Complications of Deep Nonpenetrating Sclerectomy

Authors: P. Strnad;  J. Svačinová;  E. Vlková
Authors‘ workplace: Oční klinika LF MU a FN, Brno přednosta prof. MUDr. Eva Vlková, CSc.
Published in: Čes. a slov. Oftal., 68, 2012, No. 3, p. 109-113
Category: Original Article


The purpose of this retrospective study was to evaluate an incidence of complications after deep nonpenetrating sclerectomy with different type of implant.

A total of consecutive 92 eyes (76 patients) that underwent deep sclerectomy were divided into 3 groups according to the type of nonpenetrating surgery.

The first group underwent deep sclerectomy without implant (34 eyes, 29 patients), the second group underwent deep sclerectomy with absorbable collagen implant Staar© (31 eyes, 25 patients) and the third group underwent deep sclerectomy with non-absorbable implant

T-Flux© (27 eyes, 22 patients). The complications were divided into 3 types – peroperative, early postoperative and late postoperative.

The incidence of complications in above mentioned 3 groups was as follows: Peroperative complications: Perforation of trabeculo-Descemet’s membrane (2.6; 4.2; 3.7 % respectively). Early postoperative complications: Filtrating operating wound (no occurrence in our groups), Choroideal detachment (17; 19; 16 % resp.), Hypotony (10; 8; 5 % resp.), Hyphaema (7; 3; 0 % resp.), Infectious complications (no incidence of blebitis or endophthalmitis in our groups), Flat anterior chamber (7; 5.7; 5.5 % resp.), Dislocation of implant (1 case of dislocation of Staar©, 1 case of dislocation of T-Flux©). Late postoperative complications: Fibrosis of filtering bleb (30; 36; 24 % resp.), Encapsulated filtering bleb (2.9; 10.3; 0 %), Peripheral anterior synechiae (0; 4.2; 3.7 % resp.), Cataract progression (total incidence 5.5 %), there was no incidence of chronic hypotony, scleral ectasia and late endophthlamitis in our groups.

Deep sclerectomy allows effective lowering of intraocular pressure, without necessity of opening anterior chamber. It brings lower incidence of complications compared to classical penetrating trabeculectomy. Use of implant increases success of surgery due to intrascleral fibrosis reduction. We documented better effect of non-absorbable implant T-Flux© compared to absorbable collagen implant Staar©. The highest incidence of intrascleral fibrosis was in group of patients that underwent deep sclerectomy without implant.

Key words:
deep sclerectomy, T-Flux©, collagen implant Staar©, laser goniopuncture


1. Jehn, A. B., Bohnke, M., Mojon, D. S.: Deep sclerectomy with collagen Implant: Initiale experience. Ophthalmologica, 2002; 216: 235–238.

2. Brooks, A. M., Harper, C. A., Gillies, W. E.: Occurrence of malignant glaucoma after laser iridotomy. Brit J Ophthalmol, 1989; 73(8): 617–620.

3. Brubaker, R. F., Pederson, J. E.: Ciliochoroidal detachement. Surv Ophthalmol, 1983; 27: 281–289.

4. De Laage de Meux, P., Kantelip, B.: Surgical anatomy of corneoscleral limbus. Arch Ophthalmol, 1976; 36: 39–50.

5. Demailly, P., Lavat, P., Kretz, G. et al.: Non-penetrating deep sclerectomy with or without collagen device in primary open-angle glaucoma: modele-term retrospective study. Inter Ophthlamol, 1996; 20: 131–140.

6. Detry-Morel, M., Detry, M. B.: Five-year experience with non-penetrating deep sclerectomy. Bull Belg Soc Ophthalmol, 2006; 299: 83–94.

7. Ewing, R. H., Stamper, R. L.: Needle revision with and without 5-fluorouracil for the treatment of failed filtering blebs. Amer J Ophthalmol, 1990; 110: 254–259.

8. El-Sayyad, F., Helal, M., El-Kholify, H. et al.: Nonpenetrating deep sclerectomy versus trabeculectomy in bilateral primary open-angle glaucoma. Ophthalmology, 2000; 107 (9): 1671–1674

9. Price, F. W., Zeh, W. G.: Viscoelastic material as an adjunct to dissection and to treat microperforations during non-penetrating filtering surgery. J Cataract Refract Surg, 2001; 27: 639–641.

10. Fyodorov, S. N.: Non-penetrating deep sclerectomy in open-angle glaucoma. Eye Microsurg, 1989; 52–55.

11. Henchoz, L., Schnyder, C., Shaarawy, T. et al.: Surgery-induced cataract and cataract progression following deep sclerecomy with collagen implant compared to trabeculectomy. Ophthalmology, 2000; 107: 205.

12. Hyams, M., Geyer, O.: Iris prolapse at the surgical site: A late complication of Nonpenetrating Deep Sclerectomy. Ophthalmic surgery, lasers & Imaging, 2003; 34: 132-135.

13. Chiou, A. G. Y., Mermoud, A., Hediguer, S. E. A. et al.: Ultrasound biomicroscopy of eyes undergoing deep sclerectomy with collagen implant. British Journal of Ophthalmology, 1996; 80: 541-544.

14. Chiou, A. G. Y., Mermoud, A., Hediguer, S. E. A.: Malignant glaucoma after deep sclerectomy-ultrasound biomicroscopy imaging. Klein Monatsbl Augenheilkd, 1996; 208: 279–281.

15. Chiou, A. G. Y., Mermoud, A., Jewelewicz, D. A.: Comparison of post-operative inflammation following deep sclerectomy with collagen implant versus standard trabeculectomy. Graefeęs Arch Clin Exper Ophthalmol, 1998; 236: 593–96.

16. Choi, S. S., Kim, S. S., Kim, C. Y. et al.: Short term surgical outcomes of modified deep sclerectomy with catgut implant. Kor J Ophthalmol, 2001; 15: 113–117.

17. Karlen, M. E., Sanchez, E., Schnyder, C. C. et al.: A deep sclerectomy with collagen implant: medium results. Brit J Ophthalmol, 1999; 83: 6–11.

18. Kim, J. I., Bae, J. H., Song, J. K.: The efficacy of nonpenetrating deep sclerectomy with 0,02% Mytomycin C. Kor J Ophthalmol, 2001; 42: 1284–1288.

19. Kozlov, V. I., Bagrov, S. N., Anisimova, S. Y. et al.: Deep sclerectomy with collagen. Eye Microsurg, 1990; 3: 44–46.

20. Kozobolis, V. P., Christodoulakis, E. V., Siganos, Ch. S. et al.: Hemorrhagic Descement`s membrane detachement as a complication of deep sclerectomy: A case report. J Glauc, 2001; 10: 497–500.

21. Krasnov, M. M.: Externalization of Schlemm’s canal (sinusotomy) in glaucoma. Brit J Ophthalmol, 1968; 52: 157–161.

22. Lachkar, Y., Neverauskiene, J., Jeanteur-Lunel, M. N. et al.: Nonpenetrating deep sclerectomy: A 6-year retrospective study. Europ J Ophthalmol, 2004; 14: 26–36.

23. Leszczynski, R., Gierek-Ciaciura, S., Forminska-Kapuscik, M. at al.: Nonpenetrating very deep sclerectomy with reticulated hyaluronic acid implant in galucoma treatment. Med Sci Monitor, 2008; 14: 86–89.

24. Luke, C., Dietlein, T, Jacobi, P. et al.: Intracorneal inclusion of high-molecular-weight sodium hyaluronate following detachment of Descemet`s membrane during viscocanalostomy. Cornea, 2000; 19: 556–557.

25. Manku, M. S.: Spontaneous bilateral malignant glaucoma. Clin Exper Ophthalmol, 2007; 13 (3): 249–250.

26. Mermoud, A., Schnyder, C. C., Sickenberg, M. et al.: Comparison of deep sclerecomy with collagen implantand and trabeculectomy in open-angle glaucoma. J Cataract Refract Surg, 1999; 25: 323–331.

27. Mermoud, A., Karlen, M. E., Schnyder, C. C. et al.: Nd:YAG goniopuncture after deep sclerectomy with collagen implant. Ophthal Surg Lasers, 1999; 30: 120–125.

28. Mermoud, A., Ravinet, E.: Complications and reoperations. In: Mermoud, A., Shaarawy, T., Ritch, R. et al.: Non-Penetrating Glaucoma Surgery, London, UK: Martin Dunitz, 2001; 140–159.

29. Mermoud, A., Salmon, J. F., Alexander, P. et al.: Molteno tube implantation for neovascular glaucoma. Long-term results and factors influencing the outcome. Ophthalmology, 1993; 100: 897–902.

30. Milazzo, S., Turut, P., Malthieu, D. et al.: Scleral ectasia as a complication of deep sclerectomy. J Cataract Refract Surg, 2006; 26: 785–787.

31. Moreno-MontaĖés, J., Rodríguez-Conde, R.: Bleeding during gonioscopy after deep sclerectomy. J Glaucoma, 2003; 12: 427–429.

32. Ophir, A., Ticho, U.: Encapsulated filtering bleb and subconjunctival 5-fluorouracil. Ophthalm Surg , 1992; 23: 339–341.

33. Othenin-Girard, P., Tritten, J. J., Pittet, N. et al.: Dexamethasone versus Diclofenac sodium eyedrops to treat inflammation after cataract surgery. J Cataract Refract Surg, 1994; 20: 9–12.

34. Pederson, J. E., Smith, S. G.: Surgical management of encapsulated filtering blebs. Ophthalmology, 1985; 92: 955–958

35. Pitrová, Š., Pešková, H., Lešták, J.: První klinické zkušenosti s hlubokou sklerektomií v ambulantní chirurgii glaukomů. Čs. Oftalmol, 1999; 1: 3–9.

36. Ravinet, E., Tritten, J. J., Roy, S. et al.: Descemet membrane detachment after nonpenetrating filtering surgery. J Glaucoma, 2002; 11: 244–52.

37. Roth, S. M., Spaeth, G. L., Starita, R. J. et al.: The effects of postoperative corticosteroids on trabeculectomy and the clinical course of glaucoma: Five-year follow-up study. Ophthalmic Surg, 1991; 22: 724–729.

38. Roy, S., Mermoud, A.: Complications deep nonpenetrating sclerectomy. J Franc DęOphtalmol, 2006; 29: 1180–1197.

39. Ruderman, J. M., Harbin, T. S., Campbell, D. G.: Postoperative suprachoroidal hemorrhage following filtration procedures. Arch Ophthalmol, 1986; 104: 201–205.

40. Saito, A., Amemiya, T., Dake, Y. et al.: Short-term outcome of nonpenetrating trabeculectomy with deep sclerectomy for glaucoma. Japan J Clin Ophthalmol, 2001; 55: 553–556.

41. Sanchez, E., Schnyder, C. C., Sickenberg, M. et al.: Deep sclereclomy: results with and without collagen implant. Inter Ophthalmol, 1997; 20: 157–162.

42. Shaarawy, T., Karlen, M. E., Sanchez, E. et al.: Long term results of deep sclerectomy with collagen implant. Acta Ophthalmol Scand, 2000; 78: 323–328.

43. Sharawy, T., Nguyen, C., Schnyder, C. et al.: Comparative study between deep sclerectomy with and without collagen implant: long term follow-up. Brit J Ophthalmol, 2004; 88: 95–98.

44. Shaarawy, T., Mansouri, K., Schnyder, C. et al.: Long-term results of deep sclerectomy with collagen implant. J Cataract Refract Surg, 2004; 30: 1225–1231.

45. Skuta, G. L., Beeson, C. C., Higginbotham, E. J. et al.: Intraoperative mitomycin versus postoperative 5-fluorouracil in high-risk glaucoma filtering surgery. Ophthalmology, 1992; 99: 438–444.

46. .Stegmann, R., Pienaar, A., Miller, D.: Viscocanalostomy for open-angle glaucoma in black African patiens. J Cataract Refract Surg, 1999; 25(3): 316–322.

47. Stegmann, R. C.: Viscocanalostomy: a new surgical technique for open angle glaucoma. Anales del Instituto Barraquer, 1995; 25: 225–232.

48. Strnad, P., Svacinova, J., Vlkova, E.: Long-term follow up after non-penetrating glaucoma surgery, 11. In: Book of abstracts: 6th I.G.S., Athens, Greece, 2007, 209 p.

49. Strnad, P., Svačinová, J., Vlková, E.: Dlouhodobá kompenzace pacientů po nepenetrující filtrační operaci, 147. In: Sborník abstrakt XIV. výročního sjezdu ČOS, Galén, Praha, 2006, 232 s., ISBN 80-71777-974-1.

50. Strnad, P., Svačinová, J., Vlková, E.: Komplikace u neperforujících operací glaukomu, 45. In: Sborník abstrakt, kongres ČGS, Luhačovice, 2008, 61 s., ISBN 978-80-254-1568-9.

51. Strnad P., Svačinová J., Vlková E.: Neperforující operace glaukomu – komplikace, 43. In: Sborník abstrakt, Mezinárodní kongres ČSRKCH, Praha, 2008, ISBN 978-80-254-1569-6.

52. Strnad P., Svačinová J., Vlková E.: Deep nonpenetrating sclerectomy – complications, 344. In: Book of abstract, World Glaucoma Congress, Boston, July 8–11, 2009.

53. Strnad P., Svačinová J., Vlková E.: Komplikace u nepenetrujících hlubokých sklerektomií, 103-104. In: Sborník abstrakt XVII. výročního sjezdu ČOS, Praha, 2009, ISBN 978-80-254-5321-6.

54. Strnad P., Svačinová J., Vlková E.: Complications of non-penetrating glaucoma surgery, 56. In: Book of abstract, 4th International Congress on Glaucoma Surgery, Geneva, 2009.

55. Vaudaux, J., Mermoud, A.: Aqueous dynamics after deep sclerectomy: ex-vivo study. Ophthalmic Practice, 1998; 16: 204–209.

56. Vlková, E., Svačinová, J., Danielová, L.: Hluboká sklerektomie v chirurgii glaukomu, 42. In: Sborník abstrakt VIII. výročního sjezdu ČOS, Galén, Praha, 2000, 166 s., ISBN 80-7262-066-5.

57. Vlková, E., Svačinová, J., Neugebauerová, T.: Hluboká sklerektomie s použitím dvou typů implantátů, In: Sborník abstrakt IX. výročního sjezdu ČOS, Galén, 2001, Praha, ISBN 80-7262-123-8.

58. Vlková, E., Svačinová, J., Schoříková, L.: Neperforující hluboká sklerektomie, 56. In: Sborník abstrakt VII. výročního sjezdu ČOS, Galén, Praha, 1999, 154 s., ISBN 80-7262-011-8.

59. Vouri, M. L.: Complications of Nd:YAG laser goniopuncture after deep sclerectomy. Acta Ophthalmol Scand; 2003; 81: 573–576.

60. Watson, P. G., Jakeman, C., Ozturk, M. et al.: The complications of trabeculectomy. Eye, 1990; 4: 425–438.

61. Zimmerman, T. J., Kooner, K. S., Ford, V. J. et al.: Effectiveness of non penetrating trabeculectomy in aphakic patients with glaucoma. Ophthalmic Surg, 1984; 15: 44–50.

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