Glaucoma is a big cause of vision loss globally, and it’s getting worse as more people get older. Lowering the pressure inside the eye is key to treating glaucoma. Trabeculectomy has been the top surgery for glaucoma, but it can lead to serious problems after surgery.
Non-penetrating surgeries like deep sclerectomy aim to make eye surgeries safer. Deep sclerectomy is a new, less invasive way to lower eye pressure. It doesn’t cut all the way through the eye, making it a safer choice for treating glaucoma.
Key Takeaways
- Deep sclerectomy is a non-penetrating glaucoma surgery that offers a similar IOP-lowering effect to trabeculectomy but with fewer complications.
- It is considered a clinically reasonable option for various types and severities of glaucoma in many European countries, although it is rarely performed in the United States.
- Deep sclerectomy may be the best first-line surgical option for high-risk eyes, monocular patients, and certain types of glaucoma.
- Close monitoring and adherence to post-operative care are important for the success of deep sclerectomy.
- Advancements like CO2 laser-assisted sclerectomy surgery are making deep sclerectomy more accessible and easier to perform.
Introduction to Deep Sclerectomy
Deep sclerectomy is a new way to treat glaucoma. It’s seen as a better option than traditional surgeries. The idea of non-penetrating glaucoma surgeries started in the 1960s. Since then, it has evolved into the deep sclerectomy method.
History and Development of Non-Penetrating Glaucoma Surgeries
In 1964, Kasnov and Walker first talked about non-penetrating glaucoma surgery. This idea was improved over the years. In 1989, Kozlov and Fyodorov came up with deep sclerectomy.
Deep sclerectomy removes a part of the deep sclera. It also deroofs Schlemm’s canal and removes the juxtacanalicular trabecular meshwork. This creates a space for aqueous humour to drain. It’s safer than traditional surgeries because it doesn’t fully penetrate the eye.
Overview of Deep Sclerectomy Procedure
The deep sclerectomy procedure helps lower eye pressure. It does this by improving the eye’s natural drainage system. This method is safer than traditional surgeries.
During the surgery, a partial-thickness scleral flap is created. This exposes and deroofs Schlemm’s canal. The juxtacanalicular trabecular meshwork is also removed. This allows better drainage of aqueous humour, lowering eye pressure.
“Nonpenetrating deep sclerectomy was introduced by Fyodorov in 1989 for open-angle glaucoma.”
The deep sclerectomy technique is a safer way to manage glaucoma. It aims to reduce eye pressure for a long time. This means patients may need less medication.
Indications for Deep Sclerectomy
Deep sclerectomy is a modern surgery for glaucoma. It works well for primary open-angle glaucoma and secondary open-angle glaucoma. It’s great for those with high eye pressure that can’t be controlled by medicine or other treatments.
It’s especially good for people with high-risk eyes or those with only one eye. It’s also a good choice for those who have had deep sclerectomy before. Even those with uveitic glaucoma see good results, thanks to less inflammation.
Primary and Secondary Open-Angle Glaucoma
Deep sclerectomy is a good option for managing both types of open-angle glaucoma. It’s a non-penetrating surgery that’s different from traditional trabeculectomy. It’s great for those with eye pressure that can’t be controlled by medicine.
Patients Requiring Lower-Risk Surgery Options
Deep sclerectomy is a safer choice for those with high-risk eyes or those needing a safer surgery. It’s perfect for monocular patients. The surgery has fewer risks compared to other procedures.
“Deep sclerectomy is a promising technique for the management of glaucoma, providing effective IOP reduction with a lower risk of complications compared to traditional penetrating procedures.”
Contraindications for Deep Sclerectomy
Deep sclerectomy is a promising surgery for glaucoma. But, it’s not for everyone. Ophthalmologists must think about certain things before suggesting it.
Absolute Contraindications
There are some conditions that make deep sclerectomy not an option. These include:
- Angle-closure glaucoma – This is when the angle between the iris and cornea is too narrow. It stops the aqueous humour from draining properly, which is key for deep sclerectomy.
- Neovascular glaucoma – This is when blood vessels grow in the eye and block the drainage. Deep sclerectomy can’t help in this case.
Narrow-angle glaucoma and traumatic glaucoma are also not good for deep sclerectomy. They might make the surgery not work well.
“Contraindications for deep sclerectomy include non-functioning, closed, and narrow-angles, as this pathology prevents or limits aqueous humour outflow through the trabeculo-Descemet membrane, which deep sclerectomy relies on to have an effect.”
Ophthalmologists need to check each patient’s situation carefully. They must know the type of glaucoma before deciding on deep sclerectomy.
Surgical Technique of Deep Sclerectomy
The deep sclerectomy surgery has key steps to avoid problems and improve results. First, a conjunctival dissection is done. This is either limbal-based or fornix-based to show the scleral surface.
Then, antimetabolites like 5-fluorouracil or mitomycin C are applied to the sclera. These help prevent scarring and fibrosis after surgery. This step is vital for the surgery’s long-term success.
Scleral Flap Creation and Schlemm’s Canal Deroofing
After the conjunctival dissection and antimetabolite application, a superficial scleral flap is made. Then, a deeper scleral flap is dissected. This lets the surgeon find and open Schlemm’s canal.
The internal wall of Schlemm’s canal and the juxtacanalicular trabecular meshwork are removed. This creates a space for aqueous humour to drain.
“The surgical technique of deep sclerectomy involves a meticulous approach to expose the sclera, apply antimetabolites, and create a scleral flap that allows for the deroofing of Schlemm’s canal, the key structure responsible for aqueous humour drainage.”
This careful surgical method aims to lower eye pressure. It helps manage glaucoma without the risks of more invasive surgeries, like trabeculectomy.
Advancements in Deep Sclerectomy
The field of glaucoma surgery has seen big changes lately. Two main developments in deep sclerectomy are the use of CO2 laser-assisted sclerectomy and the use of drainage implants or devices.
CO2 Laser-Assisted Deep Sclerectomy
The CO2 laser-assisted sclerectomy (CLASS) method uses a CO2 laser to make the deep scleral flap. It also opens up Schlemm’s canal. This makes surgery safer and easier for doctors to learn.
Studies show CLASS can lower eye pressure as well as traditional deep sclerectomy. It also cuts down on surgery time and might lead to fewer problems.
Use of Drainage Implants and Devices
Space-maintaining devices, like implants, are used in deep sclerectomy. They help keep the scleral space open after surgery. This improves how well the eye filters out fluid.
These implants and devices have shown great results. They help deep sclerectomy work better, keeping the optic nerve safe and eye pressure down. About 80% of patients see their eye pressure stay low, preventing further damage.
These new methods, CO2 laser-assisted sclerectomy and drainage implants, have made deep sclerectomy a better choice for glaucoma treatment. They offer a less invasive option with better results and fewer risks.
Deep Sclerectomy: Efficacy and Outcomes
Deep sclerectomy is a new way to treat glaucoma. It helps lower eye pressure without many side effects. This method is as good as traditional surgeries but safer.
A study showed that 87.2% of patients with glaucoma got better after deep sclerectomy. Their eye pressure went from 20.8 mm Hg to 13.9 mm Hg. They also needed fewer eye drops, from 2.9 to 0.3.
Long-term studies also show deep sclerectomy works well. Patients on long-term eye drops had a success rate of 78.3% at 18 mm Hg. This is much better than those on short-term eye drops.
| Outcome Measure | STCT Group | LTCT Group |
|---|---|---|
| Complete Success (IOP | 54.5% | 87.0% |
| Qualified Success (IOP | 90.9% | 100% |
| Median Medications Reduction | 3 to 0 | 3 to 0 |
| Goniopuncture Required | 13.0% | 22.7% |
Deep sclerectomy might not lower eye pressure as much as some surgeries. But it has fewer risks. This makes it a good choice for those needing eye pressure control without many side effects.
Postoperative Management and Complications
After a deep sclerectomy, the focus is on watching the patient’s eye pressure closely. Any problems need quick action. Regular check-ups are key for a smooth recovery and the surgery’s success.
Postoperative Follow-up and Medication
At first, patients get eye drops to control pressure and prevent issues. The type and how often they use these drops depends on how they react and the doctor’s advice. It’s important to keep an eye on the eye pressure, chamber depth, and bleb formation during these visits.
Potential Complications and Management
- Hyphema: Blood in the front part of the eye, or hyphema, is a common early problem. It’s usually treated with eye drops and careful watching.
- Hypotony: When eye pressure drops too low, it can cause shallow chamber, detachment, and vision problems. Managing this with eye drops and sometimes surgery is needed.
- Choroidal Detachment: When the choroid separates from the sclera, it’s due to low pressure. It’s often treated with eye drops and sometimes surgery.
- Conjunctival Dehiscence: When the conjunctiva separates, it can cause problems with the bleb. This might need more surgery to fix.
Spotting and treating these issues early is vital. It helps make sure the deep sclerectomy works well and improves the patient’s vision.
Comparison with Trabeculectomy
Deep sclerectomy and trabeculectomy are both effective in lowering intraocular pressure (IOP). But deep sclerectomy has fewer complications, making it safer. This is especially true for patients at high risk or needing a safer option.
A study looked at deep sclerectomy with mitomycin C (DS + MMC) and trabeculectomy with mitomycin C (Trab + MMC) over two years. Both groups saw a drop in IOP. Trabeculectomy had a slightly higher IOP reduction. Yet, deep sclerectomy had fewer complications and a lower failure rate over 24 months.
| Outcome Measure | Deep Sclerectomy + MMC | Trabeculectomy + MMC |
|---|---|---|
| Mean IOP Reduction from Baseline | 33.94% | 38.39% |
| IOP ≤ 16 mmHg | 82.61% | 95.46% |
| IOP ≤ 12 mmHg | 52.17% | 72.72% |
| Complete Success Rate at 24 Months | 67.39% | 61.36% |
| Failure Rate at 24 Months | 6.52% | 9.09% |
| Further Surgical Intervention | 13% | 29.55% |
Trabeculectomy might offer a bit more IOP lowering. But deep sclerectomy is safer with fewer complications. This makes deep sclerectomy a good choice for those needing a safer surgery.
“Deep sclerectomy exhibits a significantly lower risk of postoperative complications, making it a safer surgical option, particularly for high-risk patients or those requiring a lower-risk procedure.”
Conclusion
Deep sclerectomy is a safe and effective surgery for open-angle glaucoma. It helps control eye pressure when other methods fail. Although it may not lower pressure as much as some other surgeries, it has fewer risks.
This surgery is a modern, non-invasive option for glaucoma treatment. It can significantly lower eye pressure while keeping risks low. This makes it a good choice for those looking for a safer treatment.
Deep sclerectomy is a valuable tool in managing glaucoma. It helps control eye pressure while keeping patients safe and comfortable. As it continues to improve, it will remain a key part of glaucoma treatment.
FAQ
What is deep sclerectomy?
Deep sclerectomy is a surgery for glaucoma that doesn’t fully open the eye. It lowers eye pressure by removing part of the sclera. This lets fluid drain out.
How does deep sclerectomy differ from trabeculectomy?
Deep sclerectomy is safer than traditional trabeculectomy. It has fewer risks like eye pressure dropping too low. Yet, it works just as well in lowering eye pressure.
What are the indications for deep sclerectomy?
It’s used for open-angle glaucoma, especially in high-risk eyes. It’s also good for those who’ve had it before. It can help with uveitic glaucoma too.
What are the contraindications for deep sclerectomy?
You shouldn’t have it if you have angle-closure or neovascular glaucoma. It’s not for narrow-angle or traumatic glaucoma either.
How is the deep sclerectomy procedure performed?
The surgery starts with opening the conjunctiva. Then, antimetabolites are applied. Next, a flap is made in the sclera. Finally, Schlemm’s canal is opened to drain fluid.
What advancements have been made in deep sclerectomy?
New techniques include CO2 laser-assisted surgery. Also, implants help keep the space open for better fluid flow.
How effective is deep sclerectomy in lowering intraocular pressure?
It’s very effective in lowering eye pressure. Success rates are similar to trabeculectomy but with fewer complications.
What are the potential complications of deep sclerectomy?
Risks include bleeding, low eye pressure, and shallow chamber. These can usually be treated without surgery.
