Purpose: To study the short term efficiency and safety of a new filtering procedure, the non-penetrating deep sclerectomy, in the treatment of open-angle glaucoma.
Methods: We conducted a retrospective study (January 1998-September 1998). Our material included a consecutive non-randomized series of 29 patients, 34 eyes in total. The mean age was 68 years. The mean follow-up period was 5.3 months (3-8). Preoperatively all eyes suffered from medically uncontrolled glaucoma. Under a fornix-based conjunctival flap, through deep sclerectomy, the external wall of Schlemms canal is removed. Ultimately, only the trabeculodescemetic membrane remains intact. At this moment one obtains a visible filtration of aqueous humour through this thin trabeculo-descemetic membrane which is responsible for the IOP-lowering mechanism of the deep sclerectomy. Peroperative and postoperative complications were noticed. Visual acuity, slitlamp examination and intraocular pressures were noticed preoperatively and at day 1, 2, 7 and each month after surgery.
Results: During the learning period, (micro)perforation of the anterior chamber occurred in 9 eyes (perfDS-group). In the remaining 25 eyes (nonperfDS-group) we noticed 2 IOP failures (IOP > 20 mmHg). In this nonperfDS-group the mean IOP decreased from 5.64-7.28 mmHg preoperatively to 15.31-4.28 mmHg at the end of the follow-up. Postoperative complications were rare and transient.
Conclusions: Non-penetrating deep sclerectomy seems to be an efficient procedure in the treatment of open-angle glaucoma. It is a difficult technique to learn and during the learning period perforation of the anterior chamber is the main complication. It allows a progressive decrease in IOP and thus a very low rate of associated complications.