Deep sclerectomy with mitomycin C in failed trabeculectomy.
OBJECTIVE
To evaluate the success rate and complications associated with deep sclerectomy with mitomycin C (MMC) and a reticulated hyaluronic acid implant in previously failed trabeculectomy.


METHODS
This prospective study included 20 eyes with a previously failed trabeculectomy, which were treated with deep sclerectomy with 0.2 mg/ml MMC application under the conjunctiva and superficial scleral flap. Intraocular pressure (IOP), glaucoma medications, visual acuity, and complications were recorded preoperatively and 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively.


RESULTS
The mean preoperative IOP was 25.8+/-7.3 mmHg; the IOP significantly decreased to 14.6+/-3.2 mmHg 1 year postoperative. At each interval, the mean IOP was significantly lower than preoperatively (P=0.000). At 1 year, the complete success rate (IOP<or=21 mmHg untreated) was 65% and the qualified success rate (IOP<or=21 mmHg with and without medication) was 100%. 12 patients (60%) achieved an IOP<or=15 mmHg with and without medication. No shallow or flat anterior chamber, endophthalmitis, or leakage developed.


CONCLUSIONS
These data suggest that deep sclerectomy augmented with MMC is a safe surgical procedure that decreases IOP in eyes with a previously failed trabeculectomy.
Rebolleda
G
G
Glaucoma Unit, Ophthalmology Department, Hospital Ramón y Cajal, University of Alcala, Madrid, Spain. grebolleda@telefonica.net
Muñoz-Negrete
F J
FJ
D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D004334:Drug Administration Schedule; D005260:Female; D005901:Glaucoma / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D005902:Glaucoma, Open-Angle / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007429:Intraocular Pressure; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage / Q000627:therapeutic use*; D019384:Nucleic Acid Synthesis Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D012599:Sclerostomy / Q000379:methods*; D014130:Trabeculectomy; D017211:Treatment Failure; D016896:Treatment Outcome; D014792:Visual Acuity
D000959:Antihypertensive Agents; D019384:Nucleic Acid Synthesis Inhibitors; D016685:Mitomycin