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Combined phacoemulsification and deep sclerectomy (PDS) with intraoperative mitomycin C (MMC) augmentation
1West Yorkshire rotation, St James's University Hospital, Beckett Street, Leeds, UK.
Aim:
To report the safety and efficacy of intraoperative mitomycin (MMC) augmentation of combined phacoemulsification and deep sclerectomy (PDS).
Methods:
Retrospective, non-randomized, comparative, interventional case series of 119 eyes (63 with and 56 without MMC augmentation) of 119 patients who had PDS between September 2001 and April 2004.
Results:
The mean follow-up was 23 months (range 12-41 months). There were no differences in the baseline characteristics of the two groups except that patients from the phacoemulsification and deep sclerectomy with mitomycin C (PDS-MMC) group were on average, younger by 3 years (P=0.01). Two years after surgery, the probability of maintaining an IOP below 19 and 15 mmHg without glaucoma medications or needle revision was 76 and 62% in the PDS-MMC group and 62 and 45% in the PDS-no MMC group (P=0.02 and 0.04, respectively). Nd:YAG laser goniopuncture was performed in 71.4% of eyes in the PDS-no MMC and 61.9% of the PD-MMC group (P=0.33). Needle revision was performed in 21.4% of the PDS-no MMC and 17.4% of the PDS-MMC group (P=0.65). Ten patients (8.4%) lost more than two lines of Snellen's visual acuity during follow-up, with no difference between the groups. There were few serious complications related to MMC use (hypotony in one eye after laser goniopuncture). The overall incidence of transconjunctival oozing in the PDS-MMC group was 9.5% compared with 5.4% in the PDS-no MMC group.
Conclusion:
This study demonstrates that augmentation of PDS with MMC is safe. MMC augmentation appears to increase the probability of achieving lower target intraocular pressures after combined PDS.
Insights
Intraoperative mitomycin (MMC) augmentation of phacoemulsification and deep sclerectomy (PDS) is safe and increases the likelihood of achieving lower intraocular pressures. This combined PDS-MMC approach offers improved glaucoma management outcomes.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Surgical Innovation
Background:
- Phacoemulsification and deep sclerectomy (PDS) is a surgical procedure for glaucoma management.
- Mitomycin C (MMC) is an antifibrotic agent used in ophthalmic surgery.
- Optimizing intraocular pressure (IOP) control after PDS is crucial for long-term glaucoma management.
Purpose of the Study:
- To evaluate the safety and efficacy of intraoperative mitomycin (MMC) augmentation in combined phacoemulsification and deep sclerectomy (PDS).
- To compare IOP reduction and surgical outcomes between PDS with and without MMC augmentation.
Main Methods:
- Retrospective, non-randomized, comparative interventional case series.
- 119 eyes of 119 patients undergoing PDS between September 2001 and April 2004.
- Comparison of outcomes between eyes augmented with MMC (PDS-MMC) and those without (PDS-no MMC).
Main Results:
- Two-year postoperative IOP below 19 mmHg was achieved in 76% of PDS-MMC eyes vs. 62% of PDS-no MMC eyes (P=0.02).
- Two-year postoperative IOP below 15 mmHg was achieved in 62% of PDS-MMC eyes vs. 45% of PDS-no MMC eyes (P=0.04).
- No significant differences in Nd:YAG laser goniopuncture, needle revision rates, or visual acuity loss; minimal MMC-related complications observed.
Conclusions:
- Intraoperative MMC augmentation of PDS is a safe adjunctive treatment.
- MMC augmentation enhances the probability of achieving target lower intraocular pressures after PDS.
- This approach may improve long-term IOP control in glaucoma patients undergoing PDS.
