Primary phakic deep sclerectomy augmented with mitomycin C: long-term outcomes.

Abstract

AIM:

To report the long-term outcomes of deep sclerectomy (DS) with intraoperative mitomycin C in eyes with no previous ocular surgery.

METHODS:

One hundred ninety-four eyes of 160 consecutive patients who had primary phakic DS between August 2001 and April 2005 were included from a database on all glaucoma surgery in our department. The mean follow-up was 48±15 months (median, 49 mo).

RESULTS:

The probability of a final intraocular pressure (IOP) of less than 19, 16, and 13 mm Hg without medications or needle revisions at 1 year was 85% (80% to 90%, 95% confidence intervals), 83% (78% to 88%), and 68% (62% to 75%). At 3 years was 78% (73% to 85%), 76% (60% to 82%), and 60% (53% to 67%), respectively. The probability of performing Nd:YAG laser goniopuncture (LGP) was 66% (59% to 74%) 3 years after DS. Further glaucoma surgery was undertaken in 16 eyes (8.2%). Intraoperative perforations occurred in 28 eyes (14.4%). Iris synechiae or incarceration in the goniopuncture were observed in 54 (27.8%) during follow-up and were associated with an acute symptomatic rise in IOP in 6 eyes (3.1%). Hypotony with maculopathy was seen after LGP and needling in 3 eyes (1.5%). Blebitis developed in 2 eyes (1%) after LGP and endophthalmitis in 1 eye (0.5%), which had an intraoperative perforation.

CONCLUSIONS:

Mitomycin C-enhanced primary DS effectively reduces IOP in primary phakic open-angle glaucoma. Most eyes required LGP to maintain IOP control. However, complications associated with partial-thickness procedures, like bleb-related infections and hypotonic maculopathy were observed.

• Authors: Nitin Anand, Ashish Kumar, Alok Gupta
• Journal: Journal of glaucoma (J Glaucoma) Vol. 20 Issue 1 Pg. 21-7 (Jan 2011) ISSN: 1536-481X [Electronic] United States
• PMID: 20179623 (Publication Type: Journal Article)

Chemical References

• Alkylating Agents
• Mitomycin

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Alkylating Agents (administration & dosage)
• Combined Modality Therapy
• Female
• Follow-Up Studies
• Glaucoma, Open-Angle (surgery)
• Humans
• Intraocular Pressure
• Intraoperative Complications
• Intraoperative Period
• Lens, Crystalline (physiology)
• Male
• Middle Aged
• Mitomycin (administration & dosage)
• Postoperative Complications
• Reoperation
• Retrospective Studies
• Sclera (drug effects, surgery)
• Sclerostomy
• Surgical Flaps
• Tonometry, Ocular
• Treatment Outcome
• Young Adult