Elsevier

Ophthalmology

Volume 107, Issue 9, September 2000, Pages 1671-1674
Ophthalmology

Nonpenetrating deep sclerectomy versus trabeculectomy in bilateral primary open- angle glaucoma1Icce to phaco

Presented in part at the annual meeting of the American Academy of Ophthalmology, Orlando, Florida, October 1999.
https://doi.org/10.1016/S0161-6420(00)00263-3Get rights and content

Abstract

Objective

To establish the efficacy and safety of nonpenetrating deep sclerectomy versus trabeculectomy in primary open-angle glaucoma.

Design

Prospective randomized trial.

Participants

Thirty-nine patients (78 eyes) with bilateral primary open angle glaucoma were included in the study.

Intervention

Eyes were randomly assigned to receive deep sclerectomy in one eye and trabeculectomy in the other eye.

Main outcome measures

Mean intraocular pressure (IOP), postoperative medications, visual acuity, success rate, and complications.

Results

At 12 months, mean IOP reduction was 12.3 ± 4.2 (sclerectomy) versus 14.1 ± 6.4 mmHg (trabeculectomy) (P = 0.15), and an IOP ≤ 21 mmHg was achieved in 36 (92.3%) and 37 eyes (94.9%) (P = 0.9), respectively. Complications included three (7.7%) flat/shallow anterior chambers and one (2.6%) hypotony (trabeculectomy), whereas internal iris incarceration was encountered in two eyes (5.1%) (sclerectomy).

Conclusions

Deep sclerectomy may provide comparable IOP reduction with fewer complications in management of primary open angle glaucoma.

Section snippets

Patients and methods

A total of 39 patients (78 eyes) with bilateral primary open-angle glaucoma underwent bilateral filtering surgery between October 1997 and March 1998.

Patients were assigned randomly to receive deep sclerectomy in one eye and trabeculectomy in the other; the surgeries were scheduled with no more than 3 days between the two procedures. Patients were included in the study if they had uncontrolled glaucoma (intraocular pressure [IOP] >21 mmHg) despite maximally tolerated medications. Excluded were

Results

Seventy-eight eyes of 39 patients were enrolled in the study. The mean ± standard deviation reported age of the patients was 53.4 ± 9.6 years (range, 38–75 years). Most patients were men (62.5%). Two patients were excluded from the study and were replaced because accidental perforation of the trabecula-Descemet’s membrane occurred during deep sclerectomy.

Preoperative and postoperative IOPs are shown in Table 1. There was a significant IOP reduction after surgery in both groups throughout the

Discussion

Nonpenetrating sclerectomy allows aqueous filtration from the anterior chamber to the subconjunctival space through a thin trabecula-Descemet’s membrane.15 This membrane avoids the sudden IOP drop, thus lowering the incidence of postoperative complications encountered with trabeculectomy.

Nonpenetrating filtration surgery was first proposed by Zimmerman et al.8, 9 Different techniques were described by others16, 17 with encouraging results. Fyodororv et al10 and Kozlov et al18 reported the use

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The authors have no proprietary or financial interest in any product of this study.

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