Purpose: Non-penetrating deep sclerectomy has been performed in France since the early nineties and appears to be an interesting alternative to Cairn's trabeculectomy. The technical characteristics, the ability to use antimitotic procedures and postoperative YAG laser goniotomy contribute to make deep sclerectomy an attractive surgical method. We evaluated its efficacy and adverse effects in a mid-term retrospective series.
Patients and methods: Fifty patients (all POAG) without usually accepted failure risks for trabeculectomy (trabeculoretraction less than 3 months, intraocular anterior or posterior lens, aphakia, black or Asian subject, failure of previous surgical procedure, patients under 40) underwent this surgical procedure between June 96 and October 97 performed by several skilled surgeons in our unit. This was the first antiglaucoma surgical procedure for all patients. Collagen draining implant was not used. Two pressure criteria (21 mmHg and 16 mmHg) were used to assess success. Success rate and adverse effects were compared with previously published data using the Kaplan-Meier test.
Results: Medium follow-up was 14.24 months. The success rate was 81% (IOP 21 mmHg) and 50% (IOP 16 mmHg) at maximum follow-up of 18 months. There was no statistical difference between treated and untreated groups for target IOP at 21 mmHg (p = 0.12). These results were comparable to those in previous studies and to those obtained with trabeculectomy. The complication rate was low (hyphema 0%, choroidal detachment 2%, hypothalamia 2%, endocular infection 0%).
Discussion: Our success rate and complication rate were comparable with previously published series. Choosing a target IOP of 16 mmHg allowed a better comparison between daily clinical observations and mid-term results, showing a significant difference from the 21 mmHg target. Nevertheless, the success rate was comparable to that obtained with trabeculectomy and the complication rate was lower, supporting the favorable opinion concerning deep sclerectomy.
Conclusion: Non-penetrating deep sclerectomy appears to be as efficient as Cairn's trabeculectomy for surgical treatment of glaucoma and allows a lower complication rate. Long-term results, visual field and papilla remain to be evaluated. Furthermore, results with a pressure goal of 16 mmHg are interesting to evaluate because they reflect the real clinical situation better than the target 21 mmHg IOP. This technique should be evaluated in other forms of glaucoma.