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.
Highlights
Since the first description of trabeculectomy in 1968 by Cairns,[1] this technique has become the gold standard for the surgical management of glaucoma
The modified deep sclerectomy (MDS) and trabeculectomy groups were similar in terms of age, sex, central corneal thickness (CCT), and number of glaucoma medications
The phaco‐MDS group used more medications (P = 0.031) and had a lower best corrected visual acuity (BCVA) (P = 0.012) than the phacotrabeculectomy group, but age, sex, intraocular pressure (IOP), and CCT were similar between groups [Table 1]
Summary
Since the first description of trabeculectomy in 1968 by Cairns,[1] this technique has become the gold standard for the surgical management of glaucoma. How to cite this article: Sharifipour F, Yazdani S, Asadi M, Saki A, Nouri-Mahdavi K. Modified deep sclerectomy for the surgical treatment of glaucoma. Modified Deep Sclerectomy for Glaucoma; Sharifipour et al success rates of other procedures are compared to that of trabeculectomy. Despite its efficacy in reducing intraocular pressure (IOP), trabeculectomy is far from ideal because of high complication rates and a low safety profile.[2] Glaucoma drainage devices (GDDs) have been shown to be effective and have low complication rates.[3] they have not replaced trabeculectomy[4] and are generally used in eyes with conjunctival scars or a history of failed trabeculectomy.[5]
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