Deep sclerectomy in normal-tension glaucoma with and without mitomycin-c.

Abstract

PURPOSE:

To compare the outcome of deep sclerectomy (DS) with and without mitomycin-C (MMC) in patients with normal-tension glaucoma (NTG).

METHODS:

We prospectively analysed the results of 37 eyes of 37 consecutive patients with NTG (age; mean ± SD; 64 ± 7 years) who underwent DS with a collagen implant. Patients were randomized to the MMC and non-MMC groups. Subconjunctival MMC (0.4 mg/ml for 3 min) was used intraoperatively in 15 of 37 eyes. We defined total success as 25% reduction in intraocular pressure (IOP) without medication. Follow-up time was 12 months.

RESULTS:

The mean preoperative IOP was significantly reduced from 15.2 ± 2.8 mmHg to 9.3 ± 2.7 (p < 0.001) in the MMC group after 12-month follow-up and from 15.1 ± 2.9 mmHg to 11.8 ± 2.0 (p < 0.001) in the non-MMC group. At 12 months, the mean IOP was significantly lower in the MMC group (p = 0.003) compared with the non-MMC group. Total success was achieved in 10 of 15 eyes (67%) in MMC group and in nine of 22 eyes (41%) in non-MMC group (p = 0.12). The number of glaucoma medications was decreased from 2.2 ± 0.8 to 0.5 ± 1.2 in MMC group (p = 0.001) and from 2.6 ± 1.0 to 0.5 ± 0.7 in non-MMC group (p < 0.001). Goniopuncture was performed in seven eyes (47%) in the MMC group, compared with 16 eyes (73%) in the non-MMC group (p = 0.13). IOP < 10 mmHg was achieved in seven of 15 eyes in the MMC group and in two of 22 in the non-MMC group (p = 0.009). Complication rate was low, and no difference between groups was evident.

CONCLUSION:

Deep sclerectomy seems to be effective and safe in reducing IOP in patients with NTG. Intraoperative use of MMC results in lower postoperative IOP 12-month postoperatively without increased rate of complications.

• Authors: Sakari Suominen, Mika Harju, Leena Kurvinen, Eija Vesti
• Journal: Acta ophthalmologica (Acta Ophthalmol) Vol. 92 Issue 7 Pg. 701-6 (Nov 2014) ISSN: 1755-3768 [Electronic] England
• PMID: 24373326 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2013 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Chemical References

• Alkylating Agents
• Mitomycin

Topics

• Aged
• Alkylating Agents (administration & dosage)
• Combined Modality Therapy
• Conjunctiva (drug effects)
• Female
• Humans
• Intraocular Pressure (physiology)
• Intraoperative Complications
• Low Tension Glaucoma (drug therapy, physiopathology, surgery)
• Male
• Middle Aged
• Mitomycin (administration & dosage)
• Postoperative Complications
• Prospective Studies
• Sclera (surgery)
• Sclerostomy
• Tonometry, Ocular
• Visual Acuity (physiology)