Journal of Ophthalmic and Vision Research

Published date: Jul 30 2025

Journal Title: Journal of Ophthalmic and Vision Research

Issue title: ‎Volume 20 - 2025

Pages: 1 - 8

DOI: 10.18502/jovr.v20.15249

Mahdi Sharifzadeh Kermanimsharif3000@yahoo.comClinical Research Development Unit, Shafa Hospital, Kerman University of Medical Sciences, Kerman

Sana Jalalmaneshsana.jalalmanesh1991@gmail.comClinical Research Development Unit, Shafa Hospital, Kerman University of Medical Sciences, Kerman

Hesam Fat'hi-zadehhesamfathizadeh1991@gmail.comClinical Research Development Unit, Shafa Hospital, Kerman University of Medical Sciences, Kerman

Ali Sharifisharifialim2@gmail.comClinical Research Development Unit, Shafa Hospital, Kerman University of Medical Sciences, Kerman

Amin Zandsandpost3@gmail.comClinical Research Development Unit, Shafa Hospital, Kerman University of Medical Sciences, Kerman

Purpose: To evaluate the impact of inadvertent intraoperative microperforation of the trabeculo- Descemet’s membrane (TDM) on postoperative outcomes in cases with cataract and either primary open-angle glaucoma (POAG) or pseudoexfoliative glaucoma (PEXG) during combined phacoemulsification and deep sclerectomy (PDS).
Methods: In this prospective case–control study, 73 eyes of 73 patients with cataract and POAG/PEXG who underwent PDS were enrolled. Patients were divided into two groups based on the presence or absence of inadvertent intraoperative TDM microperforation. The primary outcome measures included intraocular pressure (IOP), number of antiglaucoma drugs, and assessment of adverse effects during a six-month follow-up period.
Results: Significant decreases in IOP were observed at all follow-up time points (day 7, month 1, and month 6) in both groups compared to baseline (P < 0.001). No significant differences in IOP were found between the groups at any time point, except on day 7, while the perforation group exhibited a significantly lower IOP compared to the non-perforation group (11.84 ± 4.78 vs 14.03 ± 2.50 mmHg, P = 0.017). At month 6, the mean number of antiglaucoma drugs was 0.19 ± 0.46 in the perforation group and 0.06 ± 0.23 in the non-perforation group, suggesting a significant reduction in both groups compared to baseline (P < 0.001) with no statistically significant difference between the two groups (P = 0.124). Hypotony was observed in 3 (8.1%) eyes with perforation, but it resolved without persistent complications in subsequent follow-ups.
Conclusion: Inadvertent TDM microperforation during PDS for POAG or PEXG did not impact IOP outcomes compared to non-perforated cases over a six-month period, nor did it increase the incidence of complications.

Keywords: Deep Sclerectomy, Intraocular Pressure; Microperforation, Open-angle Glaucoma, Pseudoexfoliation, Trabeculo-Descemet’s Membrane

1. Zimmerman TJ, Kooner KS, Ford VJ, Olander KW, Mandlekorn RM, Rawlings EF, et al. Trabeculectomy vs. nonpenetrating trabeculectomy: a retrospective study of two procedures in phakic patients with glaucoma. Ophthalmic Surg 1984;15:734–740.

2. Vuori ML. Gonioscopic view of the trabeculo-Descemet’s membrane after deep sclerectomy. Acta Ophthalmol Scand 2004;82:154–157.

3. Anand N, Atherley C. Deep sclerectomy augmented with mitomycin C. Eye (Lond) 2005;19:442–450.

4. Anand N, Pilling R. Nd:YAG laser goniopuncture after deep sclerectomy: Outcomes. Acta Ophthalmol 2010;88:110–115.

5. Kozobolis VP, Christodoulakis EV, Tzanakis N, Zacharopoulos I, Pallikaris IG. Primary deep sclerectomy versus primary deep sclerectomy with the use of mitomycin C in primary open-angle glaucoma. J Glaucoma 2002;11:287–293.

6. Mermoud A, Karlen ME, Schnyder CC, Sickenberg M, Chiou AG, Hédiguer SE, et al. Nd:Yag goniopuncture after deep sclerectomy with collagen implant. Ophthalmic Surg Lasers 1999;30:120–125.

7. Roy S, Mermoud A. Deep sclerectomy. In: Bettin P, Khaw PT, eds. Glaucoma surgery. Karger; 2017:36–42.

8. Khan OA, Sesma G, Alawi A, AlWazae M. Outcomes of non-penetrating deep sclerectomy for primary congenital glaucoma performed by experienced versus trainee surgeons: A cohort study. Clin Ophthalmol 2023;17:897–906.

9. AlQattan A, Schargel K, AlJadaan I, AlZendi N, Sesma G. Effect of trabeculodescemetic window perforation in deep sclerectomy on intraocular pressure in primary congenital glaucoma. Ophthalmol Ther 2024;13:581–596.

10. Papadopoulos M, Edmunds B, Fenerty C, Khaw PT. Childhood glaucoma surgery in the 21st century. Eye (Lond) 2014;28:931–943.

11. Rękas M, Rudowicz J, Lewczuk K, Kluś A, Pawlik B, Stankiewicz A. Phacoemulsification-deep sclerectomy modified by trabeculum microperforations and implantation of lens anterior capsule as autologous scleral implant. Curr Med Res Opin 2010;26:2025–2032.

12. Dietlein TS, Jacobi PC, Lüke C, Krieglstein GK. Morphological variability of the trabecular meshwork in glaucoma patients: Implications for non-perforating glaucoma surgery. Br J Ophthalmol 2000;84:1354–1359.

13. AlDarrab A, Malik R. Bilateral deep sclerectomy with microperforations as a successful secondary procedure in aniridia-associated glaucoma. Middle East Afr J Ophthalmol 2018;25:52–55.

14. Ding C, Zeng J. Clinical study on Hypotony following blunt ocular trauma. Int J Ophthalmol 2012;5:771–773.

15. Teekhasaenee C, Ritch R. The use of PhEA 34c in trabeculectomy. Ophthalmology 1986;93:487–491.

16. Sunaric-Mégevand G, Leuenberger PM. Results of viscocanalostomy for primary open-angle glaucoma. Am J Ophthalmol 2001;132:221–228.

17. Kobayashi H, Kobayashi K. Randomized comparison of the intraocular pressure-lowering effect of phacoviscocanalostomy and phacotrabeculectomy. Ophthalmology 2007;114:909–914.

18. Elbably A, Othman TM, Mousa A, Elridy M, Badawy W, Elbably M. Deep sclerectomy with porous collagen in open-angle glaucoma, short-term study. J Curr Glaucoma Pract 2018;12:85–89.

19. Mercieca K, Shevade B, Anand N. Outcomes of combined phacoemulsification and deep sclerectomy: A 10-year UK single-centre study. Eye (Lond) 2015;29:1495–1503.

20. Marek R, Joanna W, Lewczuk K, Siemiatkowska A, Stankiewicz A. Efficacy and safety of deep sclerectomy and phacoemulsification and deep sclerectomy in clinical material of Military Health Service Institute—Yearly observations. Klin Oczna 2006;108:385–391.

21. Khairy HA, Green FD, Nassar MK, Azuara-Blanco A. Control of intraocular pressure after deep sclerectomy. Eye (Lond) 2006;20:336–340.

22. Suominen S, Harju M, Ihanamäki T, Vesti E. The effect of deep sclerectomy on intraocular pressure of normal-tension glaucoma patients: 1-year results. Acta Ophthalmol 2010;88:27–32.

23. Lachkar Y, Neverauskiene J, Jeanteur-Lunel MN, Gracies H, Berkani M, Ecoffet M, et al. Nonpenetrating deep sclerectomy: A 6-year retrospective study. Eur J Ophthalmol 2004;14:26–36.

24. Kozobolis V, Kalogianni E, Sideroudi H. Penetrating deep sclerectomy in primary open-angle and pseudoexfoliative glaucoma. Eur J Ophthalmol 2020;30:264–268.

25. Shaarawy T, Nguyen C, Schnyder C, Mermoud A. Comparative study between deep sclerectomy with and without collagen implant: Long term follow up. Br J Ophthalmol 2004;88:95–98.

26. Dagres E, Wishart M. Perforation of the trabecular– Descemet window during intended non-penetrating glaucoma surgery combined with phacoemulsification (phacoviscocanalostomy) does not affect outcome. Invest Ophthalmol Vis Sci 2006;47:38.

27. Pullig B, Koerber NJ, Dietlein T. Can perforations of Descemet’s window (DW) improve the outcome of canaloplasty in open angle glaucoma? Graefes Arch Clin Exp Ophthalmol 2019;257:1733–1740.

28. Sharifipour F, Yazdani S, Asadi M, Saki A, Nouri-Mahdavi K. Modified deep sclerectomy for the surgical treatment of glaucoma. J Ophthalmic Vis Res 2019;14:144–150.

29. Kalala A, Gillmann K, Mermoud A. Prospective evaluation of penetrating deep sclerectomy in advanced open-angle glaucoma: Filtration surgery adapted to resource scarcity in developing countries. J Fr Ophtalmol 2020;43:228–236.

30. Sanchez E, Schnyder CC, Mermoud A. Résultats comparatifs de la sclérectomie profonde transformée en trabéculectomie et de la trabéculectomie classique. Klin Monbl Augenheilkd 1997;210:261–264.

31. Karaconji T, Mercieca K, Romera P, McNaught A, Anand N. A comparison of deep sclerectomy trainer versus trainee outcomes. J Glaucoma 2019;28:427–432.