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Deep sclerectomy and trabeculectomy augmented with Mitomycin C: 2-year post-operative outcomes
Rahul Dwivedi1, Tobi Somerville2, Robert Cheeseman2
1St Pauls Eye Unit, Royal Liverpool University Hospital, Liverpool, UK. r.dwivedi@doctors.org.uk.
Summary
Deep sclerectomy (DS) with Mitomycin C (MMC) and trabeculectomy (Trab) with MMC both effectively lower intraocular pressure (IOP) long-term. DS + MMC demonstrated fewer complications and clinic visits, suggesting it may be a preferred surgical option.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Surgical Outcomes
Background:
- Glaucoma is a leading cause of irreversible blindness worldwide.
- Surgical interventions like deep sclerectomy (DS) and trabeculectomy (Trab) are crucial for managing intraocular pressure (IOP).
- Mitomycin C (MMC) is frequently used as an adjunct to enhance surgical success rates.
Purpose of the Study:
- To compare the two-year post-operative outcomes of deep sclerectomy (DS) augmented with Mitomycin C (MMC) versus trabeculectomy (Trab) augmented with MMC.
- To evaluate the efficacy and safety of these two glaucoma surgical procedures.
Main Methods:
- A retrospective review of 90 eyes (46 DS + MMC, 44 Trab + MMC) undergoing glaucoma surgery between February 2015 and March 2018.
- Patients had a minimum 12-month follow-up, with post-operative assessments at multiple intervals up to 24 months.
- Primary outcomes included changes in intraocular pressure (IOP) and best-corrected visual acuity (BCVA); secondary outcomes included medication use, complications, and further interventions.
Main Results:
- Both DS + MMC and Trab + MMC significantly reduced IOP from baseline at all post-operative time points (p < 0.001).
- Trab + MMC showed a slightly higher mean IOP reduction (38.39% vs. 33.94%) and a greater proportion of eyes achieving IOP ≤ 12 mmHg (72.72% vs. 52.17%).
- DS + MMC resulted in significantly fewer post-operative complications, less need for further surgical intervention (13% vs. 29.55%), and fewer clinic visits (p = 0.005).
Conclusions:
- Both deep sclerectomy and trabeculectomy augmented with MMC provide sustained IOP reduction at two years.
- Deep sclerectomy with MMC offers a favorable safety profile with lower complication rates and reduced healthcare resource utilization.
- DS + MMC may be a preferred surgical option, particularly in contexts like the COVID-19 pandemic, to minimize patient and clinician exposure.
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