A Prospective Non-Randomised Trial to Compare the Results of Intraocular Pressure Reduction Between Trabeculectomy and Deep Sclerectomy in Primary Open Angle Glaucoma

Abstract

BACKGROUND Maintenance of Intraocular Pressure and its pathophysiology revolves around the aqueous dynamics, and this is almost always the cause of Primary Open Angle Glaucoma and thus becoming the target for many medical and surgical therapies. Deep sclerectomy still holds an equal place in management. As in deep sclerectomy there is non-invasion of the anterior chamber, the reduced postoperative complications like over filtration and hypotony are rare. Aims and Objectives-To evaluate and compare the results of trabeculectomy and deep sclerectomy in mild and moderate primary open angle glaucoma patients and assess their intraocular pressure pre-operatively and post-operatively. MATERIALS AND METHODSThis was a prospective randomised trial conducted among 50 patients with mild or moderate primary open angle glaucoma at Government Rajaji Hospital for a period of nine months. All subjects were evaluated pre-operatively and randomly divided into 2 groups using simple randomisation method. IOP was measured on the 3 rd post-operative day followed by weekly intervals for 1 month and monthly intervals thereafter till 6 months. RESULTSMale-to-female ratio was almost equal in both groups. There was significant reduction of IOP post-operatively in the trabeculectomy as well as the deep sclerectomy groups, right from the 3 rd post-operative day till the 6 th month. The advantages of deep sclerectomy over trabeculectomy in open angle glaucoma are safety without loss of efficacy with fewer complications and faster recovery. However, the long-term efficacy of IOP control in deep sclerectomy is poor, unlike in trabeculectomy, in which case a number of adjunctive techniques are being used to increase the efficacy like intraoperative use of antimetabolites, Ologen like intrascleral implants as well as performing laser goniopuncture early when the IOP rises above the target value. CONCLUSIONDeep sclerectomy were equally effective in reducing the intraocular pressure in POAG patients during the immediate postoperative and up to 6 months of follow-up period. Deep sclerectomy henceforth should be considered at an earlier stage. KEYWORDSIntraocular Pressure, Open Angle Glaucoma, Trabeculectomy, Anti-Glaucoma Surgery. HOW TO CITE THIS ARTICLE: Parvathasundari N, Chandrakumar S, Sowmi SK, et al. A prospective non-randomised trial to compare the results of intraocular pressure reduction between trabeculectomy and deep sclerectomy in primary open angle glaucoma.