Deep sclerectomy Versus trabeculectomy: A Comparative study of their efficacy in primary open angle glaucoma By Kishor Kumar,MS; Manish Sharma,MS; Vikas Gupta

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Editor                                   Dr Sudhir Singh   Advisors Prof. P.K Mathur Dr  Pavan Shorey   Editorial Board Dr Anshoo Choudhary Dr Arun Kshetrapal Dr L S Jhala Dr Mayank Agrawal Dr Mukesh Sharma Dr Sandeep Arora Dr Sonu Goel Dr Subodh Saraf Dr Sukesh Tandon Dr Sunil Gupta Dr Suresh Kumar Pandey Dr Swati Tomar Dr Virendra Agrawal                                         Deep sclerectomy Versus trabeculectomy: A Comparative study of their efficacy in primary open angle glaucoma   Kishor Kumar,MS; Manish Sharma,MS; Vikas Gupta Corresponding Author Dr Kishor Kumar S.M.S.Medical College Jaipur Rajasthan India Article Code RJO20110112 Aim To compare the efficacy of non-penetrating (deep sclerectomy) and penetrating (trabeculectomy) filtering procedures in POAG. Material and Method The study was conducted on patients admitted in Upgraded Department of     Ophthalmology, SMS Medical College, Jaipur from Sep 2008 to Sep 2009. A total 40 patients of POAG were included in study. After detailed ocular and systemic examination, the patients were randomly divided into 2 groups of 20 patients each. The inclusion criteria was POAG patients of age 40-60 years where IOP was uncontrolled (>20mmHg) even by maximum antiglaucoma drugs.           Group A: Trabeculectomy (Modified Cairns’ technique)           Group B:  Deep sclerectomy (Kozlov’s technique) Surgical technique   Trabeculectomy (Modified Cairns’ technique): A limbal based conjunctival flap was prepared. A partial thickness rectangular scleral flap, 5×5 mm in size and hinged at limbus was dissected. An inner sclerotomy block of dimension 2×3 mm was removed at the base of hinge of superficial scleral flap. Peripheral iridectomy was performed. The external scleral flap was closed by two 10-0 nylon sutures. The conjunctiva and tenon’s capsule were closed separately by running sutures. Deep sclerectomy (Kozlov’s technique): A limbal based conjunctival flap was prepared. A 5×5 mm rectangular one-third thickness scleral flap was made and dissected 1-1.5 mm anteriorly into clear cornea. A second 3×3 mm deep scleral flap (90% thickness) was dissected leaving a thin layer of sclera. The dissection was then carried further into clear cornea for 2 mm. The schlemm’s canal was identified and unroofed. The sclero-corneal dissection was further carried forward for 1-1.5 mm to remove the sclero-corneal tissue in front of the anterior trabeculum and descemet’s membrane.  The external scleral flap was closed by two 10-0 nylon sutures. The conjunctiva and tenon’s capsule were closed separately by running sutures. OBSERVATION Post Operative IOP   Result The reduction in mean IOP after surgery in Group A (Trabeculectomy) and Group B (Deep sclerectomy) was as follows:  1st day (67.8% Vs 69.0%), 1 month (50.09% Vs 32.9%), 6 month (41.1% Vs 28.6%). The most common early postoperative complications in Group A were hyphema and shallow anterior chamber (25%).  The most common early postoperative complications in Group B was inflammation (15%). Conclusion Both Trabeculectomy and Deep sclerectomy were comparable in reducing IOP on 1st operative day. Mean reduction in IOP gradually decreased over time in both the groups, more so in deep sclerectomy group. Postoperative complications occurred in statistically significant number of cases in Trabeculectomy group as compared to Deep sclerectomy group. The study suggests that Deep sclerectomy provided comparable IOP reductions with fewer complications .Though the results of study are very encouraging, we still recommend a long study on a larger group of patients to substantiate our study. References: 1.      Kozlov IV. Non-penetrating deep sclerectomy with collagen IRTC microsurgery, Moscow; RSFSR, Ministry of Public Health 1989; 44-46. 2.      Cheseltia D. Non-penetrating deep sclerectomy VsTrabeculectomy in POAG. Eye2001; 15; 131-2 3.      Cairns JE. Trabeculectomy; Trans. Am. Oph. Soc.1971;75; 1395 4.      Ambresin  A. Deep sclerectomy with collagen implantin one eye compared with Trabeculectomy in the other eye of the same. 5.      Mermoud A. Comparision of deep sclerectomy with collagen implant and trabeculectomy in open angle glaucoma.J Cataract Refract. Surgery 1999 25;3;323-325 Disclaimer The Rajasthan Journal Of Ophthalmology An Official Publication Of The Rajasthan Ophthalmological Society
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