Deep sclerectomy and trabeculectomy in uveitic glaucoma

Abstract

To compare the results of deep sclerectomy (DS) and trabeculectomy (TRAB) in the management of uveitic glaucoma. A retrospective chart review was carried out of 41 eyes (38 patients) operated on for uncontrolled uveitic glaucoma, 20 by DS with an implant and 21 by TRAB, with antiproliferative agents in both cases. Main outcome criteria were intraocular pressure (IOP), flare values, complications, and need for postoperative adjustments or re-operation. Mean follow-up lasted 21.1+/-11.3 months in the TRAB group and 18.9+/-10.7 months in the DS group (P=0.184). Mean IOP did not differ significantly in the two groups on the day before surgery, at postoperative days 1 and 7, or at months 1, 6, and 12. At postoperative month 12, IOP values in the TRAB and DS groups were 12.4+/-4.3 and 11.7+/-3.3 mm Hg (P=0.688), respectively. The cumulative probability of success at 12 months was 89% for TRAB and 88% for DS (P=0.306). After DS, more postoperative adjustments were necessary to lower IOP than after TRAB (85 vs 9.5%, P<0.001), but 7 days after surgery, intraocular inflammation was higher after TRAB (245.8 vs 38.5 ph/ms, P<0.001). DS and TRAB afforded equivalent IOP control in uveitic glaucoma. TRAB involved deeper invasion of the eye and resulted in more inflammation during the week after surgery, but successful DS required closer postoperative monitoring and more postoperative adjustments.