Results of a modified non-penetrating deep sclerectomy in the treatment of open angle glaucoma with or without cataract

George Kitsos¹, Miltiades Aspiotis¹, Yannis Alamanos², Konstantinos Psilas¹

¹Department of Ophthalmology, Medical School, University of Ioannina, Ioannina, Greece; ²Department of Hygiene and Epidemiology, Medical School, University of Patras, Patras, Greece

Purpose: To present the technique of a modified deep sclerectomy, which we will call “reversed” deep sclerectomy (RDS) and the results and our observations of its use in patients with open angle glaucoma (OAG) and with or without cataract extraction (phacoemulsification).

Materials and methods: This prospective study included 132 eyes which underwent RDS: 37 eyes (group A) with uncontrolled OAG and 95 eyes (group B) with OAG and visually significant cataract. Mean pressure preoperatively for group A was 24.48 ± 4.92 mmHg and for group B was 22.99 ± 3.00. The mean number of antiglaucoma drugs received was 2.97 ± 0.69 and 2.56 ± 0.73 for groups A and B respectively. The RDS was performed where the deep scleral stroma is prepared in 2 parts, folded and inserted under the lateral sides of the sclerectomy, and the Schlemm’s canal is opened prior to deep scleral stroma preparation. Cataract was extracted by phacoemulsification through the same scleral opening. The follow-up for group A was 22.23 ± 10.18 months and for group B, 25.36 ± 10.12 months.

Results: Postoperative intraocular pressure (IOP) ≤ 21 mmHg was achieved for group A in 40.5% without antiglaucoma drugs and 94.6% with antiglaucoma drugs, and for group B in 66.3% and in 94.7% respectively. Mean IOP reduction was 7.02 ± 6.35 mmHg (28.67%, P < 0.05) for group A and 5.26 ± 3.72 mmHg (25.06%, P ≤ 0.05) for group B, while mean drug reduction was 1.97 ± 1.09 (P < 0.01) and 2.14 ± 0.95 (P ≤ 0.01) respectively. 5-Fluorouracil was used in 8 eyes of group A and in 5 eyes of group B.

Conclusion: In the follow-up time during which the two groups were under study, the RDS was effective with a few complications, similar to the classic deep sclerectomy using implants or not, with the advantage, in our opinion, of a short learning curve.

Keywords: modified deep sclerectomy, cataract