Deep sclerectomy for the treatment of exfoliation and primary open‐angle glaucoma

Abstract

. Purpose: To retrospectively compare the efficacy of deep sclerectomy in the treatment of primary open‐angle glaucoma (POAG) and exfoliation glaucoma (ExG). Methods: Deep sclerectomy with either collagen or hyaluronate implants was performed in 31 eyes (45%) with POAG and 38 eyes (55%) with ExG. Pre‐ and postoperative intraocular pressure (IOP) was recorded, as was the number of glaucoma medications used pre‐ and postoperatively in each group. The follow‐up data referred to a mean period of 18 months (range: 2 weeks to 36 months). Results: At 18 months, complete success had been achieved in 56.3% of POAG eyes and 44.9% of ExG eyes. Qualified success had been achieved in 83.1% and 71.6% of POAG and ExG eyes, respectively. The mean IOP was 18.6 mmHg in POAG eyes and 16.3 mmHg in ExG eyes. YAG‐descemetotomies were performed in nine eyes in each group. There were no statistically significant differences between the groups in IOP (except at 1 week postoperatively in favour of POAG; p = 0.05), success rates, need for postoperative glaucoma medication or number of complications. Reoperations were required in three (10%) POAG eyes and seven (18%) ExG eyes. Conclusions: Deep sclerectomy is equally effective in controlling IOP in both POAG and ExG and has low rates of serious complications, even when the surgeon is inexperienced in the technique. Both survival rates and IOP control were similar between the groups, and there were no serious intra‐ or postoperative complications.

Conjunctival Inflammatory Cells and Their Predictive Role For Deep Sclerectomy in Primary Open-angle Glaucoma and Exfoliation Glaucoma

“…However, our earlier series of 69 consecutive DS surgeries in POAG and ExG showed that success rates are equally good in both glaucoma types. 28 On the basis of our results, the high-inflammatory cell count at the time of the operation is a risk factor for the surgical failure during the follow-up of 3 years. Furthermore, the statistically higher number of inflammatory cells in the conjunctiva of the failed POAG than failed ExG suggests that at least in ExG, there are additional risk factors for failing DS.…”

“…Conjunctival biopsies were obtained during DS surgery from 11 The surgical technique has been described earlier. 28 DS surgery was classified as successful if the IOP was less than or equal to 18 mm Hg without any antiglaucoma drugs and there was no requirement for repeated surgery. Moreover, if IOPs were higher than 18 mm Hg with or without the need for initiation of medical therapy and/or for a reoperation, the surgery was considered failed.…”

“…24 Non-penetrating deep sclerectomy (DS) surgery has been reported as an effective and safe method in reducing the IOP of POAG and ExG patients. [25][26][27][28][29][30] In many centers, DS has gained popularity because of fewer immediate postoperative complications. However, there are only limited amount of data available about the factors that predict the success or failure in DS surgery.…”

Long-term Evaluation of Efficacy and Safety of Deep Sclerectomy in Uveitic Glaucoma

“…8 In an attempt to lower the incidence of complications of trabeculectomy, nonpenetrating glaucoma surgery (NPGS) was developed. [9][10][11][12][13][14][15][16][17][18][19][20] There is increasing evidence that deep sclerectomy is probably more appropriate for uveitic glaucoma. Auer et al have reported that nonpenetrating deep sclerectomy has controlled the intraocular pressure in 90% of eyes with uveitic glaucoma that were resistant to medical therapy, with low rate of surgical complications compared to classical trabeculectomy.…”

Efficacy and safety of deep sclerectomy in uveitic glaucoma

“…Deep sclerectomy surgery has been suggested as an alternative to trabeculectomy [9][10][11][12][13][14][15][16][17][18][19]. The nonopening of the anterior chamber and the avoidance of a peripheral iridectomy may lower the incidence of such complications while retaining the efficacy of trabeculectomy [8,[10][11][12][13][14][15][16][17][18][19][20].…”