Trabeculectomy Vs Non‐penetrating Deep Sclerectomy for the Surgical Treatment of Open-Angle Glaucoma: A Long-Term Report of 201 Eyes

Barbosa, Renato Correia; Gonçalves, Rita; Bastos, Ricardo; Pereira, Sara; Basto, Rita; Viana, Ana Rita; Tenedório, Paula

doi:10.2147/opth.s405837

Cited by 3 publications

(2 citation statements)

References 21 publications

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“…In contrast, Chiselita reported a lower IOP after trabeculectomy than after NPDS, with a lower complication rate in the latter, in adults with primary open-angle glaucoma [ 36 ]. Correia Barbosa et al reached a similar conclusion in a group of adults with open-angle glaucoma [ 37 ]. This observed difference may indicate variable efficacy of the NPDS for different age groups.…”

Section: Discussionmentioning

confidence: 58%

Non-penetrating deep sclerectomy versus combined trabeculotomy–trabeculectomy in primary congenital glaucoma

Hassan Elabd,

Elsayed,

Fekry Elgazzar

et al. 2024

Med Hypothesis Discov Innov Ophthalmol

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Background: The primary mode of therapy in children with primary congenital glaucoma (PCG) and mild or no corneal edema is goniotomy, which has a high success rate. However, in developing countries, the diagnosis of PCG is usually delayed, and corneal cloudiness interferes with goniotomy. Therefore, trabeculotomy may be the best choice in such eyes. We compared the short-term efficacy and safety of primary combined trabeculotomy–trabeculectomy (primary CTT) with that of non-penetrating deep sclerectomy (NPDS) in managing PCG. Methods: This prospective, randomized, comparative study included patients with PCG referred to Al-Azhar University Hospitals within a 1-year period. Eyes were randomly allocated to one of two groups: eyes in NPDS group underwent NPDS, and those in primary CTT group underwent primary CTT. Baseline and frequent postoperative assessments of intraocular pressure (IOP), cup-to-disc ratio (C/D ratio), corneal diameter, and axial length were performed for up to 6 months. The success rates were recorded in both groups. Results: Forty eyes of 26 patients were included, with 20 eyes allocated to each group. The mean (standard deviation) age of all patients was 12.9 (9.5) months, with comparable ages and sex ratios between groups (both P > 0.05). Both groups demonstrated a significant reduction in IOP and C/D ratio at each postoperative visit compared to the baseline visit (all P < 0.001), with no significant difference detected between the groups (all P > 0.05), except for a significantly lower IOP in NPDS group at 1 month (P < 0.05). The corneal diameter and axial length were comparable between groups at baseline and remained unchanged at all postoperative visits (all P > 0.05). The groups had comparable success rates (P > 0.05). No serious complications were detected. Conclusions: CTT and NPDS both yielded reasonable IOP control and reversal of cupping in eyes with PCG. We observed equal effectiveness of the surgical procedures without major safety concerns. Further large-scale clinical trials with longer follow-up periods are needed to verify our preliminary findings.

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Section: Discussionmentioning

confidence: 58%

Non-penetrating deep sclerectomy versus combined trabeculotomy–trabeculectomy in primary congenital glaucoma

Hassan Elabd,

Elsayed,

Fekry Elgazzar

et al. 2024

Med Hypothesis Discov Innov Ophthalmol

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“…ElSayyad et al reported that some aqueous humor enters the suprachoroidal space, passes through the subconjunctival pathway, and reaches the filtration bleb [ 34 ]. A scleral flap can help regulate the aqueous outflow by providing resistance [ 35 ]. Episcleral venous drainage, conjunctival bleb, scleral channels, and suprachoroidal filtration are potential mechanisms for lowering IOP.…”

Section: Discussionmentioning

confidence: 99%

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

AlQattan,

Schargel,

AlJadaan

et al. 2024

Ophthalmol Ther

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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.

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Systematic review of clinical practice guidelines for the diagnosis and management of open angle glaucoma

Galvez-Olortegui,

Bernales-Urbina,

Jarroudi

et al. 2024

Preprint

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Précis: Clinical Practice Guidelines(CPGs) for Open Angle Glaucoma(OAG) have evolved through the years and differ in their methodological quality. NICE, IETSI and SNSG have a high methodological quality, appraised with AGREE-II. Topic: To assess the methodological quality of Clinical Practice Guidelines (CPG) for the diagnosis and management of open angle glaucoma (OAG). Clinical relevance: An assessment of the methodological quality of Clinical Practice Guidelines (CPG) for the diagnosis and management of open angle glaucoma (OAG) is reported. Methods: A systematic review of CPGs for the diagnosis and management of OAG, published between January-2017 and November-2023, was carried out with a search in databases, metasearch engines, CPG development institutions, ophthalmology associations and CPG repositories. A search update was run in January 2024. Protocol was registered in the International Prospective Register of Systematic Reviews PROSPERO: CRD42024510656. Nine CPGs published in English/Spanish, between 2017 and 2024 were selected, and 5 authors evaluated them independently, using the Appraisal of Guidelines for Research and Evaluation (AGREE-II) instrument. An individual assessment by domain (AGREE-II), an overall assessment of the guide, and its use with or without modifications was performed. Additionally, a meta-synthesis of the recommendations for the most relevant outcomes of each CPG was performed. Results: The lowest scores were in applicability and rigour of development (mean 47.9% and 48% respectively). The highest score (mean 72.1%) was for domain 4 ‘clarity of presentation’. NICE (92.1%), IETSI (77.5%) and SNSG (75.8%) presented the best score in domain 3 ‘Rigour of development’. When evaluating the overall quality of the CPGs analysed, only NICE, EGS-5-TGG, SNS and MaHTAS could be recommended with modifications. All the CPGs used GRADE approach for making recommendations. In the meta-synthesis, recommendations are similar between CPG, however variability was found in selective laser trabeculoplasty and minimally invasive glaucoma surgery indications (MIGS). Conclusions: NICE, IETSI and SNSG CPGs for the diagnosis and management of OAG, have a high methodological quality, appraised with AGREE-II. NICE, EGS-5-TGG, IETSI and SNSG have high scores in applicability.

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Trabeculectomy Vs Non‐penetrating Deep Sclerectomy for the Surgical Treatment of Open-Angle Glaucoma: A Long-Term Report of 201 Eyes

Cited by 3 publications

References 21 publications

Non-penetrating deep sclerectomy versus combined trabeculotomy–trabeculectomy in primary congenital glaucoma

Non-penetrating deep sclerectomy versus combined trabeculotomy–trabeculectomy in primary congenital glaucoma

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

Systematic review of clinical practice guidelines for the diagnosis and management of open angle glaucoma

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