Control of intraocular pressure after deep sclerectomy

Area of Science:

• Ophthalmology
• Surgical Innovation
• Glaucoma Management

Background:

• Open-angle glaucoma requires effective long-term intraocular pressure (IOP) management.
• Standard trabeculectomy can be associated with significant postoperative complications.
• Deep sclerectomy presents an alternative surgical approach for glaucoma control.

Purpose of the Study:

• To evaluate the long-term efficacy and safety of deep sclerectomy in patients with medically uncontrolled open-angle glaucoma.
• To compare the complication profile of deep sclerectomy with standard trabeculectomy.
• To assess the durability of IOP reduction following deep sclerectomy.

Main Methods:

• A prospective consecutive series of 43 eyes (38 patients) with open-angle glaucoma underwent deep sclerectomy.
• Clinical assessments, including IOP measurements, were performed preoperatively and up to 36 months postoperatively.
• Surgical success was defined as IOP < 22 mmHg with >20% reduction from baseline, without medication. Kaplan-Meier survival analysis was used.

Main Results:

• Mean IOP significantly decreased from 24.6 mmHg preoperatively to 18.5 mmHg at 36 months (P < 0.001).
• The success rate at 12, 24, and 30 months was 61.4%, 36.6%, and 18.9%, respectively.
• Minor complications included microperforation of the trabecular meshwork (7.0%) and ciliary body prolapse (2.3%); late complications were rare, but surgical failure occurred over time.

Conclusions:

• Deep sclerectomy effectively reduces IOP in the short term with a lower risk of immediate complications compared to trabeculectomy.
• However, the IOP-lowering effect of deep sclerectomy is not sustained long-term.
• Further research may be needed to optimize deep sclerectomy techniques or patient selection for durable glaucoma control.