Five-Year Outcomes of Deep Sclerectomy in Pseudoexfoliation Glaucoma Compared to Primary Open-Angle Glaucoma

<b>Objectives</b>: This study aimed to investigate the five-year outcomes of deep sclerectomy (DS) in patients with pseudoexfoliation glaucoma (PEXG) and primary open-angle glaucoma (POAG). <b>Methods</b>: This retrospective, observational, unicentric study analyzed POAG and PEXG patients. Intraocular pressure (IOP), the number of IOP-lowering medications, peripapillary retinal nerve fiber layer (RNFL) thickness, the number of postoperative interventions, surgical success rates, and secondary surgery rates were evaluated at baseline and during follow-up appointments. <b>Results</b>: A total of 109 POAG and 153 PEXG eyes were included. Over the 5-year follow-up, IOP decreased in both groups (<i>p</i> = 0.17), from 22.8 ± 0.7 to 13.3 ± 0.6 mmHg (<i>p</i> < 0.001; POAG) and from 24.3 ± 0.8 to 16.6 ± 1.2 mmHg (<i>p</i> < 0.001; PEXG). The number of IOP-lowering medications decreased comparably (<i>p</i> = 0.99), from 3.1 ± 0.1 to 1.7 ± 0.3 (<i>p</i> = 0.001; POAG) and from 3.4 ± 0.1 to 1.7 ± 0.2 (<i>p</i> < 0.001; PEXG). Peripapillary RNFL thickness decreased in both groups (<i>p</i> = 0.31), from 60.6 ± 1.9 to 54.2 ± 2.4 µm (<i>p</i> < 0.001; POAG) and from 63.1 ± 1.7 to 58.0 ± 2.3 µm (<i>p</i> < 0.001; PEXG). The 5-year complete success rates were 33% and 12% for the POAG and PEXG groups, respectively (<i>p</i> = 0.01). The qualified success rates were 63% and 40% (<i>p</i> = 0.03). Secondary glaucoma surgery was required in 8% of POAG eyes and 21% of PEXG eyes (<i>p</i> = 0.04). <b>Conclusions</b>: DS resulted in comparable results for IOP, medications, and RNFL development in the PEXG and POAG groups but in less favorable outcomes concerning surgical success and further necessary repeated glaucoma surgery in patients with PEXG over the 5-year follow-up period.