Deep sclerectomy augmented with mitomycin C

Abstract

Aims To investigate the comparative efficacy and safety of deep sclerectomy with and without intraoperative mitomycin C (MMC) application for lowering the intraocular pressure (IOP). Methods A total of 71 eyes of 71 consecutive patients who had routine deep sclerectomy (DS), nonaugmented (DS-noMMC) or with mitomycin C (DS-MMC) augmentation (0.2 mg/ml for 2 min) and follow-up of 4 months or more were identified from an ongoing prospective database on glaucoma surgery. Indications for MMC use were the presence of risk factors for subconjunctival scarring and low target IOPs. MMC 0.2 mg/ml was applied in the sub-Tenons space for 2 min. Results There were 19 eyes in the DSnoMMC group and 52 eyes in the DS-MMC group. In 11 eyes (15.5%), the procedure was complicated by intraoperative perforation of the trabeculo-Descemet's window. Eyes in the DS-MMC group had significantly lower IOPs (MANOVA, P ¼ 0.04). Kaplan-Meier survival curve analysis showed that the probability of maintaining IOP below target IOP level, below 18 mmHg and below 14 mmHg at 1 year was 51, 67, and 35% for the DS-noMMC group and 80, 86, and 74% for the DS-MMC group. The survival rates of the DS-MMC group were not statistically significant (P ¼ 0.06) when the success criterion was maintaining an IOP less than 18 mmHg but were significant for the other criteria, namely IOP less than target levels (P ¼ 0.03) and less than 14 mmHg (P ¼ 0.03). Nd:YAG goniopuncture to lower IOP to target levels was done more frequently in the DS-noMMC group (13 eyes, 81%) than the DS-MMC group (20 eyes, 45%) and this difference was significant (P ¼ 0.03). The prevalence of avascular areas within filtration blebs and transconjunctival oozing of aqueous was significantly higher in the DS-MMC group (Po0.01).Conclusions The use of intraoperative MMC during deep sclerectomy has a significant effect on the postoperative IOP and increases the probability of achieving target IOPs. However, our current technique of MMC application is associated with a higher incidence of avascular blebs and transconjunctival oozing.

Outcomes of combined phacoemulsification and deep sclerectomy: a 10-year UK single-centre study

“…32,33 There is also evidence for a similar role of MMC in primary DS. [34][35][36][37][38][39] The decision to use MMC during individual surgical cases was difficult to pinpoint from our database. Patients in the MMC group were slightly younger and probably had worse visual field (VF) mean deviation.…”

E-PTFE (Gore-Tex®) implant with or without low-dosage mitomycin-C as an adjuvant in penetrating glaucoma surgery: 2 year randomized clinical trial

“…In our experience, MMC can be regarded as an enhancement of the deep sclerectomy IOP-lowering effect without evidence of antimetabolite-related complications (Cillino et al 2005). On the other hand, MMC-augmented glaucoma surgery can be associated with a significantly higher frequency of late bleb leaks (Anand & Atherley 2005;Anand et al 2006). and Gaetano Lodato A detailed database search (Medline and PubMed) failed to show any report on the use of synthetic implant materials as adjuvants in penetrating glaucoma surgery (Jampel et al 2002;Wilkins et al 2005).…”

Biodegradable collagen matrix implant vs mitomycin-C as an adjuvant in trabeculectomy: a 24-month, randomized clinical trial

“…1,2,[11][12][13] Unfortunately, antimetabolite-augmented glaucoma surgery can be associated with a higher frequency of prolonged wound leaks, hypotony with choroidal effusions and maculopathy, thin avascular blebs, and/or bleb leaks with late infection. 9,14,15 Recently, a new biodegradable porous collagen-glycosaminoglycan (GAG) copolymer matrix implant has been proposed for glaucoma surgery on the basis of animal experiments. [16][17][18] Ologen (OLO) collagen matrix (Aeon Astron Europe BV, Leiden, The Netherlands) is a biodegradable collagen-GAG implant, available in various shapes and dimensions, that may maintain the hypotensive effect in glaucoma surgery and enhance the healing in other selected ophthalmic surgeries (eg, pterygium or strabismus).…”