Deep Sclerectomy versus Trabeculectomy with Low-Dosage Mitomycin C: Four-Year Follow-Up

Abstract

Aims: To compare the long-term effects of low-dosage mitomycin C (MMC) in both deep sclerectomy (DSMMC) and trabeculectomy (TPMMC) on intraocular pressure (IOP). Methods: Analysis of extended follow-up of data from a prospective clinical trial. Forty patients were originally randomised to undergo either DSMMC (19 eyes) or TPMMC (21 eyes). Follow-up was performed at postoperative day 1, weeks 1, 2 and 3, as well as months 1, 3, 6, 9, 12, 18, 24, 36 and 48. Two- to three-week data were not included in the statistical analysis. Postoperative complications, number of antiglaucoma medications and IOP were recorded at each visit. Complete (no medications) and qualified (with or without medications) successes were assessed at 2 target IOPs (≤21 and ≤17 mm Hg) and evaluated by Kaplan-Meier curves. Results: At 48 months, the mean IOP (± SD) was 17.6 ± 3.4 and 17.8 ± 3.6 mm Hg in the DSMMC and TPMMC eyes, respectively, a significant reduction from preoperative IOP in each group (p < 0.0005). Complete success was achieved at the ≤21 mm Hg target IOP in 10 (52.6%) and 14 (66.6%) eyes and qualified success in 15 (78.9%) and 18 (85.7%) eyes in the DSMMC and TPMMC groups, respectively. There were no differences in the Kaplan-Meier curves. Hypotony and shallow anterior chamber were significantly more frequent in the TPMMC group. Conclusions: Either procedure controlled IOP efficaciously at our endpoint. Low-dosage MMC can be considered a mild enhancement of deep sclerectomy IOP-lowering effect.

Deep sclerectomy and trabeculectomy in uveitic glaucoma

“…1,3,[12][13][14] In many studies, the results of DS and TRAB were also compared in patients with primary glaucoma. [5][6][7]15,16 However, as regards the management of uveitic glaucoma, only one of these two procedures was usually analysed. 2,9-11 For TRAB, our surgical success rate of 89% at 12 months is comparable with the rates reported by Ceballos 1 or Towler 2 for uveitic glaucomas.…”

“…In primary open-angle glaucoma, both DS with a collagen implant and TRAB result in equal control of intraocular pressure (IOP), and similar cumulative success rates have indeed been reported for the two techniques. 5,6 In addition, DS seems to require fewer postoperative complications than TRAB, although results for the longevity of IOP stabilisation remain uncertain. 7 Few complications and low levels of postoperative intraocular inflammation make DS a surgical procedure of interest in the management of uveitic glaucoma.…”

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

“…2 The comparative efficacy of the various types of NPGS to trabeculectomy remains a subject of some debate but most reports agree that NPGS has a lower rate of complications than trabeculectomy. [10][11][12][13][14][15] DS has been shown to be equivalent to trabeculectomy in lowering the intraocular pressure (IOP) in some recent publications. 11,16,17 Excellent long-term results have been reported with DS as the primary surgery for open-angle glaucoma.…”

“…[10][11][12][13][14][15] DS has been shown to be equivalent to trabeculectomy in lowering the intraocular pressure (IOP) in some recent publications. 11,16,17 Excellent long-term results have been reported with DS as the primary surgery for open-angle glaucoma. [18][19][20] The IOP after DS can be further lowered by Nd:YAG laser goniopuncture (LGP) of the TDM.…”

Enhanced Trabeculectomy – The Moorfields Safer Surgery System

“…The variation in the current practice (preoperative strategies, intraoperative tech-niques and postoperative management) of GFS, diverse case-mix and different suc-cess criteria account for the variable results published in the literature, with 'success' rates ranging from 71 to 100% [2][3][4][5][6][7][8][9][10][11]. In the Tube Versus Trabeculectomy (TVT) study, the cumulative probability of failure in the trabeculectomy group was 30.7% at 3 years and 46.9% at 5 years [3].…”