Non-penetrating deep sclerectomy (NPDS) by S.N.Fyodorov and V.I.Kozlov has certain advantages before fistulizing surgery: absence of eyeball perforation, dosed filtration with possibility of its enhancement by YAG-laser goniopuncture (LGP). We have an experience of 12 000 NPDS, in 13.2% of cases (combined glaucoma) preceded by laser iridotomy and/or gonioplastics. Remote efficacy of NPDS combined with LGP was 98.2% (including 6.1% with hypotensive therapy and 3.5% after reconstruction of filtering zone).
We have developed microinvasive NPDS technique that includes: 1) epibulbar anesthesia; 2) eyeball fixation with 8/0 transcorneal suture; 3) prelimbal conjunctival incision no more than 2.5 mm; 4) superficial scleral valve no more than 3.5x3.5 mm, by all means exceeding the size of conjunctival incision; 5) deep scleral flap 0.2 mm less than superficial valve with blunt separation of corneal stroma from Descemet's membrane; 6) removal of Schlemm's channel outer wall; 7) conjunctival incision closure so that conjunctiva and Tenon's capsule are gathered above the scleral valve.
Microinvasive surgery ensures: 1) low pain to the patient as retrobulbar block and bridle suture on the superior rectus muscle are excluded; 2) low-traumatic formation of filtering zone; 3) absence of postoperative scarring in filtering zone (scarring takes place above the scleral valve and doesn't influence aqueous outflow); 4) possibility of repeated operations in necessity in the zone free of scarring. Simple calculations show that using the described technique one can perform up to 7-8 operations in one eye working in not damaged tissues, thus having a possibility to create a normal filtering zone.