Outcomes of non-penetrating deep sclerectomy combined with mitomycin C in advanced open-angle glaucoma in Indian eyes

Abstract

Purpose: To assess the safety and efficacy of non-penetrating deep sclerectomy (NPDS) in advanced open-angle glaucoma patients.

Design: Retrospective observational study.

Methods: Forty-two eyes of 38 patients with advanced glaucoma who underwent NPDS surgery combined with mitomycin-C with or without phacoemulsification were evaluated for up to 12 months at a tertiary eye care center in South India. Patients with intraoperative perforation of the trabeculo-Descemet membrane who did not meet the follow-up criteria were excluded. The primary outcome measured was intraocular pressure (IOP) reduction postoperatively on day 1, week 2, and months 1, 3, 6, and 12. The secondary outcomes measured were the need for antiglaucoma medications (AGMs), postoperative complications, and interventions.

Results: Patients enrolled had a mean age of 61.08 ± 10.2 years. There was a statistically significant reduction ( P < 0.001) of IOP from 29.48 ± 10.89 mmHg (baseline) to 11.58 ± 6.29, 11.90 ± 5.99, 13.60 ± 7.06, 14.03 ± 8.00, 13.94 ± 4.65, and 13.19 ± 3.29 mmHg at day 1, week 2, and months 1, 3, 6, and 12, respectively. The number of AGMs reduced from 3.14 ± 1.03 preoperatively to 1.85 ± 0.83 at 12 months postoperatively ( P < 0.001). Nd: YAG laser goniopuncture was done in 21.4%, bleb needling in 11.9%, and one patient underwent 260° trabeculotomy after NPDS. There were no cases of choroidal detachment or wipeout.

Conclusion: NPDS with or without phacoemulsification has good safety for managing advanced open-angle glaucoma.

Figure 1

Surgical steps of non-penetrating deep sclerectomy (a) creation of superficial scleral flap (b) deep scleral flap (c) unroofing of Schlemm’s canal (d) peeling the floor of Schlemm’s canal (e) percolation of aqueous (f) superficial flap sutured with 10-0 nylon

Figure 2

Kaplan-Meier survival graph showing the cumulative probability of complete and qualified success between the groups (same for criteria 1 and criteria 2)