Efficacy and Tolerability of Nonpenetrating Filtering Surgery in the Treatment of Open-Angle Glaucoma: A Meta-Analysis

Department of Ophthalmology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Ophthalmologica (Impact Factor: 1.68). 10/2009; 224(3):138-46. DOI: 10.1159/000236039
Source: PubMed


To evaluate the efficacy and tolerability of nonpenetrating filtering surgery in the treatment of patients with open-angle glaucoma.
Pertinent studies were selected by extensive searches. A total of 17 randomized controlled trials were included in the present meta-analysis. The main outcome measures were risk differences (RDs) of complete success for efficacy and postoperative complications for tolerability. Pooled estimates were computed according to a random-effects model.
Viscocanalostomy and deep sclerectomy were significantly less effective than tra- beculectomy, and pooled RDs of complete success were -0.16 (95% confidence interval, CI, -0.30 to -0.02) and -0.10 (-0.19 to 0.00). Deep sclerectomy plus mitomycin C (MMC) was also less effective than trabeculectomy plus MMC, with pooled RD of complete success being -0.16 (95% CI -0.32 to -0.01). Viscocanalostomy and deep sclerectomy caused main complications in fewer patients than trabeculectomy.
Viscocanalostomy and deep sclerectomy were less effective than trabeculectomy in the treatment of open-angle glaucoma, and deep sclerectomy plus MMC was also less effective than trabeculectomy plus MMC. However, viscocanalostomy and deep sclerectomy were associated with fewer complications than trabeculectomy.

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    • "Several previous meta-analyses have assessed the efficacy of NPGS [2–5, 41]. We published the first meta-analysis on the same subject, in which totally 37 article were reviewed, including randomized clinical trials, prospective series of cases, and retrospective studies, and only the pooled complete success rates were estimated [4]. "
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    ABSTRACT: To evaluate the intraocular pressure (IOP)-lowering effects achieved by nonpenetrating glaucoma surgery (NPGS) and its modifications in patients with open angle glaucoma. Randomized controlled trials evaluating patients with primary and secondary open angle glaucoma treated with NPGS were identified through systematic searches. The main outcome measures were the percentage IOP reduction and the complete success rate. Complete success was defined as target endpoint IOP (usually less than 21 mm Hg) without medications. The pooled estimates were calculated using the random effects model. Both deep sclerectomy (DS) and viscocanalostomy (VCO) were less effective than trabeculectomy (TE) in lowering IOP, with the percentage IOP reductions at 2 years being 35.2% for DS, 30.2% for VCO, and 45.6% for TE. Intraoperative use of implants and mitomycin C (MMC) increased IOP-lowering effects of DS, with IOP reductions at 2 years of 41.1% and 41.7%, respectively. The complete success rates at 4 years were 35.4% for DS, and 22.7% for VCO, lower than that of TE (47.6%). The complete success rates of DS with implants and MMC of 64.6% and 52.1%, respectively, at 4 years, were greater than that of primary DS. NPGS caused major complications in fewer patients than did TE. Primary deep sclerectomy and primary viscocanalostomy, which can significantly lower IOP, were associated with fewer complications than was TE. However, the IOP-lowering effects of both NPGS seem to be lower than that of primary TE. The efficacy of DS can be improved with the intraoperative use of implants and MMC.
    Medical science monitor: international medical journal of experimental and clinical research 07/2011; 17(7):RA155-63. DOI:10.12659/MSM.881840 · 1.43 Impact Factor
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    • "The postoperative results (“total success”, “relative success”, “complete failure”) from group A are comparable to classic DS with or without implant, with the same or longer follow-up time, even though comparing the results of different studies is difficult. Therefore, some authors5,9,13,19,23,40,46,47 report complete success in 40%–70% of their cases and relative success in 85.0%–97.7%5,9,19,23,40,47 with mean postoperative reduction of IOP at 25%–50%.9,13,23,40,46,47 "
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    ABSTRACT: To present the technique of a modified deep sclerectomy, which we will call "reversed" deep sclerectomy (RDS) and the results and our observations of its use in patients with open angle glaucoma (OAG) and with or without cataract extraction (phacoemulsification). This prospective study included 132 eyes which underwent RDS: 37 eyes (group A) with uncontrolled OAG and 95 eyes (group B) with OAG and visually significant cataract. Mean pressure preoperatively for group A was 24.48 +/- 4.92 mmHg and for group B was 22.99 +/- 3.00. The mean number of antiglaucoma drugs received was 2.97 +/- 0.69 and 2.56 +/- 0.73 for groups A and B respectively. The RDS was performed where the deep scleral stroma is prepared in 2 parts, folded and inserted under the lateral sides of the sclerectomy, and the Schlemm's canal is opened prior to deep scleral stroma preparation. Cataract was extracted by phacoemulsification through the same scleral opening. The follow-up for group A was 22.23 +/- 10.18 months and for group B, 25.36 +/- 10.12 months. Postoperative intraocular pressure (IOP) </= 21 mmHg was achieved for group A in 40.5% without antiglaucoma drugs and 94.6% with antiglaucoma drugs, and for group B in 66.3% and in 94.7% respectively. Mean IOP reduction was 7.02 +/- 6.35 mmHg (28.67%, P < 0.05) for group A and 5.26 +/- 3.72 mmHg (25.06%, P </= 0.05) for group B, while mean drug reduction was 1.97 +/- 1.09 (P < 0.01) and 2.14 +/- 0.95 (P </= 0.01) respectively. 5-Fluorouracil was used in 8 eyes of group A and in 5 eyes of group B. In the follow-up time during which the two groups were under study, the RDS was effective with a few complications, similar to the classic deep sclerectomy using implants or not, with the advantage, in our opinion, of a short learning curve.
    Clinical Ophthalmology 07/2010; 4(1):695-701. · 0.76 Impact Factor
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    ABSTRACT: To determine whether the removal of the inner wall of Schlemm's canal (external trabeculectomy) improves the effectiveness of a modified method of deep sclerectomy (DS), which we will call "reversed" deep sclerectomy (RDS). We conducted a prospective study of two groups of patients. Group A included 22 eyes of 18 patients with open angle glaucoma (OAG) under maximum medical treatment, which underwent RDS - a modified method of performing DS - with the removal of the inner wall of Schlemm's canal (external trabeculectomy) and without using any implant. Group B included 20 eyes of 17 patients which had undergone RDS alone. Demographic and tonometric data of patients of Group A revealed no significant difference from data of patients in Group B. A mean follow up period for Group A was 22.8 months and for Group B was 23.4 months. The outcome of the operations was termed a total success when intraocular pressure (IOP) was <21 mmHg postoperatively, without additional treatment, relative success when IOP was <21 mmHg with additional treatment and a total failure when IOP >21 mmHg with medical treatment. Total success was achieved in 18/22 eyes (81.8%) for Group A and in 8/20 eyes (40%) for Group B (P < 0.05). Relative success was achieved in 22/22 (100%) for Group A and in 17/20 eyes (85%) in Group B (P = NS). Total failure occurred in 0/22 eyes (0%) in Group A and in 3/20 (15%) eyes in Group B (P = NS). The mean postoperative IOP in Group A was 13.5 +/- 2.8 mmHg with a reduction of 12.4 +/- 4.6 mmHg (48.1%) and in Group B mean postoperative IOP was 18 +/- 4.3 mmHg with a reduction of 6.2 +/- 6.9 (25.6%) (P < 0.001). Mean drug reduction postoperatively was 3.2 +/- 0.9 drugs in Group A and 1.7 +/- 1.2 in Group B (P < 0.001). In the follow up time during which the two groups were under study (12-36 months), the removal of the inner wall of Schlemm's canal while performing RDS proves an important factor in improving its effectiveness.
    Clinical Ophthalmology 06/2010; 4(1):557-64. · 0.76 Impact Factor
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