Primary Phakic Deep Sclerectomy Augmented With Mitomycin C

Anand, Nitin; Kumar, Ashish; Gupta, Alok C.

doi:10.1097/ijg.0b013e3181ccb926

Cited by 43 publications

(35 citation statements)

References 38 publications

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“…28 Hypotony was observed in 3% of our cohort, which also compares favourably with the hypotonyrate of 7.2% reported by the aforementioned paper by Kirwan et al 25 Over a mean follow-up period of 63.5 months (in 296 eyes), we only observed three serious complications related to hypotony: two eyes required resuturing, whereas one resulted in delayed LGP is considered an important adjunct to DS in achieving low target IOPs. Reported rates vary from 36 to 67% 19,[28][29][30][31] The overall rate of LGP in our cohort was 54.4%. Patients in the phaco-DS with MMC group had a significantly greater chance of undergoing LGP (75.7%) compared with the unaugmented phaco-DS group (51.4%) at 5 years after surgery (P = 0.05).…”

Section: Discussionsupporting

confidence: 68%

“…MMC improves the efficacy of DS, as in trabeculectomy, by decreasing outflow resistance in the subconjunctival tissues and LGP may convert the DS to a full-thickness fistula, thus increasing the probability of hypotony in the long term. 28 In the presence of an avascular bleb, LGP and needle revision may similarly increase the risk of blebrelated infections. 28 Hypotony was observed in 3% of our cohort, which also compares favourably with the hypotonyrate of 7.2% reported by the aforementioned paper by Kirwan et al 25 Over a mean follow-up period of 63.5 months (in 296 eyes), we only observed three serious complications related to hypotony: two eyes required resuturing, whereas one resulted in delayed LGP is considered an important adjunct to DS in achieving low target IOPs.…”

Section: Discussionmentioning

confidence: 99%

“…28 In the presence of an avascular bleb, LGP and needle revision may similarly increase the risk of blebrelated infections. 28 Hypotony was observed in 3% of our cohort, which also compares favourably with the hypotonyrate of 7.2% reported by the aforementioned paper by Kirwan et al 25 Over a mean follow-up period of 63.5 months (in 296 eyes), we only observed three serious complications related to hypotony: two eyes required resuturing, whereas one resulted in delayed LGP is considered an important adjunct to DS in achieving low target IOPs. Reported rates vary from 36 to 67% 19,[28][29][30][31] The overall rate of LGP in our cohort was 54.4%.…”

Section: Discussionmentioning

confidence: 99%

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

Mercieca

Shevade

Anand

2015

Eye

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Purpose To report the outcomes of combined phacoemulsification and -deep sclerectomy (phaco-DS) from a single UK centre over a 10-year period. Methods Retrospective analysis of phaco-DS data extracted from an ongoing glaucoma surgery database within Calderdale and Huddersfield NHS Trust. Two hundred and ninety-six eyes of 282 patients were included. Data included patient demographics, pre-and postoperative intraocular pressure (IOP), use of mitomycin C (MMC), spacer device implantation, and follow-up details including surgical success rates. IOP success criteria were: (A) IOP o19 mm Hg and/or 20% decrease from baseline and (B) IOP o16 mm Hg and/or 30% drop from baseline. Results Mean follow-up was 63.5 ± 35.3 months. MMC was applied in 145 eyes (49%). Kaplan-Meier success rates in all eyes for criteria A were 89.1% and 80% with glaucoma medications (qualified success) and 81.2% and 68.3% without medications (unqualified success) at 2 and 5 years, respectively. Qualified success for criteria B was 72.4 and 61.4% and unqualified rates were 67.2 and 55.2% for the same time periods. Repeatedmeasures ANOVA showed significantly lower IOP in the phaco-DS with MMC group up to 3 years postoperatively (P = 0.002). Cox's proportional hazards for criteria B, however, showed no significant effect of MMC application in the long term (P = 0.2). Increasing age and laser goniopuncture were positively associated with success, whereas the absence of spacer devices was negatively associated. At last follow-up, 20% of eyes were on glaucoma medications. Complication rates were low with hypotony rates of 0.68%. Conclusions This study confirms the longterm safety and efficacy of phaco-DS as a primary glaucoma procedure.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Mercieca

Shevade

Anand

2015

Eye

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“…We have previously reported hypotony with maculopathy in 1.5% of eyes after primary phakic DS augmented with MMC. 25 Hypotony was observed only after a postoperative procedure to lower IOP was performed in all except one eye ( Table 6). The outer scleral flap after DS is very thin offers minimal resistance to aqueous outflow.…”

Section: Eyementioning

confidence: 99%

“…21,22 Like with trabeculectomy, intraoperative mitomycin C (MMC) application results in lower IOPs in the long term 23,24 and bleb rejuvenation techniques like needle revision can be used. 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.…”

Section: Introductionmentioning

confidence: 99%

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

Anand

Wechsler²

2011

Eye

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Purpose To report outcomes of deep sclerectomy (DS) with intraoperative mitomycin C (MMC) application in eyes with previous failed glaucoma surgery (GS) and/or cataract extraction (CE). Patients and methods Single-surgeon case series of 82 eyes of 82 patients undergoing DS with MMC. The patients had previous CE with IOL and/or conjunctival GS and treated intraocular pressure (IOP) 418 mm Hg. MMC (0.2 mg/ml) was applied for 2-3 min before scleral flap dissection. Complete success was defined as IOP between 6 and 21 mm Hg or a reduction of 20% from baseline without medications. Reoperation for glaucoma or related complications, or loss of light perception vision was considered as failure. Results Mean follow-up was 57.7±22.4 months with 78% of patients completing the 3-year follow-up. Mean IOP decreased from 24.0 mm Hg (22.3-25.6, 95% confidence intervals) to 13.4 mm Hg (12.0-14.2) at 3 years after surgery (Po0.001). There was a significant decrease in the number of glaucoma medications from 2.0±1 preoperatively, to 0.3±0.7, 3 years after surgery. Kaplan-Meier cumulative success rates were 85.6% at 1 year, 80.0% at 2 years, and 76% at 3 years. At 3 years, IOP was maintained o19 and 15 mm Hg in 83 and 70% of eyes, respectively. Fourteen eyes (17.1%) had complications. Delayed hypotony (IOP o6 mm Hg) was the commonest complication in five eyes (6.1%). Conclusion DS with MMC appears to be a safe and effective surgical procedure for eyes with previous intraocular surgery.

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Adopting New Surgical Methods: How I Do It and How I Choose: Going with the Flow

Craven

2013

Surgical Innovations in Glaucoma

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Primary Phakic Deep Sclerectomy Augmented With Mitomycin C

Abstract: Mitomycin C-enhanced primary DS effectively reduces IOP in primary phakic open-angle glaucoma. Most eyes required LGP to maintain IOP control. However, complications associated with partial-thickness procedures, like bleb-related infections and hypotonic maculopathy were observed.

Cited by 43 publications

References 38 publications

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

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

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

Adopting New Surgical Methods: How I Do It and How I Choose: Going with the Flow

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