penetrating trabeculectomy: a retrospective study of two procedures in phakic patients with glaucoma. Ophthalmic Surg 1984; 12: 227–229.
Fyodorov SN . Non-penetrating deep sclerectomy in open angle glaucoma. Eye Microsurg 1989; 1: 52–55.
Kozlov VI, Bargov SN, Anisimova SY, Opsipov AV, Mogilevtsev W . Non-penetrating deep sclerectomy with collagen. Eye Microsurg (in Russian) 1990; 3: 44–46.
Sanchez E, Schnyder CC, Mermoud A . Deep sclerectomy: results with and without collagen implant. Int Ophthalmol 1997; 20: 157–162.
Stegmann RC, Pienaar A, Miller D . Viscocanalostomy for open angle glaucoma in black african patients. J Cataract Refract Surg 1999; 25: 316–321.
Johnson DH, Johnson M . How does non-penetrating glaucoma surgery work? Aqueous outflow resistance and glaucoma surgery. J Glaucoma 2001; 10: 55–67.
Shaarawy T, Nguyen C, Schnyder C, Mermoud A . A comparative study between deep sclerectomy with and without collagen implant: long term follow up. Br J Ophthalmol 2004; 88: 95–98.
Shaarawy T, Flammer J, Smits G, Mrmoud A . Low first postoperative day intraocular pressure as a positive prognostic indicator in deep sclerectomy. Br J Ophthalmol 2004; 88: 568–661.
Tan JCH, Hitchings RA . Non-penetrating glaucoma surgery: the state of play. Br J Ophthalmol 2001; 85: 234–237.
Shaarawy T, Mansouri K, Schnyder C, Ravinet E, Achache F, Mermoud A . Long term results of deep sclerectomy with collagen implant. J Cataract Refract Surg 2004; 30: 1225–1231.
Mermoud A, Schnyder CC . Nonpenetrating filtering surgery in glaucoma. Curr Opin Ophthamol 2000; 11: 151–157.
Karlen ME, Sanchez E, Schnyder CC, Sickenberg M, Mermoud A . Deep sclerectomy with collagen implants medium term results. Br J Ophthalmol 1999; 83: 6–11.
Demailly P, Lavat P, Kertz G, Jeanteur-Lunel MN . Non-penetrating deep sclerectomy (NPDS) with or without collagen device (CD) in primary open angle glaucoma: middle term retrospective study. Int Ophthalmol 1997; 20: 131–140.
Sunaric-Megevand G, Leuenberger PM . Results of viscocanalostomy for primary open angle glaucoma. Am J Ophthalmol 2001; 132: 221–228.
Mermoud A, Karlen ME, Schnyder CC, Sickenberg M, Chiou AGY, Hediguer SEA et al. Nd : YAG goniopuncture after deep sclerectomy with collagen implants. Ophthalmic Surg Lasers 1999; 30(2): 120–125.
Dahan E, Drusedau MUH . Non-penetrating filtration surgery for glaucoma: control by surgery only. J Cataract Refract Surg 2000; 26: 695–701.
Welsh NH, DeLange J, Wasserman P, Ziemba SL . The ‘deroofing’ of Schlemm's canal in patients with open angle glaucoma through placement of a collagen drainage device. Ophthalmic Surg Lasers 1998; 29: 216–226.
Lachkar Y, Hamard P . Nonpenetrating filtering surgery. Curr Opin Ophthalmol 2002; 13(2): 110–115.
Chiselita D . non-penetrating deep sclerectomy versus trabeculectomy in primary open angle glaucoma surgery. Eye 2001; 15: 197–201.
O’Brart DP, Shiew M, Edmunds B . A randomised, prospective study comparing trabeculectomy with viscocanalostomy with adjunctive antimetabolites usage for the management of open angle glaucoma uncontrolled by medical therapy. Br J Ophthalmol 2004; 86(8): 1012–1017.
Ambresin A, Shaarawy T, Mermoud A . Deep sclerectomy with collagen implant in one eye compared with trabeculectomy in the other eye of the same patient. J Glaucoma 2002; 11(3): 214–220.
Hamard P, Lachkar Y . Non penetrating filtering surgery, evolution and results. J Fr Ophthalmol 2002; 225(5)): 527–536.
Kozobolis VP, Emmanouil V, Tzanakis N, Zacharopoulos I, Pallikaris IG . Primary deep sclerectomy versus deep sclerectomy with use of Mitomycin C in primary open angle glaucoma. J Glaucoma 2002; 11(4)): 287–293.
Wishart PK, Wishart MS, Porooshani H . Viscocanalostomy and deep sclerectomy for the surgical treatment of glaucoma: a long-term follow up. Acta Ophthalmol Scand 2003; 81(4): 343–348.
Drusedau MU, von Wolff K, Bull H, von Baswisch B . Viscocanalostomy for primary open angle glaucoma: the Gross Pankow experience. J Cataract Refract Surg 2000; 2: 1367–1373.
Luke C, Dieltein TS, Jacobi PC, Konen W, Krieglestein GK . A prospective randomised trial of viscocanalostomy versus trabeculectomy in open angle glaucoma: a 1-year follow-up study. J Glaucoma 2002; 11: 294–299.
Rossier A, Uffer S, Mermoud A . Aqueous dynamics in experimental ab externo trabeculectomy. Ophthalmic Res 2000; 32: 165–171.
Vaudaux JUSMA . Aqueous after deep sclerectomy: in vitro study. Ophthalmic Practise 1999; 16: 204–209.
Gressel MG, Parrish PK, Heuer DK . Delayed nonexpulsive suprachoroidal haemorrhage. Arch Ophthalmol 1984; 102: 1757–1760.
Jonescu-Cuypers C, Jacobi P, Konen W, Krieglestein GK . Primary viscocanalostomy versus trabeculectomy in white patients with open angle glaucoma. J Cataract Refract Surg 1999; 25: 254–258.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Khairy, H., Green, F., Nassar, M. et al. Control of intraocular pressure after deep sclerectomy. Eye 20, 336–340 (2006). https://doi.org/10.1038/sj.eye.6701878
Received:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sj.eye.6701878
Keywords
This article is cited by
-
Five-year results of non-penetrating deep sclerectomy with demineralized cancellous bone xenogenically derived collagen glaucoma implant
International Ophthalmology (2021)
-
Langzeitverlauf nach primärer tiefer Sklerektomie bei Patienten mit niedriger Basisaugendrucklage
Spektrum der Augenheilkunde (2020)
-
Long-term results of ab externo trabeculotomy for glaucoma secondary to chronic uveitis
Graefe's Archive for Clinical and Experimental Ophthalmology (2016)
-
Tiefe Sklerektomie
Der Ophthalmologe (2015)
