Bilateral Nonpenetrating Deep Sclerectomy: Difference in Outcomes Between First- and Second-Operated Eyes at 24 Months

Abstract

Background/AimsThe purpose of this study was to assess the difference in outcome between the first-operated eye and the second-operated eye following non-penetrating deep sclerectomy (DS), and to identify potential success predictors for the second eye. MethodsThis single-surgeon, retrospective study analyzed the outcomes of all bilateral nonsimultaneous DS with at least 24 months of follow-up. Its main outcome measure was surgical success, defined as unmedicated intraocular pressure (IOP) ≤ 15 mmHg associated with a relative reduction ≥20%. ResultsIn all, 104 eyes of 52 patients who underwent bilateral (standalone or combined) DS, within a mean of 344.3 ± 526.3 days of each other, were analysed. Post-operatively, mean medicated IOP decreased from 20.7 ± 7.9 (first-operated) and 19.3 ± 6.6 mmHg (second) at baseline (p = 0.107) to 13.8 ± 4.8 ([-33.3%; p < 0.001] first-operated eyes) and 12.7 ± 3.8 mmHg ([-34.2%; p < 0.001] second eyes) after 2 years (p = 0.619). Post-operative IOP and treatments reduction respectively showed fair (r = 0.53) and good (r = 0.71) levels of correlation between fellow eyes. Rates of complete success were comparable between first-operated and second-operated eyes (32.7% and 40.4%, respectively; p = 0.364). At 2 years, among patients whose firstoperated eyes were considered a success, 82.4% of surgeries in second eyes were successful (p=0.001). The odd ratio of a second-operated eye experiencing complete success were 6.32 (p = 0.011) if the first operated eye experienced complete success. ConclusionThe present study demonstrated a strong association between first-operated eyes and secondoperated eyes following DS, in terms of surgical outcomes and IOP reduction. In effect, surgical success in the first-operated eye increases the odds of success in the second eye by 6 folds.

Predictability of success for combined iStent inject trabecular bypass implantation with phacoemulsification in the subsequent eye

“…Similar trends have been reported on trabeculectomy, 1 deep sclerectomy 2 as well as on XEN45 Gel Stent implantation 3,7 . Considering surgery targeting the iridocorneal angle primarily, Rosentreter et al made comparable observations on combined cataract surgery with trabecular aspiration 4 .…”

“…1 Gillmann et al described a predictability for the outcome of second eye surgery being based on the effectiveness of non-penetrating deep sclerectomy and XEN45 Gel Stent implantation (Allergan, an AbbVie Company, Dublin, CA) in the first eye. 2,3 Differences amongst first and subsequent eyes regarding IOP values at followup, the number of anti-glaucomatous eye drops taken postoperatively and the success rates turned out as non-significant. Rosentreter et al made similar observations in pseudoexfoliative eyes which underwent bilateral combined cataract surgery with trabecular aspiration in the chamber angle.…”

“…Mietz et al described a greater risk of Tenon's capsule cysts in subsequently trabeculectomized eyes 1 . Gillmann et al described a predictability for the outcome of second eye surgery being based on the effectiveness of non‐penetrating deep sclerectomy and XEN45 Gel Stent implantation (Allergan, an AbbVie Company, Dublin, CA) in the first eye 2,3 . Differences amongst first and subsequent eyes regarding IOP values at follow‐up, the number of anti‐glaucomatous eye drops taken postoperatively and the success rates turned out as non‐significant.…”