Nonpenetrating Deep Sclerectomy: Lessons From the Learning Curve

Technical nuances and intraoperative pearls to increase predictability.

Furat Alrajhi, MBBS, and Ohoud Owaidhah, MD

Glaucoma Today

Key Takeaways Mastery of traditional filtration procedures remains essential for glaucoma surgeons. Deep sclerectomy is an effective nonpenetrating procedure with a favorable safety profile, but it requires meticulous technique and careful attention to anatomic landmarks. A systematic approach to deep sclerectomy can help surgeons perform the procedure with confidence and consistency and reduce the risk of complications. Despite the rapid evolution of glaucoma surgery and technological advances, mastery of traditional filtration procedures remains essential for glaucoma surgeons. Deep sclerectomy is an effective nonpenetrating procedure with a favorable safety profile, but its steep learning curve is widely recognized. Although surgical videos are an invaluable educational resource, the technical nuances of deep sclerectomy may be difficult to discern from a visual format alone. This article provides practical tips to clarify the learning process and help surgeons perform deep sclerectomy with greater confidence and consistency. SURGICAL TECHNIQUE Exposure and Traction Suture To establish adequate exposure and globe stabilization, a 6-0 polyglactin traction suture (Vicryl, Ethicon) is placed through the superior corneal limbus, typically using two passes. The suture may be wrapped twice around a hemostat and secured to the surgical drape or left hanging beneath the inferior lid speculum, where gravity provides consistent downward traction. Conjunctival Peritomy A fornix-based conjunctival peritomy is performed in the superonasal or superotemporal quadrant.

A Lifetime of Contact Lens Wear

It’s now possible to meet the visual needs of every generation.

Chandler R. Mann II, OD

Modern Optometry

Lifetime contact lens wear isn’t a distant goal—it’s possible now and reshaping how we approach care for patients of all ages. With significant advances in myopia management and multifocal lens technology, eye care practitioners are uniquely positioned to introduce patients to contact lenses at a young age and help them comfortably wear them throughout their lifetime—from childhood myopia through presbyopia and everything in between. At our practice, this full-spectrum approach informs eveFry patient encounter and conversation. Whether we’re guiding a child toward their first myopia control lens or helping a long-time spectacle wearer transition into multifocal lenses, our goal is to deliver personalized, high-quality care adapted to each patient’s age and lifestyle. This mindset enhances patient outcomes, increases patient satisfaction, encourages long-term contact lens wear, and supports consistent practice growth for the benefit of everyone involved. MYOPIA INTERVENTION Preventive care is the cornerstone of our philosophy, particularly in pediatrics. Studies suggest myopia affects an estimated 40% of US children, and the prevalence for all ages is expected to reach 50% by 2030, underscoring the importance of early intervention.1 By discussing long-term visual health implications and lifestyle considerations with our young patients and their parents, we can make informed and personalized recommendations that support lasting outcomes. For most of my pediatric patients, soft contact lenses are my go-to choice for slowing the progression of myopia. They are easy for children to manage, and in my own experience fitting more than 100 patients, outcomes have been consistently positive. For patients with higher levels of astigmatism, or whose lifestyles make overnight lens wear a better fit, orthokeratology continues to serve as a valuable alternative for myopia management.

Ocular Releases Phase 3 Data for Wet AMD Candidate Axpaxli

Eyetube

Ocular Therapeutix releases its long-awaited SOL-1 phase 3 data for wet AMD drug candidate Axpaxli; Nordic Pharma expands the availability of its novel dry eye therapy Lacrifill; and Alcon launches the only multifocal toric contact lens featuring Water Gradient Technology. Learn more about your ad choices. Visit megaphone.fm/adchoices