Mitomycin C‐augmented deep sclerectomy in primary open‐angle glaucoma and exfoliation glaucoma: a three‐year prospective study

• Published in: Acta ophthalmologica (Oxford, England) Vol. 89; no. 6; pp. 548 - 555
• Main Authors: Ollikainen, Minna L., Puustjärvi, Tuomo J., Rekonen, Petri K., Uusitalo, Hannu M., Teräsvirta, Markku E.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.09.2011
• Subjects: Aged; Alkylating Agents - administration & dosage; Combined Modality Therapy; deep sclerectomy; exfoliation glaucoma; Exfoliation Syndrome - physiopathology; Exfoliation Syndrome - surgery; Female; Follow-Up Studies; Glaucoma, Open-Angle - physiopathology; Glaucoma, Open-Angle - surgery; Humans; Intraocular Pressure - physiology; Intraoperative Complications; Laser Therapy; Lasers, Solid-State; Male; Mitomycin - administration & dosage; mitomycin C; non‐penetrating surgery; open‐angle glaucoma; Postoperative Complications; Prospective Studies; Sclera - drug effects; Sclera - surgery; Sclerostomy - methods; Tonometry, Ocular; Trabeculectomy
• ISSN: 1755-375X; 1755-3768
• DOI: 10.1111/j.1755-3768.2009.01772.x

. Purpose:  To investigate the efficacy and safety of mitomycin C (MMC)‐augmented deep sclerectomy with implant (DSCI) in primary open‐angle glaucoma (POAG) and exfoliation glaucoma (ExG) patients. Methods:  A total of 68 eyes of 68 patients with POAG and ExG were enrolled consecutively to undergo DSCI with MMC (0.4 mg/ml for 2 min). The intraocular pressure (IOP), number of antiglaucoma medications, neodymium:yttrium‐aluminum‐garnet (Nd:YAG) laser goniopuncture treatments and complications were compared postoperatively after 36‐ month follow‐up. Surgery was considered as a complete success when IOP was <18 mmHg without antiglaucoma medication. Results:  Preoperatively the mean IOPs were 23 ± 6 mmHg and 25 ± 8 mmHg, and 13 ± 4 mmHg and 11 ± 4 mmHg in the POAG and ExG groups, respectively, at 36 months. At 36 months, 74% and 73% of surgeries were a complete success in the POAG and ExG group, respectively [not significant (NS)]. Two patients (8%) of the POAG group and one of the ExG group (3%) were receiving antiglaucoma medication at 36 months (NS). Nd:YAG laser goniopuncture was performed more often in the ExG group (87%) than in the POAG group (61%, p = 0.024). Postoperatively choroidal detachment occurred in 16% of eyes in the POAG group and in 11% of eyes in the ExG group (NS). Conclusions:  DSCI with MMC augmentation appears to be as effective in patients with ExG and POAG in lowering IOP to target levels at medium term with few immediate postoperative complications.