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Deep sclerectomy in normal-tension glaucoma with and without mitomycin-c.

Sakari Suominen1, Mika Harju, Leena Kurvinen

  • 1Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland.

Acta Ophthalmologica
|December 31, 2013
PubMed
Summary

Deep sclerectomy effectively lowers intraocular pressure in normal-tension glaucoma patients. Adding mitomycin-C (MMC) during surgery further reduces IOP at 12 months without increasing complications.

Keywords:
deep sclerectomyglaucoma surgeryintraocular pressuremitomycin-Cnormal-tension glaucomaprospective study

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Area of Science:

  • Ophthalmology
  • Glaucoma Research
  • Surgical Innovation

Background:

  • Normal-tension glaucoma (NTG) is a progressive optic neuropathy characterized by visual field loss despite normal intraocular pressure (IOP).
  • Deep sclerectomy (DS) is a surgical procedure aimed at reducing IOP in glaucoma patients.
  • The adjunctive use of mitomycin-C (MMC) in glaucoma surgery can enhance IOP reduction but may also increase complication rates.

Purpose of the Study:

  • To compare the efficacy and safety of deep sclerectomy (DS) with and without intraoperative mitomycin-C (MMC) in patients diagnosed with normal-tension glaucoma (NTG).

Main Methods:

  • A prospective study involving 37 NTG patients randomized into two groups: DS with MMC and DS without MMC.
  • Intraoperative subconjunctival MMC (0.4 mg/ml for 3 min) was administered to one group.
  • The primary outcome measure was a 25% reduction in IOP without medication at 12 months post-surgery.

Main Results:

  • Both groups showed significant IOP reduction (p < 0.001).
  • The MMC group achieved a significantly lower mean IOP at 12 months (p = 0.003) compared to the non-MMC group.
  • IOP < 10 mmHg was achieved in 7/15 eyes (MMC) versus 2/22 eyes (non-MMC) (p = 0.009).
  • Medication use decreased significantly in both groups (p < 0.001).
  • Complication rates were low and similar between groups.

Conclusions:

  • Deep sclerectomy is an effective and safe surgical option for IOP reduction in NTG patients.
  • Intraoperative MMC use in DS for NTG leads to superior IOP control at 12 months postoperatively.
  • The addition of MMC does not appear to elevate the complication rate in this cohort.