Deep sclerectomy with mitomycin C in eyes with failed glaucoma surgery and pseudophakia.

Abstract

PURPOSE:

To report outcomes of deep sclerectomy (DS) with intraoperative mitomycin C (MMC) application in eyes with previous failed glaucoma surgery (GS) and/or cataract extraction (CE).

PATIENTS AND METHODS:

Single-surgeon case series of 82 eyes of 82 patients undergoing DS with MMC. The patients had previous CE with IOL and/or conjunctival GS and treated intraocular pressure (IOP) >18 mm Hg. MMC (0.2 mg/ml) was applied for 2-3 min before scleral flap dissection. Complete success was defined as IOP between 6 and 21 mm Hg or a reduction of 20% from baseline without medications. Reoperation for glaucoma or related complications, or loss of light perception vision was considered as failure.

RESULTS:

Mean follow-up was 57.7 ± 22.4 months with 78% of patients completing the 3-year follow-up. Mean IOP decreased from 24.0 mm Hg (22.3-25.6, 95% confidence intervals) to 13.4 mm Hg (12.0-14.2) at 3 years after surgery (P<0.001). There was a significant decrease in the number of glaucoma medications from 2.0 ± 1 preoperatively, to 0.3 ± 0.7, 3 years after surgery. Kaplan-Meier cumulative success rates were 85.6% at 1 year, 80.0% at 2 years, and 76% at 3 years. At 3 years, IOP was maintained <19 and 15 mm Hg in 83 and 70% of eyes, respectively. Fourteen eyes (17.1%) had complications. Delayed hypotony (IOP <6 mm Hg) was the commonest complication in five eyes (6.1%).

CONCLUSION:

DS with MMC appears to be a safe and effective surgical procedure for eyes with previous intraocular surgery.

• Authors: N Anand, D Wechsler
• Journal: Eye (London, England) (Eye (Lond)) Vol. 26 Issue 1 Pg. 70-9 (Jan 2012) ISSN: 1476-5454 [Electronic] England
• PMID: 21979860 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Mitomycin

Topics

• Aged
• Analysis of Variance
• Female
• Glaucoma (drug therapy, physiopathology, surgery)
• Humans
• Intraocular Pressure (drug effects)
• Intraoperative Care (methods)
• Male
• Minimally Invasive Surgical Procedures
• Mitomycin (therapeutic use)
• Postoperative Complications
• Pseudophakia (physiopathology, surgery)
• Reoperation
• Retrospective Studies
• Sclera (drug effects, physiopathology, surgery)
• Sclerostomy (methods)
• Trabeculectomy
• Visual Acuity