“New” surgical treatments for glaucoma

In the beginning of 1998 many ophthalmologists in the United Kingdom received inquiries from their patients with glaucoma about a “new” operation for glaucoma. These inquiries were the result of an article in the popular press, which featured a patient who had undergone non-penetrating sclerostomy with a collagen wick device.1 2 Ophthalmologists in the United States also had a similar experience when an article appeared in a popular Sunday colour supplement, with some glaucoma patients actually demanding the procedure from their specialist based on the article (HA Quigley, 1998, personal communication). It was difficult to advise patients based on facts, as a search of the literature at the time revealed very little published on the results of this procedure (in commonly quoted peer reviewed journals) with a significant follow up period.

Therefore, it will be very useful for ophthalmologists that Karlen and colleagues have reported in this issue of theBJO (p 6) the medium term results of this procedure in a large group of white patients. The majority of these patients appear to be in groups that have a relatively low risk of filtration surgery failure as a result of scarring. This study helps to give us an idea where this procedure stands in relation to the gold standard which is Cairns type guarded filtration surgery (trabeculectomy).

The idea of producing a non-penetrating sclerectomy is not new and has a long history (A Bechetoille, 1998, personal communication). Contributors include Zimmerman et al who published some early results with non-penetrating sclerectomy in the early 1980s3 4 and Arenas.5 Koslovet al developed the technique in the current paper where the deep dissection was moved forward to Descemet’s membrane and they proposed an additional collagen implant as well as the term “deep sclerectomy”.6 Subsequently, in collaboration with …