Non-penetrating deep sclerectomy: mid-term results

Purpose : Non-penetrating deep sclerectomy has been performed in France sin ce the early nineties and appears to be an interesting alternative to Cairn 's trabeculectomy. The technical characteristics, the ability to use antimi totic procedures and postoperative YAG laser goniotomy contribute to make d eep sclerectomy an attractive surgical method. We evaluated its efficacy an d adverse effects in a mid-term retrospective series. Patients and methods: Fifty patients (all POAG) without usually accepted fa ilure risks for trabeculectomy (trabeculoretraction less than 3 months, int raocular anterior or posterior lens, aphakia, black or Asian subject, failu re of previous surgical procedure, patients under 40) underwent this surgic al procedure between June 96 and October 97 performed by several skilled su rgeons 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 advers e effects were compared with previously published data using the Kaplan-Mei er lest. Results: Medium follow-up was 14.24 months. The success rate was 81% (IOP 2 1 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 previo us studies and to those obtained with trabeculectomy. The complication rate was low (hyphema 0 %, choroidal detachment 2 %, hypothalamia 2 %, endocula r infection 0 %). Discussion: Our success rate and complication rate were comparable with pre viously published series. Choosing a target IOP of 16 mmHg allowed a better comparison between daily clinical observations and mid-term results, showi ng a significant difference from the 21 mmHg target. Nevertheless, the succ ess rate was comparable to that obtained with trabeculectomy and the compli cation rate was lower, supporting the favorable opinion concerning deep scl erectomy. Conclusion: Non-penetrating deep sclerectomy appears to be as efficient as Cairn's trabeculectomy for surgical treatment of glaucoma and allows a lowe r complication rate. long-term results, visual field and papilla remain to be evaluated. Furthermore, results with a pressure goal of 16 mmHg are inte resting to evaluate because they reflect the real clinical situation better than the target 21 mmHg IOP. This technique should be evaluated in other f orms of glaucoma.