Journal Mobile Options
Table of Contents
Vol. 224, No. 3, 2010
Issue release date: April 2010
Ophthalmologica 2010;224:138–146

Efficacy and Tolerability of Nonpenetrating Filtering Surgery in the Treatment of Open-Angle Glaucoma: A Meta-Analysis

Cheng J.-W. · Xi G.-L. · Wei R.-L. · Cai J.-P. · Li Y.
aDepartment of Ophthalmology, Changzheng Hospital, and bCenter for New Drug Evaluation, Second Military Medical University, Shanghai, China

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Aims:To evaluate the efficacy and tolerability of nonpenetrating filtering surgery in the treatment of patients with open-angle glaucoma. Methods: Pertinent studies were selected by extensive searches. A total of 17 randomized controlled trials were included in the present meta-analysis. The main outcome measures were risk differences (RDs) of complete success for efficacy and postoperative complications for tolerability. Pooled estimates were computed according to a random-effects model. Results:Viscocanalostomy and deep sclerectomy were significantly less effective than tra- beculectomy, and pooled RDs of complete success were –0.16 (95% confidence interval, CI, –0.30 to –0.02) and –0.10 (–0.19 to 0.00). Deep sclerectomy plus mitomycin C (MMC) was also less effective than trabeculectomy plus MMC, with pooled RD of complete success being –0.16 (95% CI –0.32 to –0.01). Viscocanalostomy and deep sclerectomy caused main complications in fewer patients than trabeculectomy. Conclusions:Viscocanalostomy and deep sclerectomy were less effective than trabeculectomy in the treatment of open-angle glaucoma, and deep sclerectomy plus MMC was also less effective than trabeculectomy plus MMC. However, viscocanalostomy and deep sclerectomy were associated with fewer complications than trabeculectomy.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Zimmerman TJ, Kooner KS, Ford VJ, et al: Effectiveness of nonpenetrating trabeculectomy in aphakic patients with glaucoma. Ophthalmic Surg 1984;15:44–50.
  2. Demailly P, Lavat P, Kretz G, Jeanteur-Lunel MN: Non-penetrating deep sclerectomy (NPDS) with or without collagen device (CD) in primary open-angle glaucoma: middle-term retrospective study. Int Ophthalmol 1997;20:131–140.
  3. Sanchez E, Schnyder CC, Sickenberg M, et al: Deep sclerectomy: results with and without collagen implant. Int Ophthalmol 1997;20:157–162.
  4. Carassa RG, Bettin P, Fiori M, Brancato R: Viscocanalostomy: a pilot study. Eur J Ophthalmol 1998;8:57–61.
  5. Massy J, Gruber D, Muraine M, Brasseur G: Non-penetrating deep sclerectomy in the surgical treatment of chronic open-angle glaucoma: mid-term results (in French). J Fr Ophtalmol 1999;22:292–298.
  6. Stegmann R, Pienaar A, Miller D: Viscocanalostomy for open-angle glaucoma in black African patients. J Cataract Refract Surg 1999;25:316–322.
  7. Karlen ME, Sanchez E, Schnyder CC, et al: Deep sclerectomy with collagen implant: medium term results. Br J Ophthalmol 1999;83:6–11.
  8. Hamard P, Plaza L, Kopel J, et al: Deep nonpenetrating sclerectomy and open angle glaucoma: intermediate results from the first operated patients. J Fr Ophtalmol 1999;22:25–31.
  9. Shaarawy T, Karlen M, Schnyder C, et al: Five-year results of deep sclerectomy with collagen implant. J Cataract Refract Surg 2001;27:1770–1778.
  10. Drusedau MU, von Wolff K, Bull H, von Barsewisch B: Viscocanalostomy for primary open-angle glaucoma: the Gross Pankow experience. J Cataract Refract Surg 2000;26:1367–1373.
  11. Sunaric-Megevand G, Leuenberger PM: Results of viscocanalostomy for primary open-angle glaucoma. Am J Ophthalmol 2001;132:221–228.
  12. Jadad AR, Moore RA, Carroll D, et al: Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996;17:1–12.
  13. DerSimonian R, Laird N: Meta-analysis in clinical trials. Control Clin Trials 1986;7:177–188.
  14. Higgins JP, Thompson SG, Deeks JJ, Altman DG: Measuring inconsistency in meta-analyses. BMJ 2003;327:557–560.
  15. Cook RJ, Sackett DL: The number needed to treat: a clinically useful measure of treatment effect. BMJ 1995;310:452–454.
  16. Mermoud A, Schnyder CC, Sickenberg M, et al: Comparison of deep sclerectomy with collagen implant and trabeculectomy in open-angle glaucoma. J Cataract Refract Surg 1999;25:323–331.
  17. Spinelli D, Curatola MR, Faroni E: Comparison between deep sclerectomy with reticulated hyaluronic acid implant and trabeculectomy in glaucoma surgery. Acta Ophthalmol Scand 2000;78(suppl):60–62.
  18. Jonescu-Cuypers C, Jacobi P, Konen W, Krieglstein G: Primary viscocanalostomy versus trabeculectomy in white patients with open-angle glaucoma: a randomized clinical trial. Ophthalmology 2001;108:254–258.
  19. Ambresin A, Shaarawy T, Mermoud A: Deep sclerectomy with collagen implant in one eye compared with trabeculectomy in the other eye of the same patient. J Glaucoma 2002;11:214–220.
  20. Schnyder CC, Shaarawy T, Ravinet E, et al: Free conjunctival autologous graft for bleb repair and bleb reduction after trabeculectomy and nonpenetrating filtering surgery. J Glaucoma 2002;11:10–16.
  21. Egrilmez S, Ates H, Nalcaci S, et al: Surgically induced corneal refractive change following glaucoma surgery: nonpenetrating trabecular surgeries versus trabeculectomy. J Cataract Refract Surg 2004;30:1232–1239.
  22. Yarangumeli A, Gureser S, Koz OG, et al: Viscocanalostomy versus trabeculectomy in patients with bilateral high-tension glaucoma. Int Ophthalmol 2004;25:207–213.
  23. Detry-Morel M, Pourjavan S, Detry MB: Comparative safety profile between ‘modern’ trabeculectomy and non-penetrationg deep sclerectomy (in French). Bull Soc Belge Ophtalmol 2006;300:43–54.

    External Resources

  24. Cillino S, Di Pace F, Casuccio A, Lodato G: Deep sclerectomy versus punch trabeculectomy: effect of low-dosage mitomycin C. Ophthalmologica 2005;219:281–286.
  25. Chiou AG, Mermoud A, Jewelewicz DA: Post-operative inflammation following deep sclerectomy with collagen implant versus standard trabeculectomy. Graefes Arch Clin Exp Ophthalmol 1998;236:593–596.
  26. El Sayyad F, Helal M, El-Kholify H, et al: Nonpenetrating deep sclerectomy versus trabeculectomy in bilateral primary open-angle glaucoma. Ophthalmology 2000;107:1671–1674.
  27. Chiselita D: Non-penetrating deep sclerectomy versus trabeculectomy in primary open-angle glaucoma surgery. Eye 2001;15:197–201.
  28. Lüke C, Dietlein TS, Jacobi PC, et al: A prospective randomized trial of viscocanalostomy versus trabeculectomy in open-angle glaucoma: a 1-year follow-up study. J Glaucoma 2002;11:294–299.
  29. O’Brart DP, Rowlands E, Islam N, Noury AM: A randomised, prospective study comparing trabeculectomy augmented with antimetabolites with a viscocanalostomy technique for the management of open angle glaucoma uncontrolled by medical therapy. Br J Ophthalmol 2002;86:748–754.
  30. Wang N, Wu H, Ye T, et al: Analysis of intra-operative and early post-operative complications and safety in non-penetrating trabecular surgery. Zhonghua Yan Ke Za Zhi 2002;38:329–334.

    External Resources

  31. Carassa RG, Bettin P, Fiori M, Brancato R: Viscocanalostomy versus trabeculectomy in white adults affected by open-angle glaucoma: a 2-year randomized, controlled trial. Ophthalmology 2003;110:882–887.
  32. Kobayashi H, Kobayashi K, Okinami S: A comparison of the intraocular pressure-lowering effect and safety of viscocanalostomy and trabeculectomy with mitomycin C in bilateral open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol 2003;241:359–366.
  33. Cillino S, Pace FD, Casuccio A, et al: Deep sclerectomy versus punch trabeculectomy with or without phacoemulsification: a randomized clinical trial. J Glaucoma 2004;13:500–506.
  34. O’Brart DP, Shiew M, Edmunds B: A randomised, prospective study comparing trabeculectomy with viscocanalostomy with adjunctive antimetabolite usage for the management of open angle glaucoma uncontrolled by medical therapy. Br J Ophthalmol 2004;88:1012–1017.
  35. Schwenn O, Springer C, Troost A, et al: Deep sclerectomy using a hyaluronate implant versus trabeculectomy: a comparison of two glaucoma operations using mitomycin C. Ophthalmologe 2004;101:696–704.
  36. Yalvac IS, Sahin M, Eksioglu U, et al: Primary viscocanalostomy versus trabeculectomy for primary open-angle glaucoma: three-year prospective randomized clinical trial. J Cataract Refract Surg 2004;30:2050–2057.
  37. Huang Y, Wang NL, Wang BW, Li LJ: The long term curative effect of the nonpenetrating trabecular surgery. Yan Ke 2006;15:277–280.
  38. Cillino S, Di Pace F, Casuccio A, et al: Deep sclerectomy versus trabeculectomy with low-dosage mitomycin C: four-year follow-up. Ophthalmologica 2008;222:81–87.
  39. Johnson DH, Johnson M: Glaucoma surgery and aqueous outflow: how does nonpenetrating glaucoma surgery work? Arch Ophthalmol 2002;120:67–70.
  40. Kozobolis VP, Christodoulakis EV, Tzanakis N, et al: Primary deep sclerectomy versus primary deep sclerectomy with the use of mitomycin C in primary open-angle glaucoma. J Glaucoma 2002;11:287–293.
  41. Neudorfer M, Sadetzki S, Anisimova S, Geyer O: Nonpenetrating deep sclerectomy with the use of adjunctive mitomycin C. Ophthalmic Surg Lasers Imaging 2004;35:6–12.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50