Non-penetrating deep sclerectomy in the treatment of advanced cases of open angle glaucoma

Purpose
The purpose of the paper was to examine the efficacy of non-penetrating deep sclerectomy (NPDS) with sodium hyaluronate implants and mitomycin C in the treatment of advanced cases of open angle glaucoma.

Material and methods
Thirty-five eyes of 35 patients with medically uncontrolled advanced open angle glaucoma were retrospectively analyzed. Visual acuity and intraocular pressure measurement were performed before and after surgery at 1 and 7 days and 1, 6 and 12 months. Visual field was analyzed before and 12 months after surgery.

Results
The mean preoperative intraocular pressure was 27±3,1 mm Hg and 18,1±1,5 at 12 month after surgery (p<0,05). Visual acuity decreased more than two rows on Snellen chart in 4 patients. Visual field analysis shows mean defect MD-17±5.2 before surgery and 20,1 ± 6,2 after 12 month of follow up (p>0,05). Complete success rate defined as an IOP lower than 21mmHg without medications was 51%. In 3 eyes we performed needling and in 8 goniopuncture. Postoperative complications included hyphaema in 3 eyes, choroidal detachement in 1 eye, bleb fibrosis in 2 eyes.

Conclusions
1. Deep sclerectomy with SK-GEL implant and antimetabolites provided good reasonable control of intraocular pressure. 2. In uncomplicated cases it let us achieve stabilization of the visual field.