Efficacy And Safety Of Non-Penetrating Deep Sclerectomy In Patients With Previous Keratoplasty: A 5-Year Comparative Analysis

Published 2026 - 44th Congress of the ESCRS

Reference: PP08.08 | Type: Free paper | DOI: 10.82333/kqh6-2813

Authors: Dr Alberto Salmoral Lorenzo-Arroyo* ¹ , Dr Elena Arrondo Murillo ¹ , Dr Oscar Gris Castellón ¹ , Dr Giuliano Natalino Sebastien ¹ , Dr Maribel Acuña Salles ¹ , Dr Mar García Gispert ¹ , Dr Sofía Bielsa Alonso ¹ , Dr Jose Luis Güell Villanueva ¹

¹Instituto de Microcirugía Ocular IMO Barcelona,Barcelona,Spain

Purpose

To evaluate for the first time the efficacy and safety of non-penetrating deep sclerectomy (NPDS) in patients with a history of various corneal transplantation techniques—penetrating keratoplasty (PKP), Descemet membrane endothelial keratoplasty (DMEK), and deep anterior lamellar keratoplasty (DALK)—correlating clinical variables with intraocular pressure (IOP) reduction, visual acuity, and postoperative bleb morphology.

Setting

Instituto de Microcirugía Ocular IMO Barcelona.

Methods

We conducted a 5-year follow-up study of 50 patients who underwent NPDS after previous keratoplasty. Primary outcomes included IOP reduction and medication dependence. A subgroup analysis compared the NPDS-post-keratoplasty (NPDS-PK) cohort with a standard NPDS control group. Statistical analysis was performed to assess long-term outcomes.

Results

Mean baseline IOP was 23.20 mm Hg. Postoperative IOP showed a significant reduction: 11.06 mm Hg (SD 4.88) at 1 month, 12.02 mm Hg (SD 3.25) at 3 months, 11.76 mm Hg (SD 2.88) at 6 months, and 11.76 mm Hg (SD 3.01) at 1 year.

Regarding medical therapy, patients shifted from a high requirement (3–4 medications) to near-complete independence at 3 months. Despite the NPDS-PK group presenting with a significantly higher baseline IOP (28.32 vs. 23.20 mm Hg), the procedure achieved a greater absolute reduction (~16 mm Hg), reaching a 5-year IOP (12.40 mm Hg) comparable to the control group (11.76 mm Hg). At 2 years, no statistically significant difference in IOP control was observed (11.79 mm Hg vs. 12.14 mm Hg, p=0.966).

Conclusions

NPDS is an effective and safe surgical option for glaucoma in eyes with prior corneal transplantation. The procedure successfully compensates for higher baseline pressure, achieving long-term tension control indistinguishable from standard NPDS cases. While long-term follow-up in specific DMEK/DALK subsets remains limited, these findings support NPDS as a robust strategy in complex post-keratoplasty eyes.