Deep sclerectomy: Safety and efficacy

Varga, Zsolt; Shaarawy, Tarek

doi:10.4103/0974-9233.56223

Cited by 24 publications

(29 citation statements)

References 16 publications

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“…The lower early complication rate for NPS techniques compared with trabeculectomy may explain the reduced visit frequency. A previous report suggests postoperative evaluation after NPDS of: day 1, day 7 and 1, 3 and 6 months .…”

Section: Discussionmentioning

confidence: 99%

Survey of glaucoma surgical preferences and post‐operative care in the United Kingdom

Rodríguez-Uña¹,

Azuara‐Blanco

King³

2016

Clinical Exper Ophthalmology

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Section: Discussionmentioning

confidence: 99%

Survey of glaucoma surgical preferences and post‐operative care in the United Kingdom

Rodríguez-Uña¹,

Azuara‐Blanco

King³

2016

Clinical Exper Ophthalmology

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“…There is a consensus in that complications related to overfiltration and infection are significantly lower than in trabeculectomy [14]. Short and mid-term success rates of deep sclerectomy have been reported to be favorable [8].…”

Section: Discussionmentioning

confidence: 99%

“…As it appears to have a superior safety profile than penetrating procedures, deep sclerectomy can be considered at an earlier stage of the disease, especially in the case of intolerance or unavailability of medical and laser therapies [14].…”

Section: Discussionmentioning

confidence: 99%

Deep Sclerectomy

Roy¹,

Mermoud²

2012

Developments in Ophthalmology

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Filtering surgery evolved from the classic trabeculectomy, in which penetration into the anterior chamber is a necessary step, toward nonpenetrating deep sclerectomy. The first procedure presents several serious complications such as durable hypotony, hyphema, flat anterior chamber, choroidal detachment, endophthalmitis and surgery-induced cataract. To avoid such drawbacks, a novel nonpenetrating technique was designed to improve predictability of the intraocular pressure-lowering action, while reducing the incidence of the immediate postoperative complications encountered with the penetrating method. This surgery works by building up new outflow pathways for the drainage of the aqueous humor while keeping intact the integrity of the anterior chamber. Deep sclerectomy acts at the bulk of main resistance to aqueous humor egress, located at the juxtacanalicular meshwork and the inner wall of Schlemm's canal. It consists of dissection of these two structures while keeping a thin filtering membrane though which aqueous humor is being drained. The membrane prevents overfiltration and ensures a reproducible postoperative intraocular pressure. This surgery is indicated for most of glaucoma except angle closure and neovascular cases. The procedure consists in opening the conjunctiva and Tenon's capsule and creating a 5 × 5 mm limbus-based superficial scleral flap. A deeper scleral flap measuring about 4 × 4 mm is dissected and the roof of Schlemm's canal is removed. A space maintainer is inserted and the flap and conjunctiva are closed. Results after 10 years are good with an IOP of 12.2 ± 4.7 mmHg and an overall success rate of 77.6%with few complications.

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“…As in deep sclerectomy there is non-invasion of the anterior chamber, the reduced post-operative complications like over filtration and hypotony are rare. 3 But deep sclerectomy is done rarely due to its difficult learning curve. In our study, we thus compared the efficacy of both the procedures in terms of post-operative intraocular pressure reduction in patients with POAG.…”

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confidence: 99%

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

Parvathasundari¹,

Chandrakumar²,

Sowmi³

et al. 2018

jemds

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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.

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Deep sclerectomy: Safety and efficacy

Cited by 24 publications

References 16 publications

Survey of glaucoma surgical preferences and post‐operative care in the United Kingdom

Survey of glaucoma surgical preferences and post‐operative care in the United Kingdom

Deep Sclerectomy

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

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