Modified Deep Sclerectomy for the Surgical Treatment of Glaucoma

Farideh Sharifipour; Shahin Yazdani; Mona Asadi; Azadeh Saki; Kouros Nouri-Mahdavi

doi:10.4103/jovr.jovr_228_17

Modified Deep Sclerectomy for the Surgical Treatment of Glaucoma

J Ophthalmic Vis Res. 2019 Apr-Jun;14(2):144-150. doi: 10.4103/jovr.jovr_228_17.

Authors

Farideh Sharifipour^{1

2}, Shahin Yazdani², Mona Asadi¹, Azadeh Saki³, Kouros Nouri-Mahdavi⁴

Affiliations

¹ Department of Ophthalmology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
² Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
³ Department of Biostatistics and Epidemiology, Mashhad University of Medical Sciences, Mashhad, Iran.
⁴ Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, California, United States.

Abstract

Purpose: To report the short-term outcomes of modified deep sclerectomy (MDS) in the management of open angle glaucoma.

Methods: This prospective, non-randomized, controlled study included 105 eyes (105 patients) with open angle glaucoma. Eyes were categorized as follows: trabeculectomy (30 eyes), MDS (27 eyes), phacotrabeculectomy (28 eyes), and phaco-MDS (20 eyes). The MDS technique involved removal of a third scleral flap to expose the suprachoroidal space and excision of a trabecular block. A two-site approach was used for combined surgeries. Main outcome measures included intraocular pressure (IOP), number of glaucoma medications, and complications. Treatment success was defined as an IOP of 6-15 mmHg and/or a 30% reduction in IOP.

Results: All groups showed significant decrease in IOP and number of medications (both P s < 0.001). The MDS group had a higher IOP (13.9 ± 3.8 vs. 12.4 ± 2.5 mmHg, P = 0.080) and required more medications (P = 0.001) than the trabeculectomy group at 1 year. The MDS group had a higher baseline IOP than the trabeculectomy group (P = 0.004) and both the groups showed similar IOP reductions (33.3% vs. 25.7%, P = 0.391). The phaco-MDS and phacotrabeculectomy groups had comparable IOP (13.3 ± 3.1 vs. 12.4 ± 3.1 mmHg, P = 0.354), number of medications (P = 0.594), and IOP reduction (P = 0.509) at 1-year follow-up visit. The trabeculectomy and phacotrabeculectomy groups developed more wound leaks (P = 0.043) and required more bleb needling during the early postoperative period (P < 0.001).

Conclusion: The MDS technique seems to be slightly inferior to trabeculectomy, but when combined with phacoemulsification, is safer and results in similar IOP outcomes.

Keywords: Glaucoma; Glaucoma Surgery; Modified Deep Sclerectomy; Trabeculectomy.