[Non-pentrating deep sclerectomy--between safety and efficacy]

Abstract

Purpose: To find the indications that would benefit the most from non penetrating deep sclerectomy (NPDS) major advantages.

Method: Retrospective study that included 40 eyes with open angle glaucoma (primary or pseudoexfoliative) which were subject to NPDS as ambulatory surgery without an implant, but with intraoperative application of mitomycin C. We have determined the LOP C/D ratio, visual acuity and the number of antiglaucoma drugs preoperatively and at 3 months postoperatively. We have analyzed the intraoperative and postoperative complications of NPDS and also the profile of the patients selected for this surgery.

Results: Global success (LOP < 21 mmHg + C/D ratio that remained unchanged postoperatively + visual acuity that remained unchanged postoperatively) was obtained in 90% of cases; the number of antiglaucoma drugs was significantly decreased (from 2.72 +/- 0.73 preoperatively to 0.26 +/- 0.21 postoperatively, p < 0.00002). Complete success (LOP < 21 mmHg without antiglaucoma medication) was achieved in 80% of cases. The rate of qualified success (LOP < 21 mmHg with antiglaucoma medication) was 95%; 50% of eyes have LOP < 15 mmHg at 3 months. Intraoperative complications were rare (4 cases) and minor. Postoperative complications were: ocular hypotony (1 case), bleb fibrosis (2 cases), bleb-related endophthalmitis (1 case). The best candidates for NPDS were patients over 70 years with important extraocular comorbidities, advanced open angle glaucoma with preserved visual acuity or monophthalmic patients.

Conclusions: NPDS with intraoperative application of Mitomycin C as ambulatory surgery provides significant LOP reduction while preserving visual acuity and has a low rate of complications in elderly patients with advanced open angle glaucoma or monophthalmic patients.