Deep sclerectomy versus trabeculectomy: a morphological study with anterior segment optical coherence tomography. Issue 6 (5th April 2013)

• Record Type: Journal Article
• Authors: Konstantopoulos, Aris; Yadegarfar, Mohammad E; Yadegarfar, Ghasem; Stinghe, Alina; Macleod, Alex; Jacob, Aby; Hossain, Parwez
• Is Part Of: British journal of ophthalmology. Volume 97:Issue 6(2013)
• Page Start: 708
• Page End: 714
• Publication Date: 2013-04-05
• Subjects: Imaging -- Glaucoma; Ophthalmology -- Periodicals; 617.7
• DOI: 10.1136/bjophthalmol-2012-301926
• Languages: English
• ISSNs: 0007-1161

Abstract

Abstract : Purpose: To investigate the intraocular pressure (IOP) lowering mechanisms of deep sclerectomy (DS) with anterior segment optical coherence tomography (AS-OCT). Methods: In a prospective cross-sectional study, AS-OCT parameters were compared between DS, trabeculectomy and control cases. Association with IOP and success (IOP≤16 mm Hg without medication) was investigated. Results: 18 DS (15 patients), 17 trabeculectomy (16 patients) and 15 controls (15 patients) were examined. Successful had a taller intrascleral lake (IL) and thicker conjunctival/Tenon's layer (CTL) than non-successful cases (513.3 vs 361.1 µm, p=0.027 and 586.7 vs 251.1 µm, p<0.001, respectively). CTL thickness correlated with IOP (r=−0.6407, p=0.004). CTL thickness was significantly different between controls, DS and trabeculectomy (mean (SD): 203.3 (62.6) vs 418.9 (261.9) vs 604.1 (220.7) µm, p<0.0001). Successful trabeculectomy cases had a taller bleb cavity (BC) than non-successful cases (607.5 vs 176.7 µm, p=0.041). CTL microcysts were detected in 50% of DS and 52.9% of trabeculectomy cases (p=1). Conclusions: Trans-conjunctival aqueous percolation was identified as a novel DS drainage route. DS had a fluid reservoir below the scleral flap, the IL, in analogy to the trabeculectomy BC. A postoperative tall IL and a thick CTL were associated with good outcome.