Deep Sclerectomy Versus Trabeculectomy in Eyes With Penetrating Keratoplasty

Purpose: The aim of this study was to compare deep sclerectomy to trabeculectomy in eyes with penetrating keratoplasty (PK). Methods: In a retrospective comparative case series, 32 consecutive deep sclerectomies (deep sclerectomy group) and 32 matched trabeculectomies (trabeculectomy group) were performed in eyes with PK. Control cases were matched for the timing of glaucoma surgery, number of previous glaucoma surgical procedures, corneal disease, and lens status. The main outcome measures were the success rate of glaucoma surgery and graft survival. Intraocular pressure, graft transparency, and postoperative complications were recorded. The criteria for glaucoma surgery failure were a postoperative intraocular pressure higher than 21 mm Hg or a decrease lower than 30%. Results: The average follow-up time of glaucoma surgery was 29 6 30 months. No significant differences were observed between both groups for all baseline variables and postoperative follow-up time. The success rate of glaucoma surgery was, respectively, 76% and 44% at 1 and 5 years in the deep sclerectomy group and 69% and 49% in the trabeculectomy group (P = 0.69). The graft survival estimates were, respectively, 100% and 73% at 1 and 5 years in the deep sclerectomy group and 87% and 40% in the trabeculectomy group (P = 0.02). Nonimmune postoperative events and nonimmune graft failures were significantly more frequent in the trabeculectomy group compared with the deep sclerectomy group (P = 0.04). Conclusions: Graft survival was higher in eyes with deep sclerectomy compared with trabeculectomy. Deep sclerectomy seems as efficient as, but safer than, trabeculectomy and could be performed as a first-choice treatment in the absence of major peripheral anterior synechiae.