Outcome and Complications of Combined Modified Deep Sclerectomy and Trabeculectomy for Surgical Management of Glaucoma: A Pilot Study
Authors Sangtam T, Roy S, Mermoud A
Received 6 January 2020
Accepted for publication 11 February 2020
Published 12 March 2020 Volume 2020:14 Pages 795—803
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Scott Fraser
Tiakumzuk Sangtam,1,2 Sylvain Roy,1,3 André Mermoud1
1Glaucoma Center Montchoisi Clinic, Lausanne, Switzerland; 2Department of Ophthalmology & Visual Sciences, Khoo Teck Puat Hospital, Singapore; 3Laboratory of Hemodynamics and Cardiovascular Technology, Swiss Federal Institute of Technology, Lausanne, Switzerland
Correspondence: Tiakumzuk Sangtam Email firstname.lastname@example.org
Purpose: To report the outcome and complications of a combined surgical technique of modified deep sclerectomy and trabeculectomy (mDST) for glaucoma.
Patients and Methods: Retrospective study of 44 eyes of 43 patients with open and closed angle glaucoma who underwent mDST. Outcome measures were: Surgical Success with 3 criteria - (i) criterion 1 = intraocular pressure (IOP) ≤ 21 mmHg or reduced by ≥ 20% of pre-operative IOP or IOP ≥ 6 mmHg on 2 consecutive time points after 3 months; (ii) criterion 2 = IOP ≤ 18 mmHg or reduced by ≥ 30% of pre-operative IOP or IOP ≥ 6 mmHg on 2 consecutive time points after 3 months and (iii) criterion 3 = IOP ≤ 15 mmHg or reduced by ≥ 40% of pre-operative IOP or IOP ≥ 6 mmHg on 2 consecutive time points after 3 months; IOP Reduction; Use of Anti-glaucoma Medication; Complications; Visual Acuity and Postoperative Interventions.
Results: Median follow-up was 40 months (range 24– 77 months). At the final follow-up visit, the mean postoperative IOP was 11.5 ± 4.7 mmHg (p< 0.0001). Mean number of anti-glaucoma medications decreased from 2.45 ± 1.21 to 0.54 ± 0.95 (p< 0.0001). Surgical success in terms of IOP reduction was 50%; 43.2%; 36.4% for the 3 criteria respectively (complete success) and 70.5%; 56.8%; 47.7% for the 3 criteria respectively (qualified success). The complications noted were shallow/flat anterior chamber in 2 (4.54%), hyphema & bleb leak in 3 (6.81%), aqueous misdirection in 1 (2.27%), hypotonic maculopathy in 2 (4.45%) and hypotony requiring intervention in 6 (13.63%) eyes.
Conclusion: Combined mDST was found to be an effective surgical procedure in reducing IOP. It was associated with complications commonly encountered in glaucoma filtering surgery. The use of intra-scleral space maintainer may help lower the risk of flat or shallow anterior chamber during the early postoperative period.
Keywords: outcome and complications, combined modified deep sclerectomy and trabeculectomy
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable]