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IGOR LELEU, Benjamin Penaud, Esther Blumen-Ohana, Thibault Rodallec, raphael ADAM, Oliver LAPLACE, Jad AKESBI, Jean-Philippe NORDMANN; Non-penetrating deep sclerectomy for the management of severe glaucoma. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6514. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Report our medium-term outcomes of non-penetrating deep sclerectomy (NPDS) for severe glaucoma treatment. To date, a limited number of studies have specifically explored non-penetrating filtration surgery in this population.
We analyzed retrospectively 76 eyes of 69 patients after a NPSD with mitomycine C between 2009 and 2015, with or without a phaco-émulsification. All patients had a severe glaucoma (mean deviation (MD) <-20 dB on the preoperative visual field according to Glaucoma Staging System based on Humphrey visual field) progressing despite a maximal medical treatment.
Of the 76 eyes, we included 65 open-angle glaucoma, 3 juvenile glaucoma, 1 normal pressure glaucoma and 7 secondary glaucoma. 21 eyes had a combined surgery and 10 was already pseudophakic.The average follow-up was 21 months (min:1; max :72) and 54 eyes was followed more than 1 year. 37 eyes were in the end-stage glaucoma (MD<-30dB ou unquantifiable). The mean age of the patients was 57 years (from 33 to 86). Before surgery, the average intraocular pressure (IOP) was 21;8 mmHg, the MD was -23.5dB, the VFI 23%. The IOP, 1 year (54 eyes), 2 years (42 eyes) and 3 years after surgery was de 13.9 (-8.1mmHg reduction, P<0.001) , 14.1 et 14.2mmHg ((p<0.001) respectively. During the folllow-up, 8 patients (10,5%) had to undergo new filtration surgery. A goniopuncture has been done on 35 eyes (45%) with an average delay of 7 months. After 1 year, the number of anti-glaucomatous molecules has been reduced from an average of 3.0 before surgery to 0.5 after surgery (86,5% of reduction, p<0.001). The postoperative visual field was comparable with the preoperative (postoperative MD was -25.48 dB (reduction of -0.13dB, p=0.9)). Regarding per-operative complications, we observed 3 perforations in need of perforating trabeculectomy and 9 microperforations. Immediate postoperative complications were the occurrence of 2 iris incarcerations, 2 hypotonia with choroïdal detachment, 1 hypertonia that required one goniopuncture and 4 conjunctival seidel.None of the eyes developed a loss of central vision.
Severe glaucoma impose a low target intraocular pressure that required frequently filtration surgery. In the medium term, the non-penetrating deep sclerectomy produce good results in terms of pressure control and stability of viual field, even in the most severe glaucoma, while offering a high level of safety especially in the oss of central vision.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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