title: Effect of a Fenestration Between an Intrascleral Lake and Supraciliary Space on Deep Sclerectomy.
abstract: OBJECTIVE
  To evaluate the effects of a scleral fenestration on the surgical outcomes of modified deep sclerectomy (DS).
  
  
  METHODS
  We retrospectively studied the surgical outcomes of 83 eyes of 83 patients after modified DS for primary open-angle glaucoma (POAG) or ocular hypertension. In 39 eyes, combination of DS, incision of the trabeculo-Descemet's membrane, and iridectomy were performed (DSF-); in 44 eyes, a scleral fenestration between the supraciliary space and lake was added to the DSF- (DSF+). Forty-eight eyes of 48 patients with POAG who underwent trabeculectomy with adjunctive mitomycin C (lect MMC) served as controls.
  
  
  RESULTS
  The probability of bleb survival was more common in the following order: lect MMC>DSF->DSF+ (P=0.0029). A significantly greater intraocular pressure (IOP) reduction occurred in the lect MMC group compared with the DSF+ (P=0.0015) and DSF- (P=0.0006) groups. So far as the eyes that underwent DS were concerned, bleb formation (P=0.0130) and a scleral bed fenestration (P=0.0315) significantly lowered the IOP by the Cox proportional hazard model. In eyes treated with DSF+, the positive IOP-lowering effect of the fenestration was counterbalanced by inhibited bleb formation and resulted in equivalent IOP reductions in the DSF+ and DSF- groups (P=0.9881). IOP reduction by DSF+ without a bleb was 25.0% at 1 year (P=0.00015) and this reduction increased to 43.2% (P=0.0001) when eyes accompany a bleb and scleral fenestration.
  
  
  CONCLUSIONS
  Both the scleral fenestration and bleb formation lower IOP, whereas the scleral fenestration suppresses bleb formation in patients treated with DS.
authors.affiliation: Sensho-kai Eye Institute, Kyoto, Japan.
authors.forename: Etsuo
authors.initials: E
authors.lastname: Chihara
authors.forename: Ken
authors.initials: K
authors.lastname: Hayashi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000477:Alkylating Agents / Q000008:administration & dosage; D001082:Aqueous Humor / Q000502:physiology; D002924:Ciliary Body / Q000502:physiology; D003131:Combined Modality Therapy; D003886:Descemet Membrane / Q000601:surgery; D005110:Extracellular Space / Q000502:physiology; D005260:Female; D005902:Glaucoma, Open-Angle / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D032801:Iridectomy; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D009798:Ocular Hypertension / Q000503:physiopathology / Q000601:surgery; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012590:Sclera / Q000601:surgery*; D012599:Sclerostomy / Q000379:methods*; D014129:Trabecular Meshwork / Q000601:surgery; D014130:Trabeculectomy / Q000379:methods
chemical_list: D000477:Alkylating Agents; D016685:Mitomycin