LAUSR

Recently, Abdelrahman et al. described a novel technique modifying deep sclerectomy (DS) surgery through place-ment of a non-absorbable mattress suture beneath the super fi cial scleral fl ap. 1 The authors reported superior IOP reduction with no complications, highlighting an effective and inexpensive way of replacing a spacer device. Our standard DS technique has been described exten-sively in previous publications. 2 The main differences from Abdelrahman et al. are the 5 × 4 mm 2 trapezoid, rather than 4 × 3 mm 2 rectangular, super fi cial scleral fl ap (Figure 1) and our use of a hydroxyethyl methacrylate spacer (EsnoperV2000 ® ). We similarly place the super fi cial fl ap back loosely with a single 10-0 nylon suture or none at all. We modi fi ed our standard technique by per-forming the proposed 10-0 nylon suture instead of the spacer device, without modifying the rest of our standard DS technique, in three consecutive cases. All surgeries were performed by the same experienced surgeon and patients had a minimum of 6 months follow-up. The fi rst patient had a slow anterior leak day one post-operatively. This resolved without intervention within two weeks. IOP was 12 mmHg at week 2, and 17 mmHg at 6 months post-surgery. In the second case, a Seidel ’ s test was performed intra-operatively and was positive. An add-itional conjunctival mattress suture was used to ensure a watertight bleb. IOP remained constant at 6 – 8 mmHg over the following 6 months. The third patient was Seidel ’ s negative intraoperatively. However, a large subconjunctival bleb, hypotony (IOP 2 mmHg) and choroidal detachments with macular folds were found day one post-operatively.