Deep sclerectomy with mitomycin C reduces IOP in primary open-angle glaucoma patients

J Glaucoma. 2011;20(1):21-27.

Patients with primary phakic open-angle glaucoma had reduced IOP after primary deep sclerectomy with mitomycin C, according to a retrospective study.

Researchers evaluated 194 eyes of 160 consecutive patients who underwent primary phakic deep sclerectomy with intraoperative MMC between August 2001 and April 2005. Mean follow-up time was 48 months.

After 1 year, the probability of patients having IOP less than 19 mm Hg, 16 mm Hg and 13 mm Hg without the use of medication or needle revisions was 85%, 83% and 68%, respectively.

At 3 years, the probability of having IOP less than 19 mm Hg, 16 mm Hg and 13 mm Hg was reduced to 78%, 76% and 60%, respectively. The probability of needing Nd:YAG laser goniopuncture after 3 years was 66%.

"To achieve low IOPs, postoperative procedure, like [laser goniopuncture] and needle revision, may be required," the authors said. "Complications like bleb-related infections, delayed bleb leaks and hypotony with maculopathy are not entirely avoided with this bleb-dependent [nonpenetrating glaucoma surgery] procedure."

During follow-up, 16 eyes (8.2%) underwent additional glaucoma surgery and 28 eyes (14.4%) endured intraoperative perforations. After laser goniopuncture and needling, three eyes (1.5%) had hypotony with maculopathy, two eyes (1%) developed blebitis and one perforated eye (0.5%) developed endophthalmitis.

In addition, 54 (27.8%) eyes experienced iris synechiae or incarceration in the goniopuncture, which accounted for an acute IOP increase in six eyes (3.1%), the study said.