Non-penetrating deep sclerectomy in Moscow: effective glaucoma treatment
With glaucoma, the danger isn't always immediately apparent. Vision may remain normal, there may be no pain, and few complaints. However, pressure inside the eye is already damaging the structures responsible for transmitting visual signals.
At K+31 in Moscow, we select glaucoma treatment strategies after diagnosis. If eye drops aren't effective enough, we may consider non-penetrating deep sclerectomy as a surgical option to reduce eye strain.
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When we recommend NGSE
Surgery is considered after an in-person evaluation. We look at:
- Pressure
- Optic fibers
- Visual field
- Corneal thickness
- Anterior chamber angle
- Treatment tolerance
Sometimes the patient doesn't notice any deterioration, but the examination already shows negative dynamics. In this situation, glaucoma surgery helps keep the disease under control.
Main Indications
A reason for surgery arises when routine monitoring is no longer sufficient. For example, in open-angle glaucoma:
- Pressure remains above the desired level
- The optic nerve is changing
- The visual field, according to perimetry data, gradually narrows
If drops do not provide a stable effect or cause significant discomfort, the doctor may suggest surgical treatment.
Glaucoma does not disappear after surgery. Therefore, the patient still needs examinations, pressure monitoring, and ongoing follow-up.
When this method may not be suitable
Not every case of glaucoma is suitable for microsurgical intervention. In cases of angle-closure, active inflammation, severe scarring, some secondary forms, and severe tissue changes, the doctor may choose another method. Sometimes, a more precise diagnosis or stabilization of the eye's condition is necessary first.
If eye drops are maintaining pressure well and examinations are stable, surgery may be premature. In advanced cases and very high pressure, a non-invasive approach is sometimes insufficient.
Therefore, glaucoma surgery is planned only after assessing the indications and risks.
General information
How the surgery is performed in our practice
We explain the patient's journey in advance. First, we confirm the diagnosis, then discuss the purpose of the procedure, restrictions, and post-operative care. The patient understands which examinations are needed and when follow-up appointments will be. This reduces anxiety and helps them adhere to recommendations.
Preparing for the procedure
A pre-operative examination is performed. The doctor also clarifies the patient's chronic illnesses, allergies, previous surgeries, and medications they are taking regularly. Preparation includes:
- Ophthalmologist consultation
- History collection
- Tonometry
- Pressure dynamics assessment
- Optic nerve examination
- Anterior chamber angle examination
- Discussion of treatment, including eye drops
- Preoperative regimen recommendations
After preparation, the patient receives instructions. If tests or consultations with other specialists are needed, the doctor explains the reason.
Main stages of the surgery
The procedure is performed under an operating microscope. The surgeon creates a superficial and deep scleral flap, working with the Schlemm's canal area and the trabeculodescemet membrane. A pathway is then created to facilitate the outflow of intraocular fluid.
After the procedure, the doctor evaluates the tightness and condition of the eye. If intraocular pressure is not reduced sufficiently, an additional laser procedure may sometimes be necessary.
Anesthesia and Procedure Duration
The procedure is performed under local anesthesia. The patient should not feel significant pain. However, they may feel light, touch, or irrigation. The duration depends on the anatomy of the eye and the extent of the procedure. Before the surgery, the doctor will explain what to expect.
After the procedure, the patient remains under observation. They can go home after receiving permission from the specialist. During the first 24 hours, the following are especially important:
- Rest
- Carefulness
- Prescribed medications
Frequently Asked Questions
Before surgery, it's important for patients to understand what will be done and what to expect. The answers below are not intended to replace an in-person consultation.
Who is this surgery suitable for?
How does non-penetrating DSE differ from trabeculectomy?
What is post-operative recovery like?
Post-operative recovery includes drops, examinations, and time restrictions. Rehabilitation during this period is supervised by a doctor. In the first few days, avoid rubbing the eye, lifting heavy objects, overheating, and skipping appointments. The doctor makes the final decision based on pressure dynamics and tissue condition.
If you need a consultation about glaucoma in Moscow, contact "K+31." We will conduct an examination, explain the results, and select a safe course of action.
When glaucoma surgery or surgical treatment is indicated, the doctor will explain in detail the preparation, procedure, and follow-up. The goal is to preserve visual function as much as the eye's condition allows.
References
- Clinical Guidelines Portal of the Ministry of Health of the Russian Federation — https://cr.minzdrav.gov.ru/
- Russian Medical Journal, Ophthalmology Section — https://www.rmj.ru/articles/oftalmologiya/
- Ophthalmology Bulletin — https://www.mediasphera.ru/journal/vestnik-oftalmologii
- EyePress — ophthalmology portal — https://www.eyepress.ru/
- eLibrary — scientific library — https://www.elibrary.ru/
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What is non-penetrating deep sclerectomy?
This is a microsurgical procedure that improves the drainage of aqueous humor from the eye. The surgeon does not open the anterior chamber extensively, so this method is considered a more gentle procedure.
The main goal is to reduce intraocular pressure and relieve the strain on the optic nerves. The surgery does not restore lost visual functions, so monitoring remains mandatory.
Principle of the Method
Aqueous humor is constantly produced in the eye. Normally, it passes through the trabecular meshwork and drains through the drainage pathways. If the outflow of aqueous humor is impaired, pressure increases, and glaucoma can progress without pain or acute symptoms.
During the procedure, the ophthalmic surgeon creates a thin filtration zone in the sclera. The fluid begins to drain more gently, without a sharp pressure drop. After surgery, a filtration bleb may form—an area under the conjunctiva that helps distribute aqueous humor.
How does NDSE differ from other glaucoma surgeries?
It differs from penetrating procedures in that the anterior chamber of the eye is not fully opened. This allows for greater tissue stability, and early recovery is often more rapid. However, this method is not suitable for everyone. The decision depends on the severity of the disease, the level of pressure, the state of the anterior chamber angle, and previous surgeries.
Trabeculectomy is a penetrating procedure. It may be considered for more severe glaucoma, when a different level of pressure reduction is needed.
If the condition is stable, and the medications are well tolerated and maintain values within the target range, drug therapy remains the mainstay of treatment. Stopping drops or changing the regimen is not permitted without a doctor's permission.