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S. V. Shukhaev, O. Efimov; Long-Term Outcomes of Non-Penetrating Deep Sclerectomy. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4173. doi: https://doi.org/.
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To compare long-term outcomes of non-penetrating deep sclerectomy (NPDS) accompanied with early postoperative bleb leakage to NPDS without postoperative leakage.
Study included 50 patients after NPDS (mean follow-up 3.5 years): 15 with leaking bleb in early postoperative period (group I), 35 with uncomplicated NPDS (group II). Patients were followed with visual acuity, pneumotonometry, visual fields. Intrascleral space was evaluated with anterior segment optical coherent tomography (OCT).
Visual acuity decreased by 35% and 30% in groups I and II, respectively. Mean level of intraocular pressure (IOP) in group I was significantly lower then in group II: 17.6±1.45mmHg and 23.0±1.7mmHg, respectively (p<0.05). IOP was stabilized without additional treatment in 66.7% (n=10) in group I and in 22.9% (n=8) in group II; on hypotensive drugs in 13.3% (n=2, group I) and 28.6% (n=10, group II); after laser goniopuncture in 13.3% (n=2, group I) and 37.1% (n=13, group II). Additional NPDS was performed in 6.7% (n=1) in group I and 11.4% (n=4) in group II. Volume of the intrascleral space was not measured on OCT quantitatively due to irregular multichambered configuration of the space. Subjectively, intrascleral space in group I appeared markedly larger then in group II.
Presence of post-NPDS leakage from subconjunctival space improved long-term postoperative outcomes in glaucoma patients after the surgery. As is well known, aqueous humor (AH) influence over metabolism of extracellular matrix (ECM) at both trabecular meshwork and ciliary muscle (uveoscleral) outflow routes. Collagenolytic activity of AH in patient with glaucoma is known to be lower then in healthy individuals. Perhaps, presence of leakage in non-penetrating type surgery could be explained by ability of AH to increase ECM turnover in newly formed scleral-conjunctival outflow route.
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