Central 10-degree visual field change following non-penetrating deep sclerectomy in severe and end-stage glaucoma: preliminary results

  • Igor LeleuEmail author
  • Benjamin Penaud
  • Esther Blumen-Ohana
  • Thibault Rodallec
  • Raphaël Adam
  • Olivier Laplace
  • Jad Akesbi
  • Jean-Philippe Nordmann



To report the impact of non-penetrating deep sclerectomy (NPDS) in severe and end-stage glaucoma treatment on the central 10° visual field progression (mean deviation, four central points, foveal threshold) and assess the risk of sudden visual loss.


Monocenter database study. We reviewed records of 34 eyes with severe or end-stage glaucoma that underwent NPDS between 2009 and 2015, at the National Ophthalmology Center of XV-XX (Paris, France). Severe and end-stage glaucoma were defined according to the Bascom Palmer Modified Glaucoma Staging System classification. All eyes had a constricted visual field < 10° (severe injury by the Humphrey visual field automated (HVFA) 10-2). Visual fields were recorded every 6 months after the procedure. Data from the last visit was used for the statistical analysis.


The mean follow-up duration was 29 months (range 6 to 54) and 33 (97%) eyes were followed for more than 1 year. There were no cases of postoperative sudden visual loss. The intraocular pressure (IOP) decreased from 21.9 ± 8.1 to 15.0 ± 5.4 mmHg (P < .001). Twenty-eight (82%) eyes had an IOP < 21 mmHg and 19 (56%) an IOP < 16 mmHg. The MD 10-2 remained stable (− 19.8 ± 7.4 to − 19.4 ± 8.1 dB, non-significant improvement of + 0.4 dB, P = .1). The MD 10-2 slope showed an insignificant improvement of + 0.25 ± 1.8 dB per year (dB/y) (P = 0.1), but this slope was significantly better when the IOP was reduced to < 16 mmHg than when the IOP was ≥ 16 mmHg at the last visit (+ 0.84  1.2 versus − 0.48 ± 2.2 dB/y, P = .05). The mean number of the four central test points with sensitivity ≤ 5 dB and the change in mean sensitivity of the four central field points remained stable. There were no significant changes in the VFI (from 25.4% ± 13 to 25.8% ± 20) and in foveal threshold.


NPDS appears to provide stability of the central 10° visual field (with a trend towards improvement but non-significant) with no occurrence of “wipe-out” phenomenon and few other complications. Consideration of NPDS in end-stage and severe glaucoma is advisable given its low risk of complications and its considerable IOP decrease with a relative stability of the central visual field.


End-stage glaucoma Filtering surgery Deep sclerectomy Humphrey visual field Sudden visual loss 



Non-penetrating deep sclerectomy


Intraocular pressure


Mean deviation


Visual function index


Humphrey visual field automated


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

For this type of study formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Heijl A, Leske MC, Bengtsson B, Hyman L, Bengtsson B, Hussein M et al (2002) Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial. Arch Ophthalmol 120(10):1268–1279PubMedGoogle Scholar
  2. 2.
    Collaborative Normal-Tension Glaucoma Study Group (1998) Comparison of glaucomatous progression between untreated patients with normal-tension glaucoma and patients with therapeutically reduced intraocular pressures. Am J Ophthalmol 126(4):487–497Google Scholar
  3. 3.
    Lichter PR, Musch DC, Gillespie BW, Guire KE, Janz NK, Wren PA et al (2001) Interim clinical outcomes in the collaborative initial Glaucoma treatment study comparing initial treatment randomized to medications or surgery. Ophthalmology 108(11):1943–1953PubMedGoogle Scholar
  4. 4.
    The Advanced Glaucoma Intervention Study (AGIS): 7 (2000) The relationship between control of intraocular pressure and visual field deterioration. The AGIS investigators. Am J Ophthalmol 130(4):429–440Google Scholar
  5. 5.
    Rao HL, Begum VU, Khadka D, Mandal AK, Senthil S, Garudadri CS (2015) Comparing glaucoma progression on 24-2 and 10-2 visual field examinations. PLoS One 10(5):e0127233PubMedPubMedCentralGoogle Scholar
  6. 6.
    Blumberg DM, De Moraes CG, Prager AJ, Yu Q, Al-Aswad L, Cioffi GA et al (2017) Association between undetected 10-2 visual field damage and vision-related quality of life in patients with glaucoma. JAMA Ophthalmol 135(7):742–747PubMedPubMedCentralGoogle Scholar
  7. 7.
    Aggarwal SP, Hendeles S (1986) Risk of sudden visual loss following trabeculectomy in advanced primary open-angle glaucoma. Br J Ophthalmol 70(2):97–99PubMedPubMedCentralGoogle Scholar
  8. 8.
    Costa VP, Smith M, Spaeth GL, Gandham S, Markovitz B (1993) Loss of visual acuity after trabeculectomy. Ophthalmology 100(5):599–612PubMedGoogle Scholar
  9. 9.
    Topouzis F, Tranos P, Koskosas A, Pappas T, Anastasopoulos E, Dimitrakos S et al (2005) Risk of sudden visual loss following filtration surgery in end-stage glaucoma. Am J Ophthalmol 140(4):661–666PubMedGoogle Scholar
  10. 10.
    Marques A (2014) Managing advanced unilateral pseudoexfoliative glaucoma. BMJ Case Rep. Google Scholar
  11. 11.
    Ates H, Andac K, Uretmen O (1999) Non-penetrating deep sclerectomy and collagen implant surgery in glaucoma patients with advanced field loss. Int Ophthalmol 23(3):123–128PubMedGoogle Scholar
  12. 12.
    Gierek-Lapińska A, Leszczyński R, Wróbel A (2004) Non-penetrating deep sclerectomy in the treatment of advanced cases of open angle glaucoma. Klin Ocz 106(1–2 Suppl):168–169Google Scholar
  13. 13.
    Mills RP, Budenz DL, Lee PP, Noecker RJ, Walt JG, Siegartel LR et al (2006) Categorizing the stage of glaucoma from pre-diagnosis to end-stage disease. Am J Ophthalmol 141(1):24–30PubMedGoogle Scholar
  14. 14.
    Law SK, Nguyen AM, Coleman AL, Caprioli J (2007) Severe loss of central vision in patients with advanced glaucoma undergoing trabeculectomy. Arch Ophthalmol 125(8):1044–1050PubMedGoogle Scholar
  15. 15.
    Rao HL, Raveendran S, James V, Dasari S, Palakurthy M, Reddy HB et al (2017) Comparing the performance of compass perimetry with Humphrey field analyzer in eyes with glaucoma. J Glaucoma 26(3):292–297PubMedGoogle Scholar
  16. 16.
    Bengtsson B, Heijl A (2000) False-negative responses in glaucoma perimetry: indicators of patient performance or test reliability? Invest Ophthalmol Vis Sci 41(8):2201–2204PubMedGoogle Scholar
  17. 17.
    Katz J, Sommer A, Witt K (1991) Reliability of visual field results over repeated testing. Ophthalmology 98(1):70–75PubMedGoogle Scholar
  18. 18.
    Aptel F, Bron AM, Lachkar Y, Schweitzer C (2017) Change in visual field progression following treatment escalation in primary open-angle glaucoma. J Glaucoma 26(10):875–880PubMedGoogle Scholar
  19. 19.
    Zalta AH (1991) Use of a central 10 degrees field and size V stimulus to evaluate and monitor small central islands of vision in end stage glaucoma. Br J Ophthalmol 75(3):151–154PubMedPubMedCentralGoogle Scholar
  20. 20.
    Popovic V, Sjöstrand J (1991) Long-term outcome following trabeculectomy: II. Acta Ophthalmol 69(3):305–309Google Scholar
  21. 21.
    Bhardwaj N, Niles PI, Greenfield DS, Hymowitz M, Sehi M, Feuer WJ et al (2013) The impact of surgical intraocular pressure reduction on visual function using various criteria to define visual field progression. J Glaucoma 22(8):632–637PubMedPubMedCentralGoogle Scholar
  22. 22.
    Sponsel WE, Groth SL (2013) Mitomycin-augmented non-penetrating deep sclerectomy: preoperative gonioscopy and postoperative perimetric, tonometric and medication trends. Br J Ophthalmol 97(3):357–361PubMedGoogle Scholar
  23. 23.
    Gesser C, Wiermann A, Keserü M, Richard G, Klemm M (2014) Long-term follow-up after deep sclerectomy. Klin Monatsbl Augenheilkd 231(5):535–539PubMedGoogle Scholar
  24. 24.
    Carrillo MM, Artes PH, Nicolela MT, LeBlanc RP, Chauhan BC (2005) Effect of cataract extraction on the visual fields of patients with glaucoma. Arch Ophthalmol 123(7):929–932PubMedGoogle Scholar
  25. 25.
    Helmy H (2016) Phacoemulsification combined with deep sclerectomy augmented with mitomycin and amniotic membrane implantation in chronic primary open angle glaucoma with cataract. Electron Physician 8(4):2218–2226PubMedPubMedCentralGoogle Scholar
  26. 26.
    Chen PP, Budenz DL (1998) The effects of cataract extraction on the visual field of eyes with chronic open-angle glaucoma. Am J Ophthalmol 125(3):325–333PubMedGoogle Scholar
  27. 27.
    Moster MR, Moster ML (2005) Wipe-out: a complication of glaucoma surgery or just a blast from the past? Am J Ophthalmol 140(4):705–706PubMedGoogle Scholar
  28. 28.
    Fujishiro T, Mayama C, Aihara M, Tomidokoro A, Araie M (2011) Central 10-degree visual field change following trabeculectomy in advanced open-angle glaucoma. Eye 25(7):866–871PubMedPubMedCentralGoogle Scholar
  29. 29.
    Kolker AE (1977) Visual prognosis in advanced glaucoma: a comparison of medical and surgical therapy for retention of vision in 101 eyes with advanced glaucoma. Trans Am Ophthalmol Soc 75:539–555PubMedPubMedCentralGoogle Scholar
  30. 30.
    Suominen SMA, Harju MP, Vesti ET (2016) Deep sclerectomy in primary open-angle glaucoma and exfoliative glaucoma. Eur J Ophthalmol 26(6):568–574PubMedGoogle Scholar
  31. 31.
    Moreno-López M, Pérez-Alvarez MJ (2006) Short- and medium-term intraocular pressure lowering effects of combined phacoemulsification and non-penetrating deep sclerectomy without scleral implant or antifibrotics. Arch Soc Esp Oftalmol 81(2):93–100PubMedGoogle Scholar
  32. 32.
    Ambresin A, Shaarawy T, Mermoud A (2002) Deep sclerectomy with collagen implant in one eye compared with trabeculectomy in the other eye of the same patient. J Glaucoma 11(3):214–220PubMedGoogle Scholar
  33. 33.
    Parrish RK, Feuer WJ, Schiffman JC, Lichter PR, Musch DC, CIGTS Optic Disc Study Group (2009) Five-year follow-up optic disc findings of the collaborative initial glaucoma treatment study. Am J Ophthalmol 147(4):717–724.e1PubMedPubMedCentralGoogle Scholar
  34. 34.
    Musch DC, Gillespie BW, Lichter PR, Niziol LM, Janz NK, CIGTS Study Investigators (2009) Visual field progression in the Collaborative Initial Glaucoma Treatment Study the impact of treatment and other baseline factors. Ophthalmology 116(2):200–207PubMedGoogle Scholar
  35. 35.
    EGS Foundation (2014) European Glaucoma Society Terminology and Guidelines for Glaucoma, 4th Edition - Part 1, Savona, ItalyGoogle Scholar
  36. 36.
    Blumenthal EZ, Horani A, Sasikumar R, Garudadri C, Udaykumar A, Thomas R (2006) Correlating structure with function in end-stage glaucoma. Ophthalmic Surg Lasers Imaging 37(3):218–223PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018
corrected publication July/2018

Authors and Affiliations

  • Igor Leleu
    • 1
    Email author
  • Benjamin Penaud
    • 1
  • Esther Blumen-Ohana
    • 1
  • Thibault Rodallec
    • 1
  • Raphaël Adam
    • 1
  • Olivier Laplace
    • 1
  • Jad Akesbi
    • 1
  • Jean-Philippe Nordmann
    • 1
  1. 1.Centre Hospitalier National d’Ophtalmologie des XV-XX, Service du Pr. NORDMANNParisFrance

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