Trabeculectomy combined with deep sclerectomy and scleral flap suture tension adjustment under an anterior chamber maintainer: a new modification of trabeculectomy

The objective of this study was to investigate the efficacy and safety of trabeculectomy combined with deep sclerectomy in patients with primary open angled glaucoma (POAG) and to compare the results with those from conventional trabeculectomy. In the study 12 eyes of 10 patients operated with trabeculectomy combined with deep sclerectomy (Group I) and 16 eyes of 16 patients operated with conventional trabeculectomy surgery (Group II) were included. In the described form of combined deep sclerectomy with the trabeculectomy technique the superficial scleral flap was sutured with 10/0 monofilament, the number and tension of sutures were adjusted according to the outflow dynamics, under the scleral flap, of balanced salt solution (BSS) provided by an anterior chamber maintainer. In groups I and II all the patients were male POAG cases with mean ages of 60.0 ± 19.4 and 67.0 ± 7.1 years, respectively. The mean follow-up periods were 8.3 ± 3.5 months for group I and 16.6 ± 7.0 months for group II. Preoperative mean IOP were 29.7 ± 8.3 and 29.1 ± 12.8 mmHg mmHg, and average topical antiglaucomatous medications were 2.9 ± 0.7 and 2.7 ± 1.1 for groups I and II, respectively. Postoperatively mean IOP measurements were reduced in groups I and II to 10.5 ± 2.9 vs. 9.6 ± 4.8 mmHg at 1 week, 13.7 ± 5.6 vs. 16.0 ± 9.8 at 1st month, 12.3 ± 6.4 vs. 17.3 ± 8.0 at 3rd month, 11.0 ± 4.1 vs. 15.3 ± 5.8 at 6th month, 10.8 ± 1.6 vs. 16.1 ± 4.4 at 12th month, and 11.0 ± 1.0 vs. 16.7 ± 5.0 at 18th month. Statistical analysis revealed that mean postoperative IOP measurements for group I were significantly lower than for group II for all measurements except the first week (P < 0.05). At 12th month, the complete (IOP <22 mmHg without medication) and qualified (IOP <22 mmHg with medication) success rates were 83.3 and 100% for group I and 63.6 and 90.9% for group II. Postoperatively at 12th month, the mean number of antiglaucoma medications had fallen to 0.0 ± 0.0 in group I and 0.81 ± 1.1 in group II. Trabeculectomy surgery combined with deep sclerectomy and suture adjustment under an anterior chamber maintainer provided sufficient IOP decrease and diffuse bleb morphology. This technique could be used as a safe method for management of glaucoma.