Deep Scelerectomy: Contra

Deep sclerectomy claims to be safer than trabeculectomy. This might have been true in the past but, with modern techniques, “safe trabeculectomy” can be performed with few complications. Deep sclerectomy claims to be a “non‐perforating” procedure. It is probably more correct to name it a two‐stage perforating procedure since post‐operative Yag‐laser goniopuncture is necessary in > 50% of the cases. Since an iridectomy is not performed during deep sclerectomy, iris incarceration can occur after goniopuncture and can be easily missed. Furthermore, it is puzzling that new modifications of deep sclerectomy include using an Express implant, converting it right away to a perforating procedure. Finally, a trabeculectomy usually provides lower post‐operative IOPs than a deep sclerectomy. Since one of the reasons to operate is to obtain a low target IOP, it is advisable to perform a trabeculectomy.