European specialist shares perspectives on glaucoma surgery

When it comes to questions about the timing of glaucoma surgery and procedure choice, the general consensus in Europe is that early is better than late. According to guidelines from the European Glaucoma Society (EGS), nonpenetrating glaucoma surgery (NPGS) is a viable alternative to trabeculectomy, said Tarek Shaarawy, MD.

Support for early surgical intervention finds its roots in pioneering work at Moorfields Eye Hospital, London, from glaucoma surgeons who showed that surgery was more effective than medical therapy in achieving visual field stability and IOP reduction, he said.

"These findings have since been corroborated by other multicenter studies," said Dr. Shaarawy, head, glaucoma sector, ophthalmology service, Department of Clinical Neurosciences, University of Geneva, Switzerland.

Discussing procedure choice, he noted that a more favorable safety profile is the primary reason why NPGS achieved a place alongside trabeculectomy in the EGS Terminology and Guidelines.

"Even leaders in glaucoma who [believe] trabeculectomy offers better IOP reduction accept that NPGS has a better safety margin and is deserving of a fair chance," Dr. Shaarawy said.

In contrast to trabeculectomy, NPGS is almost devoid of significant hypotony and is associated with a significantly lower incidence of cataract, he explained. Furthermore, after more than 25 years of experience with deep sclerectomy around the world, this nonpenetrating procedure has not been associated with a single published report of endophthalmitis, according to Dr. Shaarawy.