New Options for Non-Penetrating Glaucoma Surgery

First choice and as initial procedure for primary congenital glaucoma.

• Glaucoma is a complex eye disease which is the second cause of blindness in the world. It consists of the progressive deterioration of the layer of retinal nerve fibers and of the optic nerve, which lead to the appearance of defects in the visual field and of atrophy of the optic nerve. In the majority of cases, this pathology is associated with increased intraocular pressure (IOP) due to the inhibition of correct drainage of the aqueous humor of the eye. The management of glaucoma requires chronic treatment with a spectrum of therapeutic options including drugs, laser treatment, incisional filtration surgery, drainage devices, and surgical implants. Deep sclerectomy (DS) is a nonpenetrating procedure for the treatment of openangle glaucoma (OAG).

• Glaucoma Surgery is rarely restorative or Curative. It Usually Substitutes One Problem for another.

The goal of Glaucoma Surgery is too Lower intra ocular pressure. Unfortunately, many surgeons who have operated on glaucoma have been sadly surprised on the day after performing the surgery at most of the time, like soft, painful eyeball, with collapsed anterior chamber, sometime choroidal detachment and tendency to develop cataract.

Deep Sclerectomy has gained importance in glaucoma surgical treatment in contrast to trabeculectomy, it enhances aqueous humor outflow acting on the major resistance site without entering the anterior chamber, thus reducing the incidence of the intra and the postoperative, over filtration, hypotony, and its potential sequelae. Moreover, the cataract hyphemia, endothelial damage and macular edema is lower with DS.

May be difficult to do it and more demanding, need more practice and true knowledge to anatomical features, but it is excellent option if gained skill to do this procedure.

Deep Sclerectomy is a bad name for a good surgery, Because Peeling off the external trabecular or the inner wall of Schlemm’s canal to obtain a good filtration is essential phase. Thus, the technique is more appropriately described as a:

Nonpenetrating external trabeculectomy

And not deep sclerectomy.

• Inclusion criteria: Primary or secondary open angle glaucoma no longer controlled by medical treatment. In my experience First choice and as initial procedure for primary congenital glaucoma.