Outcomes of non-penetrating deep sclerectomy in the control of intraocular pressure in patients with advanced glaucoma

Objectives: Advanced glaucoma patients are at a high risk of total visual field loss and poor quality of life. Although trabeculectomy with antimetabolites is the preferred surgery in such patients to achieve the desirable target IOP, it carries a high risk of wipeout following entry into the anterior chamber. Non-penetrating deep sclerectomy (NPDS) can be used as an alternative surgery in these patients. This study assessed the early postoperative outcomes of patients who underwent NPDS.
Methodology: A descriptive study was carried utilizing clinical records of RD unit patients at the National Eye Hospital, Colombo from March to July 2023. Consecutive ecords of all eyes with advanced glaucoma which underwent NPDS during that period were included. Data regarding demographics, comorbidities of patients, baseline characteristics, control of glaucoma, and outcomes including postoperative IOP control and complications were evaluated.
Results: Six eyes of 6 patients (4 males, 2 females) were included in the study. Mean age was 56 years (42-71). POAG was present in 4 patients and 2 patients had chronic ACG. Pseudophakia was noted in 2 patients, whilst all others were phakic. Mean preoperative IOP was 30.4mmHg on maximum tolerable topical and oral medications. All eyes underwent NPDS by a single surgeon under sterile conditions. One patient developed self-limited ocular hypotony postoperatively. Mean postoperative IOP on first postsurgical day was 12.8 mmHg. Mean IOP reduction was 17.6 mmHg (p=0.08).
Conclusion: NPDS is an excellent alternative with good safety for IOP control in patients with advanced glaucoma.