Background: Deep sclerectomy and similar procedures including a deroofing of Schlemm’s canal are meeting with increasing interest owing
to the limited risk profile of non-perforating glaucoma surgery. The aim of our study was to investigate how often the outer
wall of Schlemm’s canal or parts of the trabecular meshwork were incorporated in the excised tissue on deep scleral flap dissection
by an experienced glaucoma surgeon.
Methods: The excised deep scleral flap was prepared for light microscopy after performing deep sclerectomy in 7 children and 22 adult
patients suffering from glaucoma. Meridional serial sections were checked for the presence of fragments of trabecular beams
and collector channels and parts of the endothelial wall of Schlemm’s canal. Morphology was compared with the intraoperative
appearance of the operated tissue.
Results: In 15 patients (52%) the deep scleral flap contained at least some tissue from the outer wall of Schlemm’s canal; in 5 of
these 15 patients noticeable remnants of the juxtacanalicular trabecular meshwork were also found, although only in one patient
was this obvious during surgery. In 14 patients (48%) no evidence of the deroofing of Schlemm’s canal was found within the
excised deep scleral flap, although intraoperatively the dissection seemed to have been too superficial in only 5 patients.
Conclusion: Even when performed by an experienced glaucoma surgeon, deep sclerectomy produces biopsy material of remarkable morphological
variability that does not always correspond to the intraoperative appearance of the site of operation. More than in conventional
trabeculectomy this variability may be of importance for the outcome of surgery.
Received: 8 November 1999 Revised: 25 January 2000 Accepted: 25 January 2000