Non-penetrating deep sclerectomy with the sub flap (Ahmed's) suture: a 12-month comparative study

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Surgical Innovations

Background:

• Open-angle glaucoma requires effective intraocular pressure (IOP) management to prevent optic nerve damage.
• Non-penetrating deep sclerectomy (NPDS) is a surgical option for IOP reduction.
• Enhancements to existing surgical techniques are continuously explored to improve patient outcomes.

Purpose of the Study:

• To evaluate the efficacy of incorporating an Ahmed's suture into NPDS for lowering IOP.
• To compare the IOP-lowering effect and surgical success rate of modified NPDS with Ahmed's suture versus conventional NPDS.
• To assess outcomes over a 12-month follow-up period in patients with open-angle glaucoma.

Main Methods:

• A randomized controlled study was conducted with 103 patients.
• Group A (52 eyes) underwent modified NPDS with a sub-flap Ahmed's suture.
• Group B (51 eyes) underwent conventional NPDS. Surgical success was defined by IOP levels (6-18 mmHg) with or without medication.

Main Results:

• The modified NPDS group (Group A) demonstrated significantly lower post-operative IOP at all follow-up points (1 week to 12 months) compared to the conventional NPDS group (Group B) (p < 0.05).
• After 1 year, Group A achieved a 49% IOP reduction versus 36.5% in Group B.
• Complete surgical success was achieved in 81% of Group A eyes versus 69% of Group B eyes at 12 months.

Conclusions:

• The Ahmed's suture modification to NPDS is a simple, cost-effective technique that significantly enhances IOP reduction.
• Modified NPDS with Ahmed's suture leads to superior IOP control and a higher success rate compared to conventional NPDS.
• Lower initial post-operative IOP is associated with better long-term surgical outcomes.