Nonpenetrating deep sclerectomy with or without phaco reduces IOP, medication use

Ophthalmic Surg Lasers Imaging. 2010:41(2):228-235.

Issue: June 10, 2010

Nonpenetrating deep sclerectomy with and without phacoemulsification proved similarly safe and effective in treating glaucoma, according to a study.

The longitudinal consecutive retrospective study included 376 eyes that underwent nonpenetrating deep sclerectomy alone and 87 eyes that underwent nonpenetrating deep sclerectomy with phaco.

Three criteria determined surgical success: IOP of less than 21 mm Hg without medication (complete success); a 20% reduction in preoperative IOP without medication (moderate success); and IOP less than 21 mm Hg with or without medication (qualified success).

Patients in the sclerectomy-alone group had a mean preoperative IOP of 23.7 mm Hg and a mean 2.7 medications. Patients in the combined group had a mean preoperative IOP of 23.1 mm Hg and 2.6 medications.

At 3 years postop, patients in the sclerectomy-alone group had a mean IOP of 13.1 mm Hg, and patients in the combined group had a mean IOP of 13.4 mm Hg.

Complete success was achieved in 57.5% of patients in the sclerectomy-alone group, moderate success in 53.7% and qualified success in 94.5%.

Overall, 56.1% of patients in the combined group had complete success, 56.1% had moderate success and 100% had qualified success.

At final follow-up, patients in the sclerectomy-alone group were taking a mean 0.5 medications and patients in the combined group were taking a mean 0.3 medications, the authors reported.

There has been controversy for years over whether it is best to combine cataract and glaucoma surgery or perform them separately. In fact, a patient who has need of cataract surgery and carries the burden of multiple daily doses of topical hypotensive medications will welcome a safe and effective adjunctive procedure to reduce IOP.

– Mark Packer, MD, FACS
Drs. Fine, Hoffman & Packer, Eugene, Ore.

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