Continuing Medical Education: Deep sclerectomy for uveitic glaucoma: long-term outcomes

Purpose To report long-term outcomes of deep sclerectomy (DS) in eyes with raised intraocular pressure (IOP) and glaucoma secondary to uveitis. Patients and methods Retrospective consecutive case series of 43 eyes of 43 patients with uveitic glaucoma. Mitomycin C (MMC) 0.2-0.4mg/ml was applied sub-conjunctivally prior to scleral flap dissection for 2-3min in 35 eyes (81%). Combined phacoemulsification and DS was done in 4 cases (9%). Results Mean follow-up was 68.5 +/- 33.5 months. In total, 23 eyes (53.5%) had previous intraocular surgery. Preoperative IOP was 33.6 +/- 12.0 mm Hg. Mean IOP at one, three and five years after surgery was 15.5 +/- 5.0 mm Hg, 16.9 +/- 6.7 mm Hg and 16.4 +/- 5.2 mm Hg, respectively. The probability of IOP <22 and <19mm Hg was 69 and 62% at 3 years and 60 and 51% at 5 years, respectively. This included eyes that had undergone needle revision and/or laser goniopuncture within that period but had not needed glaucoma medication or further glaucoma procedures. The overall number of glaucoma medications decreased from 3.0 +/- 1.2 to 0.8 +/- 1.2 by last follow-up (P<0.001). Serious complications included hypotony with macular folds in two eyes and occlusion of the trabeculo-Descemet's membrane (TDM) by iris in two eyes. Recurrence of uveitis was observed in 16 eyes. Seven eyes (16.3%) had subsequent procedures including trabeculectomy with MMC in one eye, DS with MMC in two eyes and Baerveldt tube implantation in five eyes. Conclusions DS is a safe and effective procedure to lower IOP in uveitic glaucoma. However, as with other glaucoma procedures, a significant proportion of patients will require another