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Deep sclerectomy versus punch trabeculectomy with or without phacoemulsification: a randomized clinical trial
Salvatore Cillino1, Francesco Di Pace, Alessandra Casuccio
1From the Department of Ophthalmology, University of Palermo, Italy. cillino@iol.it
Journal of Glaucoma
|November 10, 2004
Summary
Non-penetrating deep sclerectomy (NPDS) and punch trabeculectomy (PT) effectively lower intraocular pressure (IOP) in glaucoma patients. PT showed a better trend for lower target IOPs, suggesting suitability for higher IOP levels.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Surgical Techniques
Background:
- Primary open angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEXG) are common forms of glaucoma.
- Effective intraocular pressure (IOP) management is crucial to prevent glaucoma progression.
- Surgical interventions like non-penetrating deep sclerectomy (NPDS) and punch trabeculectomy (PT) are employed to reduce IOP.
Purpose of the Study:
- To compare the efficacy of NPDS without implants versus PT.
- To evaluate the impact of simultaneous phacoemulsification on both NPDS and PT outcomes.
- To assess IOP reduction and complication rates for both surgical techniques.
Main Methods:
- A prospective randomized clinical trial involving 65 patients (65 eyes) with POAG or PEXG.
- Patients were randomly assigned to NPDS (n=32) or PT (n=33), with some undergoing combined phacoemulsification.
- Outcomes measured included postoperative complications, medication use, and IOP levels at target goals of ≤21 mmHg and ≤17 mmHg.
Main Results:
- Both NPDS and PT significantly reduced preoperative IOP across all groups.
- No significant differences in success rates were found between NPDS and PT at the primary endpoint for target IOPs of ≤21 mmHg and ≤17 mmHg.
- Hypotony and shallow anterior chamber were more frequent in PT groups compared to NPDS groups.
Conclusions:
- Both NPDS and PT are effective IOP-lowering surgical techniques without the need for implants or antimetabolites.
- Combined phacoemulsification did not negatively impact the final IOP results for either procedure.
- PT demonstrated a better trend for achieving lower target IOPs, indicating its potential suitability for patients with higher IOP levels or longer life expectancies.