Deep sclerectomy in primary open-angle glaucoma and exfoliative glaucoma

: Suominen SMA, Harju MP, Vesti ET

Publisher: WICHTIG PUBLISHING

: 2016

European Journal of Ophthalmology

: EUROPEAN JOURNAL OF OPHTHALMOLOGY

: EUR J OPHTHALMOL

: 26

: 6

: 568

: 574

: 7

: 1120-6721

: 1724-6016

DOI: https://doi.org/10.5301/ejo.5000762

Purpose: To study the effect of deep sclerectomy (DS) in primary open-angle glaucoma (POAG) and exfoliative glaucoma (EXG).Methods: We retrospectively analyzed the intraocular pressure (IOP)-lowering effect of DS in 235 consecutive eyes. Eyes were divided into 2 groups according to glaucoma subtype: POAG (127 eyes) and EXG (108 eyes). Postoperative IOP was the main outcome measurement. We recorded complete and qualified surgical success, need for YAG-laser goniopuncture, and need for postoperative glaucoma medication. We studied factors related to outcome of surgery in a Cox regression model.Results: In the POAG group, the mean (SD) IOP decreased from 22.6 (5.1) mm Hg preoperatively to 16.8 (7.5) mm Hg, with qualified success achieved in 70% of eyes. Postoperatively, 57% were without medication. In the EXG group, IOP decreased from 25.5 (6.5) mm Hg preoperatively to 16.5 (7.8) mm Hg postoperatively, with qualified success achieved in 66% of eyes. Postoperatively, 50% were without medication. Decrease in IOP was statistically significant in both groups (p<0.001). In the POAG group, 12%, and in the EXG group, 24% needed a reoperation in the follow-up period (p = 0.037). In the Cox regression model, 1 week IOP between 2 and 14 mm Hg without medication lowered the hazard rate of losing complete success by 34% (p = 0.031) and the hazard rate of losing qualified success by 54% (p = 0.004).Conclusions: The IOP 1 week postoperatively seems to be a prominent indicator of surgical success. Deep sclerectomy is effective in reducing IOP in POAG and EXG subgroups, with reoperations more common in EXG eyes.

deep sclerectomy, EXFOLIATIVE GLAUCOMA, Learning curve, Primary open-angle glaucoma