Evaluation of the Early to Mid-term Efficacy and Safety of Deep Sclerectomy without an Intrascleral Spacer for Open-angle Glaucoma in an Australian Population
Citation Information :
Hui MM, Clement CI. Evaluation of the Early to Mid-term Efficacy and Safety of Deep Sclerectomy without an Intrascleral Spacer for Open-angle Glaucoma in an Australian Population. J Curr Glaucoma Pract 2018; 12 (3):107-112.
Purpose: This study aims to evaluate the early to the midterm efficacy of deep sclerectomy (DS) without an intra-scleral spacer for open-angle glaucoma (OAG) patients.
Materials and methods: Retrospective study of 99 eyes (88 patients) with open-angle glaucoma who underwent DS were recruited in a consecutive order following informed consent. Intraocular pressure (IOP) was collected up to 60 months post operation (mean 19.87 ± 15.13 months). Criteria of success were defined as the qualified success (QS) or complete success (CS) with IOP level less than 21, 18 and 15 mm Hg and a reduction of more than 20% IOP from baseline. QS includes additional medication post-DS, while CS requires no other medications or surgery post-DS. Further analysis includes comparing the criteria of success based on several factors. The data were analyzed using statistical package for social sciences (SPSS version 21) statistical software.
Results: The QS at 60 months for IOP less than 21, 18 and 15 mm Hg is 71.3% (45.12 ± 2.46), 63.9% (40.41 ± 2.75) and 48.7% (35.62 ± 2.85), respectively. The CS at 60 months for IOP less than 21, 18 and 15 mm Hg are 69.3% (47.51 ± 2.77), 57.9% (40.41 ± 2.75) and 45.2% (35.62 ± 2.85), respectively. There was no significant difference between QS and DS post-DS based on the level of experience of the surgeons; intraoperation complication; age and gender. There was a significant reduction in IOP post operation (p < 0.001).
Conclusion: DS is observed to be an effective surgical method with a favorable safety profile to manage patients with open-angle glaucoma. It has a better safety profile compared to trabeculectomy (TE) and can be performed by surgeons of different experience safely and successfully.
Clinical significance: To our knowledge, this is the first report of DS in an Australian population with up to 60 months of follow-up.
It is an effective procedure for IOP control in patients with OAG and has fewer complications compared to TE. DS is less popular than TE primarily due to a perceived steep learning curve, but most of the literature on DS describe single surgeon results. Our study compared the outcome of five surgeons with a variety of experience and found no significant differences in the rate of success for all levels of IOP.
Bourne R. Worldwide glaucoma through the looking glass. British Journal of Ophthalmology. 2006;90 (3):253-254.
Cairns JE. Trabeculectomy. Preliminary report of a new method. Am J Ophthalmol. 1968;66(4):673-679.
Dhingra S, Khaw PT. The moorfields safer surgery system. Middle East Afr J Ophthalmol. 2009;16(3):112-115.
Ambresin A, Shaarawy T, Mermoud A. Deep Sclerectomy With Collagen Implant in One Eye Compared With Trabeculectomy in the Other Eye of the Same Patient. Journal of glaucoma. 2002;11(3):214-220.
Edmunds B, Thompson JR, Salmon JF, et al. The national survey of trabeculectomy. III. Early and late complications. Eye (Lond). 2002;16(3):297.
Eldaly MA, Bunce C, Elsheikha OZ, et al. Non-penetrating filtration surgery versus trabeculectomy for open-angle glaucoma. Cochrane Database Syst Rev. 2014(2): CD007059.
Rulli E, Biagioli E, Riva I, et al. Efficacy and safety of trabeculectomy vs nonpenetrating surgical procedures: a systematic review and meta-analysis. JAMA Ophthalmol. 2013;131(12):1573-1582.
Fedorov S, Loffe DI., Ronkina TI. Glaucoma surgery - deep sclerectomy. Vestnik oftalmologii. 1982;4:6.
Aslan F, Yuce B., Oztas Z, et al. Evaluation of the learning curve of non-penetrating glaucoma surgery. Int Ophthalmol. 2018;38:2005-2012.
Cillino S, Di Pace F, Casuccio A, et al. Deep sclerectomy versus punch trabeculectomy: effect of low-dosage mitomycin C. Ophthalmologica. 2005;219(5):281-286.
Shaarawy T, Mermoud A. Deep sclerectomy in one eye vs deep sclerectomy with collagen implant in the contralateral eye of the same patient: long-term follow-up. Eye (Lond). 2005;19(3):298-302.
Mermoud A, Schnyder CC, Sickenberg M, et al. Comparison of deep sclerectomy with collagen implant and trabeculectomy in open-angle glaucoma. J Cataract Refract Surg. 1999;25(3):323-331.
Karlen ME, Sanchez E, Schnyder CC, et al. Deep sclerectomy with collagen implant: medium term results. Br J Ophthalmol. 1999;83(1):6-11.
Shaarawy T, Nguyen C, Schnyder C, et al. Comparative study between deep sclerectomy with and without collagen implant: long term follow up. Br J Ophthalmol. 2004;88(1):95-98.
Suominen S, Harju M, Kurvinen L, et al. Deep sclerectomy in normal-tension glaucoma with and without mitomycin-c. Acta Ophthalmol. 2014;92(7):701-706.
Shaarawy T, Mansouri K, Schnyder C, et al. Long-term results of deep sclerectomy with collagen implant. J Cataract Refract Surg. 2004;30(6):1225-1231.
Dahan E, Drusedau, MU. Nonpenetrating filtration surgery for glaucoma: control by surgery only. J Cataract Refract Surg. 2000;26:695-701.
El Sayyad F, Helal M, El-Kholify H, et al. Nonpenetrating deep sclerectomy versus trabeculectomy in bilateral primary open-angle glaucoma. Ophthalmology. 2000;107(9):1671-1674.
Chiselita D. Non-penetrating deep sclerectomy versus trabeculectomy in primary open-angle glaucoma surgery. Eye (Lond). 2001;15(Pt 2):197-201.
Cillino S, Di Pace F, Casuccio A, et al. Deep sclerectomy versus trabeculectomy with low-dosage mitomycin C: four-year follow-up. Ophthalmologica. 2008;222(2):81-87.
