{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T04:28:02Z","timestamp":1768969682607,"version":"3.49.0"},"reference-count":37,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T00:00:00Z","timestamp":1733443200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: This study aimed to investigate the five-year outcomes of deep sclerectomy (DS) in patients with pseudoexfoliation glaucoma (PEXG) and primary open-angle glaucoma (POAG). Methods: This retrospective, observational, unicentric study analyzed POAG and PEXG patients. Intraocular pressure (IOP), the number of IOP-lowering medications, peripapillary retinal nerve fiber layer (RNFL) thickness, the number of postoperative interventions, surgical success rates, and secondary surgery rates were evaluated at baseline and during follow-up appointments. Results: A total of 109 POAG and 153 PEXG eyes were included. Over the 5-year follow-up, IOP decreased in both groups (p = 0.17), from 22.8 \u00b1 0.7 to 13.3 \u00b1 0.6 mmHg (p &lt; 0.001; POAG) and from 24.3 \u00b1 0.8 to 16.6 \u00b1 1.2 mmHg (p &lt; 0.001; PEXG). The number of IOP-lowering medications decreased comparably (p = 0.99), from 3.1 \u00b1 0.1 to 1.7 \u00b1 0.3 (p = 0.001; POAG) and from 3.4 \u00b1 0.1 to 1.7 \u00b1 0.2 (p &lt; 0.001; PEXG). Peripapillary RNFL thickness decreased in both groups (p = 0.31), from 60.6 \u00b1 1.9 to 54.2 \u00b1 2.4 \u00b5m (p &lt; 0.001; POAG) and from 63.1 \u00b1 1.7 to 58.0 \u00b1 2.3 \u00b5m (p &lt; 0.001; PEXG). The 5-year complete success rates were 33% and 12% for the POAG and PEXG groups, respectively (p = 0.01). The qualified success rates were 63% and 40% (p = 0.03). Secondary glaucoma surgery was required in 8% of POAG eyes and 21% of PEXG eyes (p = 0.04). Conclusions: DS resulted in comparable results for IOP, medications, and RNFL development in the PEXG and POAG groups but in less favorable outcomes concerning surgical success and further necessary repeated glaucoma surgery in patients with PEXG over the 5-year follow-up period.<\/jats:p>","DOI":"10.3390\/jcm13237434","type":"journal-article","created":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T03:44:47Z","timestamp":1733456687000},"page":"7434","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Five-Year Outcomes of Deep Sclerectomy in Pseudoexfoliation Glaucoma Compared to Primary Open-Angle Glaucoma"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4923-6159","authenticated-orcid":false,"given":"Carlo","family":"Fiore","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiao","family":"Shang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland"},{"name":"Graduate School for Cellular and Biomedical Sciences, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joel-Benjamin","family":"Lincke","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathanael Urs","family":"H\u00e4ner","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin Sebastian","family":"Zinkernagel","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1469-0412","authenticated-orcid":false,"given":"Jan Darius","family":"Unterlauft","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1055\/s-0043-106819","article-title":"Klassifikation, Genetik und Epidemiologie der Glaukome","volume":"234","author":"Pfeiffer","year":"2017","journal-title":"Klin. Monbl. Augenheilkd."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1901","DOI":"10.1001\/jama.2014.3192","article-title":"The pathophysiology and treatment of glaucoma: A review","volume":"311","author":"Weinreb","year":"2014","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.ophtha.2020.10.022","article-title":"American Academy of Ophthalmology Preferred Practice Pattern glaucoma panel. Primary open-angle glaucoma Preferred Practice Pattern\u00ae","volume":"128","author":"Gedde","year":"2021","journal-title":"Ophthalmology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2081","DOI":"10.1016\/j.ophtha.2014.05.013","article-title":"Global prevalence of glaucoma and projections of glaucoma burden through 2040: A systematic review and meta-analysis","volume":"121","author":"Tham","year":"2014","journal-title":"Ophthalmology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/1479-7364-6-22","article-title":"Pseudoexfoliation syndrome, a systemic disorder with ocular manifestations","volume":"6","author":"Elhawy","year":"2012","journal-title":"Hum. Genom."},{"key":"ref_6","first-page":"527","article-title":"A global genetic epidemiological review of pseudoexfoliation syndrome","volume":"2","author":"Hicks","year":"2021","journal-title":"Explor. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/S1350-9462(02)00014-9","article-title":"Why is glaucoma associated with exfoliation syndrome?","volume":"22","author":"Ritch","year":"2003","journal-title":"Prog. Retin. Eye Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1093\/ajhp\/62.7.691","article-title":"Glaucoma and its treatment: A review","volume":"62","author":"Lee","year":"2005","journal-title":"Am. J. Health-Syst. Pharm."},{"key":"ref_9","first-page":"27834","article-title":"Trabeculectomy: Does it have a future?","volume":"14","author":"Rao","year":"2022","journal-title":"Cureus"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.survophthal.2011.07.005","article-title":"The changing conceptual basis of trabeculectomy: A review of past and current surgical techniques","volume":"57","author":"Razeghinejad","year":"2012","journal-title":"Surv. Ophthalmol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1001\/jamaophthalmol.2013.5059","article-title":"Efficacy and safety of trabeculectomy vs nonpenetrating surgical procedures: A systematic review and meta-analysis","volume":"131","author":"Rulli","year":"2013","journal-title":"JAMA Ophthalmol."},{"key":"ref_12","first-page":"43366","article-title":"Our experience of deep sclerectomy at a tertiary center in the United Kingdom over 14 years","volume":"15","author":"Alnuaimi","year":"2023","journal-title":"Cureus"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1007\/s00347-014-3161-6","article-title":"Tiefe Sklerektomie. Eine Alternative zur Trabekulektomie","volume":"112","author":"Klemm","year":"2015","journal-title":"Ophthalmologe"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2271","DOI":"10.1016\/j.ophtha.2009.06.042","article-title":"Natural history of open-angle glaucoma","volume":"116","author":"Heijl","year":"2009","journal-title":"Ophthalmology"},{"key":"ref_15","first-page":"2435","article-title":"Correlation of pseudoexfoliative material and optic nerve damage in pseudoexfoliation syndrome","volume":"38","author":"Gottanka","year":"1997","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"568","DOI":"10.5301\/ejo.5000762","article-title":"Deep sclerectomy in primary open-angle glaucoma and exfoliative glaucoma","volume":"26","author":"Suominen","year":"2016","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1111\/j.1755-3768.2009.01772.x","article-title":"Mitomycin C-augmented deep sclerectomy in primary open-angle glaucoma and exfoliation glaucoma: A three-year prospective study","volume":"89","author":"Ollikainen","year":"2011","journal-title":"Acta Ophthalmol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"6923208","DOI":"10.1155\/2017\/6923208","article-title":"Deep sclerectomy with nonabsorbable implant (T-Flux) in patients with pseudoexfoliation glaucoma","volume":"2017","author":"Studeny","year":"2017","journal-title":"J. Ophthalmol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1111\/j.1755-3768.2009.01509.x","article-title":"Mitomycin-C-augmented deep sclerectomy in patients with primary open-angle glaucoma and exfoliation glaucoma: A 1-year prospective study","volume":"88","author":"Ollikainen","year":"2010","journal-title":"Acta Ophthalmol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1097\/IJG.0b013e3181879e4e","article-title":"Long-term results of deep sclerectomy with collagen implant in exfoliative glaucoma","volume":"18","author":"Mendrinos","year":"2009","journal-title":"J. Glaucoma"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1111\/j.1600-0420.2006.00674.x","article-title":"Longterm follow-up after deep sclerectomy in patients with pseudoexfoliative glaucoma","volume":"84","author":"Drolsum","year":"2006","journal-title":"Acta Ophthalmol. Scand."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1111\/j.1600-0420.2006.00654.x","article-title":"Deep sclerectomy for the treatment of exfoliation and primary open-angle glaucoma","volume":"84","author":"Rekonen","year":"2006","journal-title":"Acta Ophthalmol. Scand."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.ajo.2015.05.029","article-title":"Protocols for studies of intraocular lens formula accuracy","volume":"160","author":"Hoffer","year":"2015","journal-title":"Am. J. Ophthalmol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1097\/IJG.0b013e3181ccb926","article-title":"Primary phakic deep sclerectomy augmented with mitomycin C: Long-term outcomes","volume":"20","author":"Anand","year":"2011","journal-title":"J. Glaucoma"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1097\/00055735-200004000-00015","article-title":"Nonpenetrating filtering surgery in glaucoma","volume":"11","author":"Mermoud","year":"2000","journal-title":"Curr. Opin. Ophthalmol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1590\/1677-5449.174118","article-title":"Correlation analysis in clinical and experimental studies","volume":"17","author":"Miot","year":"2018","journal-title":"J. Vasc. Bras."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1136\/bjo.87.11.1340","article-title":"Aqueous dynamic and histological findings after deep sclerectomy with collagen implant in an animal model","volume":"87","author":"Delarive","year":"2003","journal-title":"Br. J. Ophthalmol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1034\/j.1600-0420.1998.760217.x","article-title":"Preoperative features of patients with exfoliation glaucoma and primary open-angle glaucoma. The AHEPA study","volume":"76","author":"Konstas","year":"1998","journal-title":"Acta Ophthalmol. Scand."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"9423756","DOI":"10.1155\/2020\/9423756","article-title":"Clinical features of patients with exfoliation glaucoma requiring surgical intervention","volume":"2020","author":"Nakano","year":"2020","journal-title":"J. Ophthalmol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Rossi, G.C.M., Milano, G., De Silvestri, A., Savini, L., Bosi, C., Gambini, G., and Rama, P. (2023). Correlation between visual field index and quality of life in glaucoma patients: A new tool to screen quality of life perception?. Front. Med., 10.","DOI":"10.3389\/fmed.2023.1214007"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2335","DOI":"10.2147\/OPTH.S298045","article-title":"Changes of neuroretinal rim and retinal nerve fiber layer thickness assessed by optical coherence tomography after filtration surgery in glaucomatous eyes","volume":"15","author":"Koenig","year":"2021","journal-title":"Clin. Ophthalmol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1016\/j.ophtha.2006.06.051","article-title":"Evaluation of changes in peripapillary nerve fiber layer thickness after deep sclerectomy with optical coherence tomography","volume":"114","author":"Rebolleda","year":"2007","journal-title":"Ophthalmology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"142.e1","DOI":"10.1016\/j.jaapos.2020.11.025","article-title":"Factors leading to loss to follow-up after strabismus surgery in children","volume":"25","author":"Daly","year":"2021","journal-title":"J. AAPOS"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1001\/archopht.117.4.450","article-title":"Severity and stability of glaucoma: Patient perception compared with objective measurement","volume":"117","author":"Viswanathan","year":"1999","journal-title":"Arch. Ophthalmol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1136\/bjo.58.11.927","article-title":"Results of trabeculectomy for pseudo-exfoliative glaucoma. A study of 52 cases","volume":"58","author":"Jerndal","year":"1974","journal-title":"Br. J. Ophthalmol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1723691","DOI":"10.1155\/2020\/1723691","article-title":"The effects of trabeculectomy on pseudoexfoliation glaucoma and primary open-angle glaucoma","volume":"2020","author":"Li","year":"2020","journal-title":"J. Ophthalmol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1136\/bjo.83.3.305","article-title":"Course of exfoliation and simplex glaucoma after primary trabeculectomy","volume":"83","author":"Popovic","year":"1999","journal-title":"Br. J. Ophthalmol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/23\/7434\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:48:21Z","timestamp":1760114901000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/23\/7434"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,6]]},"references-count":37,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["jcm13237434"],"URL":"https:\/\/doi.org\/10.3390\/jcm13237434","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,6]]}}}