Taiwan's first clinical reports on the surgical effect of high-frequency deep sclerotomy for treating primary open-angle glaucoma.

Abstract

Background: Primary open-angle glaucoma (POAG) leads to elevated intraocular pressure (IOP) and gradual optic nerve damage. In a study by Abushanab et al., high-frequency deep sclerotomy (HFDS) effectively treated patients with POAG. HFDS creates channels through the trabecular meshwork (TM) using a high-frequency electrocautery probe tip, promoting aqueous humor outflow and reducing IOP. In Taiwan, HFDS has been rarely used to treat POAG patients. Therefore, we conducted the first trial and presented the outcomes of two cases to evaluate its effectiveness.

Case presentation: Both patients had long-term primary open-angle glaucoma (POAG) with significant optic nerve damage and visual field loss despite multiple medications. Case 1: A 66-year-old female with a preoperative intraocular pressure (IOP) of 20 mmHg and a history of diabetes mellitus (DM) underwent high-frequency deep sclerotomy (HFDS). Postoperatively, the IOP initially decreased to 12 mmHg without Abstract Pagemedications but reintroduced drops to maintain 13-15 mmHg during follow-up. Case 2: A 50-year-old female with a preoperative IOP of 18 mmHg underwent HFDS. The IOP remained stable between 11 and 13 mmHg postoperatively with a consistent medication regimen.

Discussion and conclusions: HFDS is a minimally invasive glaucoma surgery (MIGS) that effectively lowers the IOP in patients unresponsive to conventional treatments. This report presents two of Taiwan's first patients with POAG treated by HFDS, showing IOP reductions of 30% and 33.3% over one year with mild corneal endothelial cell loss, which is consistent with previous studies. HFDS demonstrated a significant IOP reduction compared to that in other MIGS techniques and fewer complications than traditional surgeries. Further research should optimize the postoperative management, consider the anatomical differences and pocket healing.