<p>Non-Penetrating Deep Sclerectomy versus Trabeculectomy in Primary Congenital Glaucoma</p>

Abstract

Purpose: To evaluate the safety and efficacy of non-penetrating deep sclerectomy with a collagen implant versus trabeculectomy in primary congenital glaucoma. Subjects and Methods: This was a retrospective interventional comparative nonrandomized clinical study that included 80 eyes of 80 children presenting with primary congenital glaucoma under the age of 3 years. Forty eyes have undergone non-penetrating deep sclerectomy (NPDS) and the other 40 eyes have undergone penetrating trabeculectomy. The main outcome measure was the reduction in intraocular pressure (IOP). Secondary outcomes included percentage of patients with complete and qualified success, need for topical antiglaucoma medications, rate of complications, and need for further interventions. Complete success of the surgical outcome was considered an IOP ≤16 mmHg with no antiglaucoma medications. Qualified success was considered an IOP ≤16 mmHg using antiglaucoma medications. Results: The mean preoperative IOP was 27.4 ± 6.9 and 28.5 ± 6.6 mmHg in NPDS and trabeculectomy groups, respectively (p = 0.175). At the end of the follow-up period, the mean IOP was 11.2 ± 4.5 and 11.1 ± 3.4 mmHg with a mean reduction of 16.2 and 17.4 mmHg in NPDS and trabeculectomy groups, respectively. At the end of the follow-up period, ie at 36 months postoperative, the complete success rate was 60% (24 eyes) versus 57.5% (23 eyes), the qualified success rate was 25% (10 eyes) versus 25% (10 eyes), the overall success rate was 85% (34 eyes) versus 82.5% (33 eyes), and the rate of failure was 15% (6 eyes) versus 17.5% (7 eyes) in NPDS and trabeculectomy groups, respectively (p = 0.952). Eight cases (20%) of the trabeculectomy group had shallow anterior chamber. None of the NPDS group cases suffered from shallow anterior chamber. Conclusion: Non-penetrating deep sclerectomy appears to be an efficient and safe surgical alternative to penetrating trabeculectomy in treatment of primary congenital glaucoma. Nonpenetrating deep sclerectomy has fewer postoperative complications in comparison to penetrating trabeculectomy with a comparative postoperative reduction in the intraocular pressure and overall success rates. Trial Registration: The trial was registered on 11/01/2020 with number PACTR202002874953456 (https://pactr.samrc.ac.za).

Outcomes of Non-Penetrating Deep Sclerectomy for Primary Congenital Glaucoma Performed by Experienced versus Trainee Surgeons: A Cohort Study

“…14 The outcomes of NPDS have been compared with those of other procedures to treat PCG. 15,16 However, to our knowledge, no studies have compared the outcomes of NPDS between surgeries performed by trainees vs experienced ophthalmologists. In this study, we compared the success rates of NPDS performed by trainees vs experienced ophthalmologists, and evaluated the determinants of success 6 months after NPDS in Saudi pediatric patients.…”

Management of Intraocular Pressure Elevation After CO2 Laser-Assisted Sclerectomy Surgery in Patients With Primary Open-Angle Glaucoma

“…Nonpenetrating deep sclerectomy (NPDS) is an alternative filtering surgery. Compared with Trab, NPDS has a higher safety, but is more technically demanding (5). It was designed to reduce the resistance of aqueous humor outflow by removing the outer wall of Schlemm's canal and the external part of the adjacent trabecular meshwork tissue, while avoiding penetrating the anterior chamber (6).…”

Treatment of Pediatric Glaucoma

“…Elhofi et al 38 reported the outcomes in 80 eyes of 80 children with primary congenital glaucoma. Forty eyes underwent deep sclerectomy, and 40 eyes had a trabeculectomy.…”