Primary phakic deep sclerectomy augmented with mitomycin C: long-term outcomes.
OBJECTIVE
To report the long-term outcomes of deep sclerectomy (DS) with intraoperative mitomycin C in eyes with no previous ocular surgery.


METHODS
One hundred ninety-four eyes of 160 consecutive patients who had primary phakic DS between August 2001 and April 2005 were included from a database on all glaucoma surgery in our department. The mean follow-up was 48±15 months (median, 49 mo).


RESULTS
The probability of a final intraocular pressure (IOP) of less than 19, 16, and 13 mm Hg without medications or needle revisions at 1 year was 85% (80% to 90%, 95% confidence intervals), 83% (78% to 88%), and 68% (62% to 75%). At 3 years was 78% (73% to 85%), 76% (60% to 82%), and 60% (53% to 67%), respectively. The probability of performing Nd:YAG laser goniopuncture (LGP) was 66% (59% to 74%) 3 years after DS. Further glaucoma surgery was undertaken in 16 eyes (8.2%). Intraoperative perforations occurred in 28 eyes (14.4%). Iris synechiae or incarceration in the goniopuncture were observed in 54 (27.8%) during follow-up and were associated with an acute symptomatic rise in IOP in 6 eyes (3.1%). Hypotony with maculopathy was seen after LGP and needling in 3 eyes (1.5%). Blebitis developed in 2 eyes (1%) after LGP and endophthalmitis in 1 eye (0.5%), which had an intraoperative perforation.


CONCLUSIONS
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.
Anand
Nitin
N
Department of Ophthalmology, Calderdale and Huddersfield NHS Trust, Huddersfield Royal Infirmary, Huddersfield, UK. anand1604@gmail.com
Kumar
Ashish
A
Gupta
Alok
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000477:Alkylating Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D007431:Intraoperative Complications; D007432:Intraoperative Period; D007908:Lens, Crystalline / Q000502:physiology; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D012590:Sclera / Q000187:drug effects* / Q000601:surgery*; D012599:Sclerostomy; D013524:Surgical Flaps; D014065:Tonometry, Ocular; D016896:Treatment Outcome; D055815:Young Adult
D000477:Alkylating Agents; D016685:Mitomycin