Deep sclerectomy in combination with cataract surgery cures glaucoma

kremer zaccheiA study tells that majority of glaucoma patients who received combined deep sclerectomy and cataract surgery maintained a lower IOP at nearly 10 years follow-up with a minimum number of complications.

At the World Glaucoma Congress here, Enrico Martini, MD, and colleagues presented their prospective, uncontrolled open series in a poster presentation.

The study examined 140 cases of uncontrolled glaucoma with IOP of more than 21 mm Hg and significant cataract. Patients underwent the same techniques of combined surgery with superior deep sclerectomy and temporal approach phacoemulsification/IOL implantation. The study had a mean follow-up of 76 months.

"In our series, combined deep sclerectomy and phacoemulsification with [posterior chamber] IOL proved to be highly effective for long-term IOP control with a mean reduction of almost 45% at 9 years and a very significant reduction of IOP-lowering drugs (half of the patients are without any therapy), very low complication rate and stable visual field (significant perimetric progression only in 5%)," Dr. Martini and colleagues said.

They said bleb manipulation with needling, 5-fluorouracil and YAG-laser goniopuncture "have to be considered postop routine treatments."

What is Scelerectomy?

Surgical removal of a portion of the sclera performed in glaucoma surgery. A common procedure is to make a conjunctival flap at the limbus, followed by a full thickness scleral opening and iridectomy.

What is Deep Sclerectomy?

A type of non-penetrating filtration surgery aimed at lowering intraocular pressure by dissecting a superficial scleral flap and excising a deeper partial thickness scleral flap below leaving a thin membrane consisting of trabeculum and Descemet's membrane through which the aqueous humour diffuses. It then drains from the anterior chamber to the subconjunctival space or though Schlemm's canal. A collagen implant is usually inserted under the superficial flap to improve drainage of aqueous humour.

Thus from the study sclerectomy promises a good future for patients suffering from glaucoma in addition to cataract.


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