Trabeculectomy Augmented with Limited Deep Sclerectomy and Cyclodialysis with Use of Scleral Tissue as a Spacer


Trabeculectomy remains the most commonly performed surgery for medically uncontrolled glaucoma. Its success in primary open angle glaucoma is approximately 82% in the initial year after surgery and 64% at the end of five years. Lower success rates have been found in secondary glaucomas like neovascular glucoma, uvietic glaucoma, post-traumatic glaucoma, and for repeat surgeries. To illustrate improvement of the efficacy of trabeculectomy, enhancement with cyclodialysis has been introduced. This involves the creation of a cyclodialysis cleft in a controlled manner to allow additional suprachoroidal drainage of the aqueous. Cyclodialysis is the result of the separation of the longitudinal ciliary muscle fibers from the scleral spur, which creates an additional pathway for aqueous humor drainage. However, such a cleft often closes on its own due to associated inflammation caused by the filtration surgery. Deep sclerectomy is a non-penetrating surgery that involves dissection of a scleral patch and excision of a block of scleral tissue, retaining a thin membrane for aqueous drainage. In this study, we introduce a novel surgical technique of combining trabeculectomy with a limited deep sclerectomy and a cyclodialysis in two pseudophakic patients who developed secondary glaucoma after vitreo-retinal surgery with silicone oil insertion. In this technique the excised scleral tissue obtained after deep sclerectomy was utilized as a spacer to maintain the patency of the cyclodialysis cleft.


Refractory Glaucoma’s, Cyclodialysis Augmented Trabeculectomy, Deep Sclerectomy

1. Lim SH, Cha SC. Long-term outcomes of mitomycin-C trabeculectomy in exfoliative glaucoma versus primary open-angle glaucoma. J Glaucoma 2017;26:303–310.

2. Dada T, Sharma R, Sinha G, Angmo D, Temkar S. Cyclodialysis-enhanced trabeculectomy with triple Ologen implantation. Eur J Ophthalmol 2016;26:95–97.

3. Roy S, Mermoud A. Deep sclerectomy. Dev Ophthalmol 2017;59:36–42.

4. Cantor LB, Mantravadi A, WuDunn D, Swamynathan K, Cortes A. Morphologic classification of filtering blebs after glaucoma filtration surgery: The Indiana Bleb Appearance Grading Scale. J Glaucoma 2003;12:266–271.

5. Agarwal HC, Sharma TK, Sihota R, Gulati V. Cumulative effect of risk factors on short-term surgical success of mitomycin augmented trabeculectomy. J Postgrad Med 2002;48:92–96.

6. Mithal S, Mathur AG, Gupta A, Kumar S. Failure in glaucoma surgery and its management. Indian J Ophthalmol 1988;36:67–70.

7. Skalicky SE, Lew HR. Surgical outcomes of combined trabeculectomy-cyclodialysis for glaucoma. J Glaucoma 2015;24:37–44.

8. Sihota R, Srinivasan G, Gupta V. Ab-externo cyclodialysis enhanced trabeculectomy for intractable post-penetrating keratoplasty glaucoma. Eye 2010;24:976–979.

9. Feusier M, Roy S, Mermoud A. Deep sclerectomy combined with trabeculectomy in pediatric glaucoma. Ophthalmology 2009;116:30–38.

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

11. Senthil S, Rao HL, Babu JG, Mandal AK, Garudadri CS. Comparison of outcomes of trabeculectomy with mitomycin C vs. ologen implant in primary glaucoma. Indian J Ophthalmol 2013;61:338–342.