A1 Refereed original research article in a scientific journal
Long-term results of deep sclerectomy in normal-tension glaucoma
Authors: Mika Harju,Sakari Suominen,Pasi Allinen,Eija Vesti
Publisher: WILEY
Publication year: 2018
Journal: Acta Ophthalmologica
Journal name in source: ACTA OPHTHALMOLOGICA
Journal acronym: ACTA OPHTHALMOL
Volume: 96
Issue: 2
First page : 154
Last page: 160
Number of pages: 7
ISSN: 1755-375X
DOI: https://doi.org/10.1111/aos.13529
Abstract
PurposeTo study the long-term outcome of deep sclerectomy with and without mitomycin-C (MMC) in patients with normal-tension glaucoma (NTG).MethodsWe prospectively analysed consecutive patients randomized to surgery performed either with (MMC group) or without (non-MMC) MMC. Surgery was considered totally successful if, after surgery, the preoperative intra-ocular pressure (IOP) level was reduced by 25% without medication, and a qualified success if medication was required to achieve the same limits.ResultsA total of 37 patients were enrolled, 15 in the MMC and 22 in the non-MMC group. The median (range) follow-up was 7.9 (1.0-9.0) years, with a drop-out of three (8%) patients. The preoperative IOP was 15 (11-21) mmHg in the MMC and 15 (10-19) mmHg in the non-MMC group. At the last 6- to 9-year follow-up, IOP was significantly reduced to 9 (2-13) mmHg (p=0.002) and 10 (5-13) mmHg (p<0.001). The overall (groups combined) complete and qualified success rates were 50% and 71%, with no significant difference between groups (p=0.48 and p=0.25). Goniopuncture was performed in 87% and 100% of eyes in the MMC and non-MMC groups (p=0.14). Needling with MMC injection was performed 0 (0-1) times in the MMC group and 0.5 (0-4) times in the non-MMC group (p=0.056). We encountered no cases of hyphema, shallow anterior chamber, hypotony maculopathy, choroidal effusion, late bleb leakage, blebitis, endophthalmitis or malignant glaucoma.ConclusionIn NTG, long-term significant IOP reduction can be achieved with deep sclerectomy with a low incidence of sight-threatening complications.
PurposeTo study the long-term outcome of deep sclerectomy with and without mitomycin-C (MMC) in patients with normal-tension glaucoma (NTG).MethodsWe prospectively analysed consecutive patients randomized to surgery performed either with (MMC group) or without (non-MMC) MMC. Surgery was considered totally successful if, after surgery, the preoperative intra-ocular pressure (IOP) level was reduced by 25% without medication, and a qualified success if medication was required to achieve the same limits.ResultsA total of 37 patients were enrolled, 15 in the MMC and 22 in the non-MMC group. The median (range) follow-up was 7.9 (1.0-9.0) years, with a drop-out of three (8%) patients. The preoperative IOP was 15 (11-21) mmHg in the MMC and 15 (10-19) mmHg in the non-MMC group. At the last 6- to 9-year follow-up, IOP was significantly reduced to 9 (2-13) mmHg (p=0.002) and 10 (5-13) mmHg (p<0.001). The overall (groups combined) complete and qualified success rates were 50% and 71%, with no significant difference between groups (p=0.48 and p=0.25). Goniopuncture was performed in 87% and 100% of eyes in the MMC and non-MMC groups (p=0.14). Needling with MMC injection was performed 0 (0-1) times in the MMC group and 0.5 (0-4) times in the non-MMC group (p=0.056). We encountered no cases of hyphema, shallow anterior chamber, hypotony maculopathy, choroidal effusion, late bleb leakage, blebitis, endophthalmitis or malignant glaucoma.ConclusionIn NTG, long-term significant IOP reduction can be achieved with deep sclerectomy with a low incidence of sight-threatening complications.
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