GLAUCOMA Central 10-degree visual field change following non-penetrating deep sclerectomy in severe and end-stage glaucoma: preliminary results Igor Leleu 1 & Benjamin Penaud 1 & Esther Blumen-Ohana 1 & Thibault Rodallec 1 & Raphaël Adam 1 & Olivier Laplace 1 & Jad Akesbi 1 & Jean-Philippe Nordmann 1 Received: 28 January 2018 /Revised: 17 April 2018 /Accepted: 29 May 2018 /Published online: 3 June 2018 # Springer-Verlag GmbH Germany, part of Springer Nature 2018, corrected publication July/2018 Abstract Purpose To report the impact of non-penetrating deep sclerectomy (NPDS) in severe and end-stage glaucoma treatment on the central 10° visual field progression (mean deviation, four central points, foveal threshold) and assess the risk of sudden visual loss. Methods Monocenter database study. We reviewed records of 34 eyes with severe or end-stage glaucoma that underwent NPDS between 2009 and 2015, at the National Ophthalmology Center of XV-XX (Paris, France). Severe and end-stage glaucoma were defined according to the Bascom Palmer Modified Glaucoma Staging System classification. All eyes had a constricted visual field < 10° (severe injury by the Humphrey visual field automated (HVFA) 10-2). Visual fields were recorded every 6 months after the procedure. Data from the last visit was used for the statistical analysis. Results The mean follow-up duration was 29 months (range 6 to 54) and 33 (97%) eyes were followed for more than 1 year. There were no cases of postoperative sudden visual loss. The intraocular pressure (IOP) decreased from 21.9 ± 8.1 to 15.0 ± 5.4 mmHg (P < .001). Twenty-eight (82%) eyes had an IOP < 21 mmHg and 19 (56%) an IOP < 16 mmHg. The MD 10-2 remained stable (- 19.8 ± 7.4 to - 19.4 ± 8.1 dB, non-significant improvement of + 0.4 dB, P = .1). The MD 10-2 slope showed an insignificant improvement of + 0.25 ± 1.8 dB per year (dB/y) (P = 0.1), but this slope was significantly better when the IOP was reduced to <16 mmHg than when the IOP was ≥ 16 mmHg at the last visit (+ 0.84 1.2 versus - 0.48 ± 2.2 dB/y, P = .05). The mean number of the four central test points with sensitivity ≤ 5 dB and the change in mean sensitivity of the four central field points remained stable. There were no significant changes in the VFI (from 25.4% ± 13 to 25.8% ± 20) and in foveal threshold. Conclusion NPDS appears to provide stability of the central 10° visual field (with a trend towards improvement but non- significant) with no occurrence of Bwipe-out^ phenomenon and few other complications. Consideration of NPDS in end-stage and severe glaucoma is advisable given its low risk of complications and its considerable IOP decrease with a relative stability of the central visual field. Keywords End-stage glaucoma . Filtering surgery . Deep sclerectomy . Humphrey visual field . Sudden visual loss Abbreviations NPDS Non-penetrating deep sclerectomy IOP Intraocular pressure MD Mean deviation VFI Visual function index HVFA Humphrey visual field automated Introduction Intraocular pressure (IOP) is the main modifiable cause of glaucoma progression. Low IOP and decrease of IOP diurnal fluctuations (IOP spikes) have been shown to be associated with reduced progression of visual field defects [1–3], espe- cially in patients with advanced glaucoma [4]. Glaucoma fil- tration surgery is the last step when maximal medical and laser therapy were not enough to lower the IOP and stabilize glau- coma progression. Significant lowering of intraocular pressure (IOP) is an absolute necessary in cases of severe and end-stage glaucoma that frequently requires surgical intervention, * Igor Leleu leleu.igor@gmail.com 1 Centre Hospitalier National d’Ophtalmologie des XV-XX, Service du Pr. NORDMANN, 28 rue de Charenton, 75012 Paris, France Graefe's Archive for Clinical and Experimental Ophthalmology (2018) 256:1489–1498 https://doi.org/10.1007/s00417-018-4025-6