Viscocanalostomy and deep sclerectomy for the surgical treatment of glaucoma: a longterm follow-up

PURPOSE: To study the outcome of viscocanalostomy (VC) and deep sclerectomy (DS) for the surgical management of medically uncontrolled glaucoma. PATIENTS AND METHODS: A non-randomized, prospective study of all consecutive non-penetrating glaucoma filtering procedures was carried out in two centres. In the first centre, one surgeon (MSW) performed VC in 105 eyes (27 VC and 78 phaco VC). In the second centre, one surgeon (PKW) performed DS in 87 eyes (52 DS and 35 phaco DS). RESULTS: The mean follow-up was 36 months (range 9-60 months). At final follow-up the complete success rate (intraocular pressure < or = 21 Hg without medication) was 92.6% for VC eyes, 96% for phaco VC eyes, 77% for DS eyes and 94% for phaco DS eyes. Kaplan-Meier survival analysis for complete success showed no significant difference between DS and VC nor between phaco VC and phaco DS (p > 0.05). By 36 months postoperatively, mean IOP was 16.8 mmHg (SD 3) in VC eyes, 16.6 mmHg (SD 3.1) in phaco VC eyes, 16.7 mmHg (SD 5.7) in DS eyes and 15 mmHg (SD 3.2) in phaco DS eyes. Postoperative Nd:YAG laser goniopuncture was necessary in 10 eyes in the DS group. Large or cystic drainage blebs occurred only in the DS eyes. CONCLUSIONS: Viscocanalostomy and DS are effective and safe methods of achieving sustained IOP reduction in glaucomatous eyes and both techniques can be successfully combined with cataract extraction.