Sclérectomie profonde: évaluation critique - Deep Sclerectomy: Critical Evaluation

Shaarawy, Tarek

doi:10.13097/archive-ouverte/unige:29904

Trabeculectomy has reigned supreme as the surgical procedure of choice for glaucoma management for many decades, never the less, our search for a procedure with improved safety and efficacy is persistent. Even though promising results have been reported, deep sclerectomy (DS), as a viable alternative, is not, hitherto, universally accepted.1-5 Deep sclerectomy is one type of non-penetrating glaucoma surgery (NPGS). The decisive advantage of NPGS is that it aims at achieving filtration through surgical dissection on the ocular surface, targeting the site of maximal resistance to the elimination of aqueous, without perforating the globe. By avoiding perforation, this type of surgery prevents the sudden decompression of the eye that is well established during penetrating glaucoma surgery. The breach of the eye's outer surface has been well implicated in many significant complications associated with penetrating glaucoma surgery. In essence, deep sclerectomy, and all types of NPGS, aims at the reduction of these serious complications, as well as the long-term control of intraocular pressure (IOP), thus preventing the deterioration in visual function of the glaucomatous patient. Despite its introduction many decades ago, the procedure failed to dethrone trabeculectomy as the gold standard of glaucoma surgery. Trabeculectomy remains, by far, the procedure with the widest practice among all types of glaucoma surgery. It is a procedure with a well-known track record of efficacy, in which most ophthalmic surgeons receive formal training and acquire wide experience. Never the less, DS has emerged as a viable option to trabeculectomy, mainly because of its well-documented safety profile. This review is an attempt to critically evaluate deep sclerectomy in terms of its histopathological basis, its varying techniques, safety profile and effectiveness. The review will also endeavor to investigate and evaluate issues hindering a wider practice of this surgical procedure.

Sclérectomie profonde: évaluation critique - Deep Sclerectomy: Critical Evaluation

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