Deep sclerectomy versus punch trabeculectomy: effect of low-dosage mitomycin C

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Intraocular Pressure Management

Background:

• Glaucoma surgery aims to reduce intraocular pressure (IOP) to prevent optic nerve damage.
• Deep sclerectomy (DS) and trabeculectomy are established glaucoma surgical procedures.
• The use of intraoperative mitomycin C (MMC) can enhance IOP reduction but may increase complication risks.

Purpose of the Study:

• To compare the efficacy and safety of deep sclerectomy with mitomycin C (DSMMC) versus trabeculectomy with the Crozafon-De Laage Punch and mitomycin C (TPMMC).
• To evaluate intraocular pressure (IOP) behavior and success rates of both surgical techniques using low-dose intraoperative MMC.

Main Methods:

• A prospective randomized clinical trial involving 40 patients undergoing glaucoma surgery.
• Patients were randomized to either DSMMC (19 eyes) or TPMMC (21 eyes).
• Postoperative IOP, complications, and medication use were monitored for 12 months, assessing success at target IOPs of ≤21 mmHg and ≤17 mmHg.

Main Results:

• Both DSMMC and TPMMC significantly reduced preoperative IOP (p < 0.0005).
• Complete success rates at ≤21 mmHg were 78.9% for DSMMC and 71.4% for TPMMC; qualified success was achieved in all eyes.
• No significant differences in success rates were observed between the groups, but TPMMC had more frequent hypotony and shallow anterior chamber complications.

Conclusions:

• Both DSMMC and TPMMC are effective in controlling IOP postoperatively.
• Low-dose MMC appears to offer a mild enhancement to DS IOP-lowering effects without compromising safety.
• DSMMC may offer a favorable safety profile compared to TPMMC regarding specific postoperative complications.