Deep sclerectomy (DS) is an effective, long-lasting surgical procedure for open-angle glaucoma (OAG), a recent study reports.

This retrospective cohort study followed 513 eyes of 409 patients with OAG who underwent deep sclerectomy. A team defined intraocular pressure (IOP) success cutoffs as ≤18mm Hg and 20% reduction, ≤15mm Hg and 25% reduction and ≤12mm Hg and 30% reduction.

The researchers observed a mean IOP decrease from 23.5mm Hg to 13.3mm Hg, 12.8mm Hg and 12.4mm Hg at three, five and seven years, respectively. At the three-year follow-up, success rates were 66.3%, 44.5% and 18.1% for each of the IOP cutoffs, respectively. They were 57.9%, 34.6% and 11.9%, respectively, at the five-year follow-up and 54.0%, 29.8% and 10.0%, respectively, at the seven-year follow-up. At each of the cutoffs, the team determined that laser goniopuncture, needling and postoperative anti-glaucoma medications were associated with increased failure. They added that intraoperative mitomycin C (MMC) was associated with reduced failure for IOP ≤15mm Hg and ≤12mm Hg, while higher preoperative IOP was associated with increased failure for those with an IOP ≤12mm Hg.

The investigators found serious complications in 49 eyes, with an estimated incidence of 3.5%, 6.0%, 8.3% and 9.3% at one, three, five and seven years, respectively. Pseudoexfoliation or pigmentary glaucoma, poorer preoperative vision, intraoperative macroperforation, avascular blebs, subsequent phacoemulsification and intraoperative bevacizumab, but not MMC, were associated with a higher risk of serious postoperative complications. For phakic patients, the estimated incidence of subsequent phacoemulsification was 16.4%, 23.6% and 33.0% at three, five and seven years, respectively.

Rabiolo A, Leadbetter D, Alaghband P, et al. Primary deep sclerectomy in open-angle glaucoma: long-term outcomes and risk factors for failure. Ophthalmology. August 31, 2020. [Epub ahead of print].