Deep sclerectomy with trabeculotomy ab externo: one-stage procedure (DS 1)

Our new full-thickness filtering procedure was performed on 20 eyes with narrow-angle glaucomas (15 patients, mean age 69 +/- 12 years) with high intraocular pressure (IOP) despite initial peripheral iridectomy. This procedure was intended to maintain anterior chamber depth completely during intraoperative and postoperative periods. Under conjunctival and thin scleral flaps, the deep (4 X 1.5 mm) scleral block containing the outer wall of Schlemm's canal was removed. After closing the scleral flap with eight interrupted sutures and the conjunctival flap with a running suture, a 1-mm spatula was inserted beneath the scleral flap, and the trabeculum was punctured. The mean preoperative and final postoperative IOPs were 34.8 +/- 17.2 mm Hg and 14.9 +/- 4.9 mm Hg, respectively. Follow-up time was at least 12 months. Final postoperative IOP was less than 21 mm Hg without oral medication in 16 eyes (80.0%). The only complication was slight bleeding from the punctured trabeculum. This bleeding was completely absorbed within a week.