Outcomes of Laser Suture Lysis After Initial Trabeculectomy With Adjunctive Mitomycin C

Ralli, Megha; Nouri‐Mahdavi, Kouros; Caprioli, Joseph

doi:10.1097/01.ijg.0000195929.94922.a2

Cited by 31 publications

(16 citation statements)

References 19 publications

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“…We chose not to perform other adjunctive procedures, such as adjustable/releasable sutures or needling, in order to avoid introducing additional variables. In fact, even though some authors report favourable outcomes with releasable sutures, other literature indicates that these do not exclude the risk of hypotony during the early postoperative period and are of little utility in phakic eyes when used after postoperative day 10 [33,34,35,36]. As for needling, it does not seem to be significantly better than medical therapy after trabeculectomy [37].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2008

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2008

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“…As stated earlier, all groups were matched with regard to factors determining success of filtering surgery (Stalmans et al 2006;Kapetansky 2003;Ralli et al 2006;Fontana et al 2006). Needling does not seem significantly better than medical therapy after trabeculectomy (Feyi-Waboso & Ejere 2004).…”

Section: Discussionmentioning

confidence: 99%

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

Cillino

Zeppa

Pace

et al. 2008

Acta Ophthalmologica

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ABSTRACT.Purpose: To test the expanded polytetrafluoroethylene (ePTFE) as a new adjuvant in trabeculectomy. Methods: Consecutive glaucoma surgical inpatients were observed at the Department of Ophthalmology of Palermo University. Sixty patients (60 eyes) were randomly assigned to undergo trabeculectomy (T), trabeculectomy with mitomycin-C (TMMC), with ePTFE (TG) or with mitomycin-C and ePTFE (TGMMC). Postoperative visits were scheduled at 24 hr, 7 days, 1, 3, 6, 12, 18 and 24 months. Complete success and qualified success were assessed at two target intraocular pressure (IOP) levels -£21 and £17 mmHg -by Kaplan-Meier curves. Results: The postoperative IOP reduction was significant (P < 0.01) at the endpoint in all groups, with a mean IOP of 16.9 (±2.9), 16.2 (±2.7), 15.3 (±3.4) and 15.2 (±4.3) mmHg in T, TMMC, TG and TGMMC eyes, respectively. No intergroup difference was found at either IOP targets. The Kaplan-Meier curves relating to either the £21 mmHg or the £17 mmHg target IOP did not show significant intergroup differences for complete and qualified success rate. When ePTFE was used, a trend favouring the medium-term survival rate was noted. No adverse reaction to the ePTFE was present, and no membrane extrusion or conjuctival erosion were noted in any cases. Hypotony was significantly more frequent (P = 0.035) in groups without ePTFE. Moreover, the late MMC-related complications were more frequent when MMC was applied. Conclusion: Expanded polytetrafluoroethylene implant in trabeculectomy is well tolerated and could act as a filtration modulating device. Therefore, it is useful in reducing early hypotony-related complications and contributes to attaining medium-term IOP control that is comparable to the low-dosage MMC.

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“…Ancak antimetabolit kullanımı ile yara iyileşmesinin gecikmesi nedeniyle trabekülektomi-sütür lizis arası 'pencere periyodu'nun uzadığı, 21. haftaya kadar başarılı olduğu bildirilmiştir (9,20,(23)(24)26). Ralli ve arkadaşları postoperatif ilk 10 günde yapılan LSK' nın geç dönemdekine göre 12 aylık süreçte GİB düşüşü üzerine daha etkili olduğunu göstermiştir (11). Bizim çalışmamızda ise trabekülektomi ile LSK arası ortalama süre 7,9±6,3 (min 2; max 27) gündü.…”

Section: Discussionunclassified

“…Skleral flebin sıkı kapatılması cerrahi sonrası erken dönemde filtrasyonun yetersiz olmasına ve göz içi basıncında (GİB) hedeflenen düşüşün sağlanamamasına yol açmaktadır. Tedavide önceden serbestleştirilebilir sütür konmuşsa gevşetme tekniği kullanılabilir veya minimal invaziv bir yöntem olan lazerle sütür kesilmesi (LSK) tekniği uygulanabilir (6)(7)(8)(9)(10)(11)(12)(13). İlk defa 1983'te Lieberman ve sonra Hoskins ve Migliazzo tarafından tanımlanan lazerle sütür kesilmesi tekniği trabekülektomi sonrası 9/0 veya 10/0 nylon skleral flep sütürlerinin termal lazer kullanılarak transkonjonktival yolla kesilmesidir (6,14).…”

Section: Introductionunclassified

Trabekülektomi̇ Operasyonu Sonrasi Erken Dönemde Yüksek Göz İçi̇ Basinci İçi̇n Yapilan Lazerle Sütür Kesi̇lmesi̇ni̇n Etki̇nli̇ği̇

Bayraktar

Dere

İzgi

2017

İstanbul Tıp Fakültesi Dergisi

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Results: Twenty-two patients were female, 20 patients were male and the mean age was 62.1±16 (34-81). LSL was performed once in 22 eyes (46.8%) and more than once in 25 eyes(53.2%). The mean number of LSL was 1.63±0.7. The mean IOP before trabeculectomy was 30.2 mmHg and it was 24.1±6.3 mmHg (14-42 mmHg) before LSL. The mean interval time between trabeculectomy and performance of suture lysis was 7.9±6.3 days. The mean IOPs before and immediately after laser suture lysis were 24.15±6.93 mmHg and 17.47±5.81 mmHg respectively in patients that LSL was performed once (p<0.001). The mean IOPs before and immediately after laser suture lysis were 23.96±7 mmHg and 16.6±4.61 mmHg respectively in patients that LSL was performed more than once (p<0.001). The difference was statistically significant in two groups (p<0.001). At the last visit, the mean IOP was 14.6±4.07 mmHg (4-25 mmHg) (p<0.001). The mean follow-up time was 21.4±20.01months (1-89 months). Conclusion:Laser suture lysis is a safe and effective method in the management of the patients in whom the target IOP was not reached after trabeculectomy and it can be performed more than once.

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Outcomes of Laser Suture Lysis After Initial Trabeculectomy With Adjunctive Mitomycin C

Abstract: Eyes that undergo laser suture lysis >10 days after initial trabeculectomy with mitomycin C are more likely to have poorer long-term IOP control than eyes not requiring laser suture lysis or eyes undergoing laser suture lysis

Cited by 31 publications

References 19 publications

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

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

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

Trabekülektomi̇ Operasyonu Sonrasi Erken Dönemde Yüksek Göz İçi̇ Basinci İçi̇n Yapilan Lazerle Sütür Kesi̇lmesi̇ni̇n Etki̇nli̇ği̇

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Outcomes of Laser Suture Lysis After Initial Trabeculectomy With Adjunctive Mitomycin C

Abstract: Eyes that undergo laser suture lysis >10 days after initial trabeculectomy with mitomycin C are more likely to have poorer long-term IOP control than eyes not requiring laser suture lysis or eyes undergoing laser suture lysis

Cited by 31 publications

References 19 publications

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

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

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

Trabekülektomi̇ Operasyonu Sonrasi Erken Dönemde Yüksek Göz İçi̇ Basinci İçi̇n Yapilan Lazerle Sütür Kesi̇lmesi̇ni̇n Etki̇nli̇ği̇

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