Modified deep sclerectomy (D-lectomy MMC) for primary open-angle glaucoma: preliminary results

J Glaucoma. 2009 Feb;18(2):132-9. doi: 10.1097/IJG.0b013e3181752cc8.


Purpose: To evaluate the outcome of modified deep sclerectomy [D-lectomy mitomycin C (MMC)] for medically refractory glaucoma patients.

Methods: In a retrospective comparative study, the surgical outcome in 1 eye each of 31 patients who underwent D-lectomy MMC was compared with that of 91 eyes of 91 patients who underwent trabeculectomy with adjunctive MMC. These eyes had a diagnosis of primary open-angle glaucoma or pseudoexfoliation glaucoma, a record of high intraocular pressure (IOP) exceeding 25 mm Hg, and planned for surgical intervention. In the D-lectomy MMC cases, a slit incision at the trabecular meshwork and peripheral iridectomy were created. The "lake" and trabeculo-Descemet membrane ("window") were examined by ultrasound biomicroscope, gonioscopy, and time-domain optical coherence tomography.

Results: Postsurgical IOP at 1, 3, 6, and 12 months after the D-lectomy MMC and trabeculectomy MMC were comparable (P=0.63-0.97). The filtering bleb was noted in 14 (45%) of the 31 D-lectomy MMC eyes at 3 months, and their survival was significantly less than trabeculectomy MMC subjects in which 81 of 91 eyes had the bleb at 3 months (P<0.0001). The lake was noted in 29 of 31 D-lectomy MMC eyes. The sealing of the once penetrated trabecular meshwork was complete at 3 months in 23 of 29 eyes by ultrasound biomicroscopic and/or gonioscopic examinations, whereas that was incomplete in 6 eyes.

Conclusions: Addition of a slit incision to the trabecular meshwork and peripheral iridectomy (D-lectomy MMC) improved postsurgical IOP of the deep sclerectomy to the level comparable with trabeculectomy MMC, with a less frequency of the bleb formation.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Exfoliation Syndrome / pathology
  • Exfoliation Syndrome / physiopathology
  • Exfoliation Syndrome / surgery
  • Female
  • Follow-Up Studies
  • Glaucoma, Open-Angle / pathology
  • Glaucoma, Open-Angle / physiopathology
  • Glaucoma, Open-Angle / surgery*
  • Gonioscopy
  • Humans
  • Intraocular Pressure / physiology
  • Male
  • Microscopy, Acoustic
  • Middle Aged
  • Mitomycin / administration & dosage
  • Retrospective Studies
  • Sclera / surgery*
  • Sclerostomy / methods*
  • Tomography, Optical Coherence
  • Trabeculectomy / methods
  • Treatment Outcome


  • Mitomycin