{"title":"Modified penetrating deep sclerectomy versus conventional trabeculectomy for the treatment of glaucoma: A 12-month randomized prospective study.","authors":"Zhike Xu, Lixiang Wang, Xin Wei","doi":"10.1111/aos.17465","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To compare the surgical outcomes and adverse events of modified penetrating deep sclerectomy with conventional trabeculectomy.</p><p><strong>Methods: </strong>A prospective randomized clinical study that successively recruited patients with moderate and advanced primary open-angle glaucoma (POAG) and primary angle closure glaucoma (PACG) in West China Hospital. The modified penetrating deep sclerectomy creates a small triangular intrascleral lake, which aims to reduce the risk of flap adhesion in conventional trabeculectomy and sudden hypotony associated with the dissection of a larger rectangular deep scleral flap. The primary effectiveness endpoint was the IOP by non-contact tonometer with or without medication use at each follow-up visit. The primary safety endpoint was the incidence of all complications during the study.</p><p><strong>Results: </strong>A total of 19 patients (21 eyes) were randomized to modified deep sclerectomy and 21 patients (21 eyes) to conventional trabeculectomy. Age, sex ratio, pre-operative intraocular pressure (IOP) and the number of IOP-lowering medications used were comparable between the two groups. At the end of the follow-up period (12 months), IOPs were (15.52 ± 3.28) mmHg and (19.66 ± 4.01) mmHg in the modified deep sclerectomy and conventional trabeculectomy groups, respectively (p = 0.006). Deterioration of the visual field appeared in four eyes (19.0%) and seven eyes (33.3%) in the two groups (p = 0.33). At 12 months, the average areas of the aqueous outflow pathway were (0.67 ± 0.30) and (0.43 ± 0.26) mm<sup>2</sup>, demonstrating a significant difference (p = 0.016). Using 18 and 15 mmHg as the IOP criteria for surgical success, the modified penetrating deep sclerectomy group showed a higher overall success rate than the conventional trabeculectomy group at 12 months (18 mmHg: 80.95% vs 52.38%, Log Rank p = 0.033; 15 mmHg: 52.38% vs 4.75%, Log Rank p = 0.001). Complication rates were similar between the two groups (23.8% vs 33.3%, p = 0.55), and no sight-threatening complications were reported.</p><p><strong>Conclusions: </strong>Modified deep sclerectomy shows superior efficacy in IOP control and maintenance of the outflow pathway opening, with comparable rates of adverse events, resulting in a higher overall success rate.</p>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":3.0000,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acta Ophthalmologica","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/aos.17465","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: To compare the surgical outcomes and adverse events of modified penetrating deep sclerectomy with conventional trabeculectomy.
Methods: A prospective randomized clinical study that successively recruited patients with moderate and advanced primary open-angle glaucoma (POAG) and primary angle closure glaucoma (PACG) in West China Hospital. The modified penetrating deep sclerectomy creates a small triangular intrascleral lake, which aims to reduce the risk of flap adhesion in conventional trabeculectomy and sudden hypotony associated with the dissection of a larger rectangular deep scleral flap. The primary effectiveness endpoint was the IOP by non-contact tonometer with or without medication use at each follow-up visit. The primary safety endpoint was the incidence of all complications during the study.
Results: A total of 19 patients (21 eyes) were randomized to modified deep sclerectomy and 21 patients (21 eyes) to conventional trabeculectomy. Age, sex ratio, pre-operative intraocular pressure (IOP) and the number of IOP-lowering medications used were comparable between the two groups. At the end of the follow-up period (12 months), IOPs were (15.52 ± 3.28) mmHg and (19.66 ± 4.01) mmHg in the modified deep sclerectomy and conventional trabeculectomy groups, respectively (p = 0.006). Deterioration of the visual field appeared in four eyes (19.0%) and seven eyes (33.3%) in the two groups (p = 0.33). At 12 months, the average areas of the aqueous outflow pathway were (0.67 ± 0.30) and (0.43 ± 0.26) mm2, demonstrating a significant difference (p = 0.016). Using 18 and 15 mmHg as the IOP criteria for surgical success, the modified penetrating deep sclerectomy group showed a higher overall success rate than the conventional trabeculectomy group at 12 months (18 mmHg: 80.95% vs 52.38%, Log Rank p = 0.033; 15 mmHg: 52.38% vs 4.75%, Log Rank p = 0.001). Complication rates were similar between the two groups (23.8% vs 33.3%, p = 0.55), and no sight-threatening complications were reported.
Conclusions: Modified deep sclerectomy shows superior efficacy in IOP control and maintenance of the outflow pathway opening, with comparable rates of adverse events, resulting in a higher overall success rate.
期刊介绍:
Acta Ophthalmologica is published on behalf of the Acta Ophthalmologica Scandinavica Foundation and is the official scientific publication of the following societies: The Danish Ophthalmological Society, The Finnish Ophthalmological Society, The Icelandic Ophthalmological Society, The Norwegian Ophthalmological Society and The Swedish Ophthalmological Society, and also the European Association for Vision and Eye Research (EVER).
Acta Ophthalmologica publishes clinical and experimental original articles, reviews, editorials, educational photo essays (Diagnosis and Therapy in Ophthalmology), case reports and case series, letters to the editor and doctoral theses.