Objective: To evaluate the effectiveness and risk profile of deep sclerectomy in surgery for refractory congenital glaucoma.

Methods: Retrospective non-comparative interventional case series. Methods: Ten eyes of eight consecutive patients underwent deep sclerectomy for refractory congenital glaucoma. The procedure was converted to a trabeculectomy in four eyes and supplemented by a trabeculotomy in two eyes. Six eyes had primary congenital glaucoma, and four eyes had secondary congenital glaucoma. The patients' ages at the time of surgery in our department ranged from 8 months to 14 years. All eyes had a history of previous glaucoma surgery. Methods: The surgical outcome was assessed in terms of complication rate, intraocular pressure (IOP) change, need for surgical revision, or additional glaucoma medication.

Results: Preoperatively, the mean IOP was 31.9 mmHg (standard deviation [SD], 5.6 mmHg). At first follow-up 1 week after surgery, the mean IOP for all eyes was 12.7 mmHg (SD, 6.8 mmHg). The average reduction of IOP was statistically significant (P < 0.001). In accordance with the success criteria, all eyes were ultimately classified as failures. Average time to failure was 2.1 months (SD, 3.6 months). Specific complications were seen in terms of non-identification of Schlemm's canal (40%), choroidal deroofing (10%), and visible perforation of the trabeculodescemetic membrane (20%). Further complications were hyphema (40%), ocular hypotony (10%), vitreous hemorrhage (10%), and vitreous loss with subsequent retinal detachment (10%).

Conclusions: Although deep sclerectomy may reduce the IOP in patients with refractory congenital glaucoma, this study indicates a specific risk profile associated with deep sclerectomy in surgery for refractory congenital glaucoma.