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Patrick Loriaut, Jean-Philippe Nordmann, Laurent Laroche, Vincent M Borderie; Deep Sclerectomy versus Trabeculectomy in eyes with Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3166.
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To compare deep sclerectomy with trabeculectomy in eyes with keratoplasty.
Forty five consecutive deep sclerectomies in eyes with keratoplasty (deep sclerectomy group) and forty five matched trabeculectomies (trabeculectomy group) were included in this retrospective comparative case series. Deep sclerectomy was performed as a first-line treatment in the absence of major peripheral anterior synechiae. Control cases were matched for the timing of glaucoma surgery, the number of previous glaucoma surgical procedures, corneal disease, and lens status. Success of glaucoma surgery and keratoplasty was assessed with the Kaplan-Meier method. Intraocular pressure, graft transparency, and post-operative complications were recorded. The criteria for glaucoma surgery failure were a post-operative intraocular pressure higher than 21 mmHg or a post-operative decrease in intraocular pressure lower than 30% compared with preoperative measurements. The main outcome measures were the success rate of glaucoma surgery and the graft survival.
The average follow-up time of glaucoma surgery (from surgery to failure for unsuccessful procedures or from surgery to the last visit for successful procedures) was 28+33 months (mean ± standard deviation). No significant differences were observed between both groups for all baseline variables and post-operative follow-up time. The success rate of glaucoma surgery was, respectively, 86% and 61% at 1 and 5 years in the deep sclerectomy group and 90% and 72% in the trabeculectomy group (P = 0.66). Graft survival was, respectively, 100% and 63% at 1 and 5 years in the deep sclerectomy group and 94% and 42% in the trabeculectomy group (P = 0.03). Non-immune post-operative events and graft failures related to non-immune causes were significantly more frequent in the trabeculectomy group compared with the deep sclerectomy group (P < 0.03). Conversely there were no significant differences between both groups in the percentages of rejection episodes and graft failures related to rejection (P > 0.8).
Graft survival was higher in eyes with deep sclerectomy compared with trabeculectomy. Both techniques showed the same success rate for glaucoma control. Deep sclerectomy seems slightly less efficient but safer than trabeculectomy and should be performed as a first-choice treatment in the absence of major peripheral anterior synechiae.
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