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Nonpenetrating Glaucoma Surgery

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Book cover Advanced Glaucoma Surgery

Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

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Abstract

Trabeculectomy was introduced in the 1960s and it quickly became the standard of care for glaucoma filtering procedures. However, despite numerous advances and modifications, reproducibility of trabeculectomy outcomes remains unsatisfactory with regards to intraocular pressure (IOP) lowering. Furthermore, sudden decompression of the eye occurs upon penetration of the anterior chamber which yields a relatively high risk of early postoperative complications such as overfiltration, hypotony, and choroidal detachment. The need to develop safer and more reliable surgical techniques led to a revival of Krasnov’s concept of nonpenetrating glaucoma surgery (NPGS), in which aqueous is allowed to filter into the subconjunctival space without the removal of a full-thickness block of trabecular tissue. NPGS is efficient at lowering IOP and carries the advantage of a superior safety profile when compared to conventional trabeculectomy. This low complication rate makes it the first choice in many indications especially in young patients. The most widely practised nonpenetrating surgical procedures for glaucoma are viscocanalostomy and deep sclerectomy. Each procedure involves a different level of partial-thickness surgical dissection into the eye’s natural filtration tissues. All these variants require a long and flat learning curve that is still the main cause of its lack of popularity among eye surgeons.

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Acknowledgements

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Ziad Khoueir and Tarek Shaarawy declare that they have no conflict of interest.

No human or animal studies were carried out by the authors for this article.

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Authors and Affiliations

  1. Department of Glaucoma, Beirut Eye Specialist Hospital, Mathaf Square, Hotel-Dieu Street, 116-5311, Beirut, Lebanon

    Ziad Khoueir M.D., M.S.Ed.

  2. Department of Clinical Neurosciences, Ophthalmology Service, University of Geneva, Geneva, Switzerland

    Tarek M. Shaarawy M.D., M.Sc.

Authors
  1. Ziad Khoueir M.D., M.S.Ed.
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  2. Tarek M. Shaarawy M.D., M.Sc.
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Correspondence to Ziad Khoueir M.D., M.S.Ed. .

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Editors and Affiliations

  1. Illinois Eye & Ear Infirmary, University of Illinois at Chicago School of Medicine, Chicago, Illinois, USA

    Ahmad A. Aref

  2. Southern California, LA, CA, USA, USC Eye Ins.Dept. of Ophth. Univ.of Southern California, LA, CA, USA, California, California, USA

    Rohit Varma

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Nonpenetrating glaucoma surgery, Tarek M. Shaarawy, M.D., M.Sc. (MP4 319282 kb)

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Khoueir, Z., Shaarawy, T.M. (2015). Nonpenetrating Glaucoma Surgery. In: Aref, A., Varma, R. (eds) Advanced Glaucoma Surgery. Essentials in Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-319-18060-1_7

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