Deep Sclerectomy With Implant Reduces IOP in Uncontrolled Glaucoma

Deep sclerectomy with a uveoscleral drainage implant safely and effectively reduces intraocular pressure (IOP) in patients with medically uncontrolled primary open-angle glaucoma (POAG), according to research published in the Journal of Glaucoma.

Researchers conducted a prospective, consecutive, interventional study to evaluate the efficacy and safety of deep sclerectomy followed by drainage device implantation (Esnoper Clip^®, AJL Ophthalmic) in patients with uncontrolled POAG.

All patients underwent complete ophthalmologic examination, including corrected visual acuity (BCVA) and IOP, at baseline and postoperative day 1, week 1, and months 1, 3, 6, 9 and 12. The investigators also documented any goniopunctures and glaucoma medications required postoperatively.

A total of 39 eyes of 35 patients (mean age, 68.6±11.4 years; range, 39-87; 34% men and 66% women) were included in the study. 

The investigators report a mean preoperative IOP of 20.8±5.2 mm Hg and mean postoperative 12-month IOP of 13.9±3.1 mm Hg (P<.001). They found the number of glaucoma medications decreased from 2.9±0.7 preoperatively to 0.3±0.8 12 months postoperatively (P<.001). 

They documented a complete success rate (IOP ≤21 mm Hg without glaucoma medication) of 87.2% and qualified success rate (IOP ≤21 mm Hg with or without glaucoma medication) of 94.9%. They found that goniopuncture was required in 33.3% of eyes and observed no significant BCVA changes at the final follow-up visit. 

The team reported 3 micro-perforations of the trabeculo-descemet membrane as perioperative complications and hyphema (6 eyes), hypotony (6 eyes), shallow anterior chamber (3 eyes), choroidal detachment (4 eyes), and conjunctival dehiscence requiring re-suture (2 eyes) as postoperative complications.

“Like all surgeries, DS is accompanied by a certain failure rate, which is directly influenced by the level of preoperative IOP. Therefore — and we noticed the same trend in our study — the higher the preoperative IOP, the worse the prognosis for long-term IOP control,” the researchers report.

Limitations of the study included the relatively short postoperative follow-up duration and absence of randomization