title: Deep Sclerectomy With Mitomycin C and Injectable Cross-linked Hyaluronic Acid Implant: Long-term Results.
abstract: To evaluate the long-term efficacy and safety of deep sclerectomy (DS) augmented with mitomycin C (MMC) and injectable cross-linked hyaluronic acid implant (Healaflow) in medically refractory glaucoma patients.
  
  
  
  Our study included 96 eyes of 83 consecutive patients with open-angle glaucoma undergoing MMC-DS with injectable cross-linked hyaluronic acid implant. Mean follow-up was 28.6±20.0 months. Variables analyzed were: intraocular pressure (IOP), best-corrected visual acuity, mean number of antiglaucomatous drugs, execution of postoperative maneuvres (goniopuncture, bleb needling, and laser lysis of scleral flap sutures). Tonometric success was defined by 2 different thresholds, specifically IOP≤21 mm Hg (criterion A) and ≤15 mm Hg (criterion B). The procedure was defined as a qualified success if reached with medication and as a complete success if reached without.
  
  
  
  For criterion A, qualified and complete success rates were 96% and 94%, respectively, at 12 months, 95% and 92% at 24 months, and 92% and 89% at 36 months. For criterion B, qualified and complete success rates were 75% and 75%, respectively, at 12 months, 62% and 60% at 24 months, and 59% and 58% at 36 months. Goniopuncture was performed in 56 eyes (58%), bleb needling with 5-fluorouracil injection in 4 eyes (5.1%), and laser release of scleral flap sutures in 4 eyes (4%). Six eyes required additional filtering surgery.
  
  
  
  DS with Healaflow and MMC seems to be an effective and safe technique to lower IOP in patients affected by open-angle glaucoma, with few postoperative complications.
authors.affiliation: Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Bettin
authors.forename: Federico
authors.initials: F
authors.lastname: Di Matteo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rabiolo
authors.forename: Marina
authors.initials: M
authors.lastname: Fiori
authors.forename: Carlo
authors.initials: C
authors.lastname: Ciampi
authors.forename: Francesco
authors.initials: F
authors.lastname: Bandello
mesh_terms: D000477:Alkylating Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D004343:Drug Implants; D005260:Female; D005902:Glaucoma, Open-Angle / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007429:Intraocular Pressure / Q000187:drug effects / Q000502:physiology; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D019736:Prostheses and Implants; D012590:Sclera / Q000601:surgery*; D012599:Sclerostomy / Q000379:methods*; D013524:Surgical Flaps; D014065:Tonometry, Ocular; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000477:Alkylating Agents; D004343:Drug Implants; D016685:Mitomycin; D006820:Hyaluronic Acid