Deep sclerectomy: Pro

Abstract

AbstractPurpose From the weight of the litterature, deep sclerectomy (DS) certainly is safer than trabeculectomy and as safe as modern trabeculectomy and thus might represent an alternative therapy earlier in the glaucoma process.Methods The controversy between the IOP‐lowering effect of trabeculectomy versus of DS will remain as long as variable definitions of success, different follow‐up times, and variable study designs render comparisons between studies very difficult.Results Although the DS is not the first choice therapy in the angle closure glaucoma, it has a significant advantage (1) in young patients where lower cataract formation occurs following DS, (2) in monocular patients, (3) in patients with high myopia, and (4) in patients with tubular visual fields. The facts that the anterior chamber is not perforating in the original DS and that postoperative intraocular inflammation is minimal make it a good alternative therapeutic choice for (5) uveitic glaucoma cases or (6) glaucoma secondary to iris melanoma. Considering goniopuncture as a failure criterion or as a two‐stage penetrating surgery as needed in at least 50% of the cases, could be weighted to considering suture lysis and capsulotomy as failure criteria of glaucoma and cataract surgeries. Performing goniopuncture with caution might avoid the most adverse events like iris incarcerationConclusion Deep sclerectomy or non penetrating glaucoma surgery continue to evolve in developing new ideas like canaloplasty that would offer better safety and efficacy than the gold standard, namely, trabeculectomy.