title: Deep sclerectomy with mitomycin C in eyes with failed glaucoma surgery and pseudophakia.
abstract: OBJECTIVE
  To report outcomes of deep sclerectomy (DS) with intraoperative mitomycin C (MMC) application in eyes with previous failed glaucoma surgery (GS) and/or cataract extraction (CE).
  
  
  METHODS
  Single-surgeon case series of 82 eyes of 82 patients undergoing DS with MMC. The patients had previous CE with IOL and/or conjunctival GS and treated intraocular pressure (IOP) >18 mm Hg. MMC (0.2 mg/ml) was applied for 2-3 min before scleral flap dissection. Complete success was defined as IOP between 6 and 21 mm Hg or a reduction of 20% from baseline without medications. Reoperation for glaucoma or related complications, or loss of light perception vision was considered as failure.
  
  
  RESULTS
  Mean follow-up was 57.7 ± 22.4 months with 78% of patients completing the 3-year follow-up. Mean IOP decreased from 24.0 mm Hg (22.3-25.6, 95% confidence intervals) to 13.4 mm Hg (12.0-14.2) at 3 years after surgery (P<0.001). There was a significant decrease in the number of glaucoma medications from 2.0 ± 1 preoperatively, to 0.3 ± 0.7, 3 years after surgery. Kaplan-Meier cumulative success rates were 85.6% at 1 year, 80.0% at 2 years, and 76% at 3 years. At 3 years, IOP was maintained <19 and 15 mm Hg in 83 and 70% of eyes, respectively. Fourteen eyes (17.1%) had complications. Delayed hypotony (IOP <6 mm Hg) was the commonest complication in five eyes (6.1%).
  
  
  CONCLUSIONS
  DS with MMC appears to be a safe and effective surgical procedure for eyes with previous intraocular surgery.
authors: Department of Ophthalmology, Calderdale and Huddersfield NHS Trust, Huddersfield Royal Infirmary, Huddersfield, UK. anand1604@gmail.com
authors: N
authors: N
authors: Anand
authors: D
authors: D
authors: Wechsler
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D005260:Female; D005901:Glaucoma / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D016685:Mitomycin / Q000627:therapeutic use*; D011183:Postoperative Complications; D019591:Pseudophakia / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012590:Sclera / Q000187:drug effects / Q000503:physiopathology / Q000601:surgery*; D012599:Sclerostomy / Q000379:methods*; D014130:Trabeculectomy; D014792:Visual Acuity
chemical_list: D016685:Mitomycin