A prospective, controlled study to compare the Scheie procedure with Watson's trabeculectomy

Decisions regarding patient care are made difficult because of lack of adequate knowledge. Surgeons try to decide upon choice of procedure and surgical technique based on the results of their experience and their understanding of published reports. Yet there are virtually no prospective controlled studies comparing different procedures for open-angle glaucoma. The present study compares peripheral iridectomy with a thermal sclerostomy, as described by Scheie, with trabeculectomy, as described by Watson. In 15 patients with primary open-angle glaucoma a Scheie procedure was performed in one eye and a trabeculectomy in the other, the choice of procedure being determined randomly. Surgical technique was standardized. Shallow or flat anterior chambers were more common in patients treated with a Scheie procedure, but in the 15 cases studied no patients required alteration of their postoperative care because of any complication. When reevaluated five years later, central visual acuity was approximately the same in both groups, control of glaucomatous disease was considered to be slightly easier in patients receiving a Scheie procedure, and intraocular pressure was 16 mm Hg in patients treated with the Scheie procedure in contrast to 22 mm Hg in those in whom a trabeculectomy had been performed. The Scheie procedure resulted in a thin cystic conjunctival bleb. In only two cases was a detectable bleb present following trabeculectomy.