Aim: To evaluate the surgical technique of deep sclerectomy with regards ease and reproducibility, to assess effectiveness of reticulated hyaluronate implant (SKGEL) with deep sclerectomy in IOP control and to analyze the histopathology of the deep scleral flap excised by the surgeon together with comparing these results with the intraoperative view of the tissue during dissection under the operating microscopeMethods: Forty eyes of 36 patients underwent deep sclerectomy and were randomly divided into 2 groups: Group A (20 eyes) underwent deep sclerectomy with SKGEL implant and Group B (20 eyes) without implant. Deep scleral flaps were histologically prepared and were compared with the intraoperative recorded appearance. Follow up of cases was carried out for at least six months. Results: The mean preoperative intraocular pressure (IOP) was 27.7 (SD 6.6) mm Hg for patients in group A and 29.5 (SD 8.5) mmHg for patients in group B. The mean IOP was 15.95 (SD 4.98) mm Hg 6 months after surgery for group A (p<0.001) and 18.25 (SD 8.4) mm Hg for group B (p<0.001). The postoperative IOP difference between the two groups was statistically insignificant (p = 0.1). The total success rate, defined as an IOP lower than 21 mm Hg without medication, was 90% in group A and 60% in group B, 6 months postoperatively (p = 0.02 statistically significant ). The number of postoperative complications was equally low for both groups. In 34 specimens (34 out of 406 specimens were not interpreted due to poor preparation technique); 62% of the deep scleral flaps who underwent histo-pathological analysis were found to contain at least some tissue of Schlemm’s canal, whereas 38% of flaps revealed absence of Schlemm’s canal. Intra-operatively superficial dissection occurred in 47% of cases. Conclusions: Deep sclerectomy is effective in lowering IOP in both groups. However SKGEL implant is more effective in maintaining better success by 6 months of follow-up. Deep sclerectomy produces biopsy material of remarkable morphological variability that is not identical to the intra-operative appearance of the site of operation.