Deep sclerectomy with mitomycin C in failed trabeculectomy

Abstract

Aim To evaluate the success rate and complications associated with deep sclerectomy with mitomycin C (MMC) and a reticulated hyaluronic acid implant in previously failed trabeculectomy. Methods This prospective study included 20 eyes with a previously failed trabeculectomy, which were treated with deep sclerectomy with 0.2 mg/ml MMC application under the conjunctiva and superficial scleral flap. Intraocular pressure (IOP), glaucoma medications, visual acuity, and complications were recorded preoperatively and 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. Results The mean preoperative IOP was 25.877.3 mmHg; the IOP significantly decreased to 14.673.2 mmHg 1 year postoperative. At each interval, the mean IOP was significantly lower than preoperatively (P ¼ 0.000). At 1 year, the complete success rate (IOPr21 mmHg untreated) was 65% and the qualified success rate (IOPr21 mmHg with and without medication) was 100%. 12 patients (60%) achieved an IOPr15 mmHg with and without medication. No shallow or flat anterior chamber, endophthalmitis, or leakage developed. Conclusions These data suggest that deep sclerectomy augmented with MMC is a safe surgical procedure that decreases IOP in eyes with a previously failed trabeculectomy.

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

“…25 DS with MMC has been reported to be a safe and effective procedure for eyes with failed trabeculectomy. 26,27 There has been a lack of consensus among glaucoma surgeons as to the best surgical option in eyes at a high-risk-to-failure, such as previous intraocular surgery. The Tube versus Trabeculectomy (TVT) trial was designed to prospectively assess trabeculectomy and Bearveldt tube implant (BGI) surgery, both augmented with MMC, in eyes with previous cataract surgery and/or failed trabeculectomy.…”

Non‐penetrating glaucoma surgery augmented with mitomycin C or 5‐fluorouracil in eyes at high risk of failure of filtration surgery: long‐term results

“…Most surgeons performing deep sclerectomy place a collagen or other implant 19,21,22,38–41 under the remaining superficial scleral flap to encourage subconjunctival drainage. With viscocanalostomy, on the other hand, Stegmann et al.…”

“…Rebolleda and Munoz‐Negerte in a study of deep sclerectomy with MMC in eyes with failed trabeculectomy (90% of which were pseudophakic) achieved a qualified success rate of 100% at 1‐year follow up without complications. They applied MMC under the conjunctival and superficial scleral flaps 46 …”

“…36 Souissi et al reported longterm IOP control in all eight eyes of a series with uveitic glaucoma using deep sclerectomy with no augmentation. 37 Most surgeons performing deep sclerectomy place a collagen or other implant 19,21,22,[38][39][40][41] under the remaining superficial scleral flap to encourage subconjunctival drainage. With viscocanalostomy, on the other hand, Stegmann et al recommend tight closure of the superficial scleral flap to avoid any bleb formation.…”

Nonpenetrating deep sclerectomy

“…Eyes that received MMC had significantly lower IOP and were less likely to require goniopuncture but also had a higher incidence of avascularized bleb and trans conjunctival oozing. Other prospective and retrospective studies have also reported the beneficial effect of antifibrotic agents on the final outcome of surgery [55][56][57].…”