IOP progressively increases after glaucoma surgery revision with MMC

IOP progressively increases with time after surgically revising failed glaucoma surgeries, a study found. Despite the adjunctive use of mitomycin-C, "a significant proportion of eyes will eventually require a needle revision procedure and/or glaucoma medications to further lower IOP," the authors noted.

Nitin Anand, MD, FRCS, FRCOphth, and Seema Arora, FRCOphth, reviewed outcomes for 54 eyes of 54 consecutive patients treated with revision surgery for failed trabeculectomy or deep sclerectomy. In all cases, the surgeon applied 0.2 mg/mL of MMC under a fornix-based conjunctival flap and dissected the existing scleral flap to re-establish filtration, according to the study.

Surgeons also performed concurrent phacoemulsification in 23 patients, the authors noted.

Follow-up averaged 39.5 months, ranging from 29.5 months to 49.5 months.

At 3 years follow-up, mean IOP had decreased to 14.4 mm Hg from 23.6 mm Hg preoperatively.

Patients had a 64% probability of maintaining an IOP between 5 mm Hg and 18 mm Hg and a 20% decrease from preoperative IOP at 3 years postop with the additional use of medications, needle revision or both. Without either medication or needling revision, the survival probability fell to 38% at 3 years, according to the study.

Surgeons performed a needling revision for bleb failure or high IOP in 23 eyes (42.5%). Another five eyes underwent further glaucoma surgery (9.3%), the authors reported.

The authors noted that there was a significant incidence of complications, including suprachoroidal hemorrhage in three eyes, delayed bleb leaks in five eyes, hypotony in two eyes and blebitis in two eyes.

The study is published in the August issue of Journal of Glaucoma.