Clinical Study
Eye (2006) 20, 336–340. doi:10.1038/sj.eye.6701878; published online 15 April 2005
Control of intraocular pressure after deep sclerectomy
H A Khairy1,2, F D Green1, M K Nassar2 and A Azuara-Blanco1
- 1Department of Ophthalmology, Aberdeen Royal Infirmary, University of Aberdeen, UK
- 2Ophthalmology Department, Menoufyia University, Egypt
Correspondence: A Azuara-Blanco, Consultant Ophthalmologist, The Eye Clinic, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK. Tel: +44 1224 553217; Fax: +44 1224 553213; E-mail: Aazblanco@aol.com
Received 10 October 2004; Accepted 15 February 2005; Published online 15 April 2005.
Abstract
Aim
To study the long-term outcome of deep sclerectomy in patients with open angle glaucoma.
Methods
Prospective consecutive series of 43 eyes (38 patients) with medically uncontrolled open-angle glaucoma undergoing deep sclerectomy. All patients underwent clinical assessment before and after surgery at day 7 and at months 1, 3, 6, 12, 18, 24, 36. Surgical success was considered if the patient's intraocular pressure (IOP)<22 mmHg and the IOP was lowered by more than 20% without the use of any medication. Kaplan–Meier survival curves were used to evaluate the success rate.
Results
The mean follow-up time was 28.1
8.2 months. Mean IOP decreased significantly from a preoperative value of 24.65.5 mmHg to a postoperative value of 18.54.6 mmHg at 36 months (P<0.001). Microperforation of TDM occurred in three cases (7.0%) and ciliary body prolapse in one case (2.3%) but did not prevent completion of the operation. Postoperatively, hyphaema was detected in one case and shallow anterior chamber in another case and both were treated conservatively. Bleb encapsulation with elevation of IOP occurred in two cases (4.7%) and was treated with 5-fluorouracil subconjunctival injection. Goniopuncture with neodymium : YAG laser was performed in two cases (4.7%). There were no other late complications with the exception of failure of the operation. On the life-table analysis the success rate at 12, 24, and 30 months were 61.4, 36.6, and 18.9%, respectively.
Conclusion
Deep sclerectomy reduced the IOP temporarily while minimising the risk of postoperative complications commonly encountered with standard trabeculectomy. However, after long-term follow-up surgery failed to maintain a low IOP.
Keywords:
glaucoma, nonpenetrating trabeculectomy, deep sclerectomy
