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. 2024 Feb;13(2):581-596.
doi: 10.1007/s40123-023-00869-9. Epub 2024 Jan 5.

Effect of Trabeculodescemetic Window Perforation in Deep Sclerectomy on Intraocular Pressure in Primary Congenital Glaucoma

Abdulaziz AlQattan #  1 , Konrad Schargel  2 , Ibrahim AlJadaan  2 , Nouf AlZendi  2 , Gorka Sesma #  3
Affiliations

Effect of Trabeculodescemetic Window Perforation in Deep Sclerectomy on Intraocular Pressure in Primary Congenital Glaucoma

Abdulaziz AlQattan et al. Ophthalmol Ther. 2024 Feb.

Abstract

Introduction: Primary congenital glaucoma causes vision loss if intraocular pressure is uncontrolled. Nonpenetrating deep sclerectomy is effective in treating primary congenital glaucoma. However, the effects of inadvertent trabeculodescemetic window perforation remain unclear.

Methods: This retrospective cohort study included patients with primary congenital glaucoma who underwent nonpenetrating deep sclerectomy between 2014 and 2021. The perforation group had intraoperative trabeculodescemetic window perforations; the non-perforation group did not. The primary outcome was intraocular pressure between the groups over 15 months. The secondary outcomes included surgical success and complications.

Results: The study included 74 eyes of 44 patients. The cohort comprised 31 perforated and 43 non-perforated eyes. Both groups showed significant intraocular pressure reduction without significant between-group differences in complete (68 vs. 77%), qualified (19 vs. 9%), or failed (13 vs. 14%) treatments. The median intraocular pressure decreased from 39 to 14 mmHg in the perforation group and 35 to 12 mmHg in the non-perforation group. Of the 74 treated eyes, 68 (92%) showed no complications.

Conclusions: An inadvertent trabeculodescemetic window perforation during nonpenetrating deep sclerectomy for primary congenital glaucoma did not significantly affect intraocular pressure outcomes compared to non-perforated cases over 15 months. Nonpenetrating deep sclerectomy reduced intraocular pressure regardless of intraoperative perforation in patients with primary congenital glaucoma. Perforation of the trabeculodescemetic window was associated with a low incidence of postoperative complications.

Keywords: Intraocular pressure; Nonpenetrating deep sclerectomy; Perforation; Primary congenital glaucoma; Trabeculodescemetic window.

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Conflict of interest statement

Abdulaziz AlQattan, Konrad Schargel, Ibrahim AlJadaan, Nouf AlZendi, and Gorka Sesma declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Iris prolapse through the perforated trabeculodescemetic window during deep sclerectomy. A deep sclerectomy photograph reveals an inadvertent perforation of the trabeculodescemetic window and consequent iris prolapse (indicated by the yellow arrow). An irregular iris contour bulging through the perforation indicates the loss of normal anatomy
Fig. 2
Fig. 2
Outcomes of deep sclerectomy with and without intraoperative perforation. This bar graph shows the percentage of eyes with complete success, qualified success, and failure after deep sclerectomy with and without intraoperative perforation
Fig. 3
Fig. 3
Effect of perforation on intraocular pressure reduction after deep sclerectomy. This violin plot shows the distribution of baseline and final intraocular pressure (IOP) in eyes undergoing deep sclerectomy with (n = 31) and without (n = 43) intraoperative perforations. The white dot represents the median, and the black bars indicate the interquartile range
Fig. 4
Fig. 4
Effect of perforation on time to reach target IOP after deep sclerectomy. The Kaplan–Meier survival curve in this study compared the time required to reach a target IOP of ≤ 21 mmHg between patients who underwent deep sclerectomy with intraoperative perforation (n = 31) and those who did not (n = 43). The number of patients at risk in each group at various time points is shown below the x-axis, and the probability of reaching the target IOP over time is plotted for each group
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