Long-term results of deep sclerectomy in normal-tension glaucoma.
Harju Mika, Suominen Sakari, Allinen Pasi, Vesti Eija
AI Summary
Deep sclerectomy effectively lowered IOP long-term in normal-tension glaucoma with few complications, offering a safe surgical option.
Abstract
Purpose
To study the long-term outcome of deep sclerectomy with and without mitomycin-C (MMC) in patients with normal-tension glaucoma (NTG).
Methods
We prospectively analysed consecutive patients randomized to surgery performed either with (MMC group) or without (non-MMC) MMC. Surgery was considered totally successful if, after surgery, the preoperative intra-ocular pressure (IOP) level was reduced by 25% without medication, and a qualified success if medication was required to achieve the same limits.
Results
A total of 37 patients were enrolled, 15 in the MMC and 22 in the non-MMC group. The median (range) follow-up was 7.9 (1.0-9.0) years, with a drop-out of three (8%) patients. The preoperative IOP was 15 (11-21) mmHg in the MMC and 15 (10-19) mmHg in the non-MMC group. At the last 6- to 9-year follow-up, IOP was significantly reduced to 9 (2-13) mmHg (p = 0.002) and 10 (5-13) mmHg (p < 0.001). The overall (groups combined) complete and qualified success rates were 50% and 71%, with no significant difference between groups (p = 0.48 and p = 0.25). Goniopuncture was performed in 87% and 100% of eyes in the MMC and non-MMC groups (p = 0.14). Needling with MMC injection was performed 0 (0-1) times in the MMC group and 0.5 (0-4) times in the non-MMC group (p = 0.056). We encountered no cases of hyphema, shallow anterior chamber, hypotony maculopathy, choroidal effusion, late bleb leakage, blebitis, endophthalmitis or malignant glaucoma.
Conclusion
In NTG, long-term significant IOP reduction can be achieved with deep sclerectomy with a low incidence of sight-threatening complications.
MeSH Terms
Shields Classification
Key Concepts5
Deep sclerectomy achieved a significant reduction in intraocular pressure (IOP) to 9 (2-13) mmHg (p = 0.002) in the mitomycin-C (MMC) group and 10 (5-13) mmHg (p < 0.001) in the non-MMC group at the 6- to 9-year follow-up, starting from preoperative IOPs of 15 (11-21) mmHg and 15 (10-19) mmHg respectively, in patients with normal-tension glaucoma (NTG).
The overall (groups combined) complete and qualified success rates for deep sclerectomy in patients with normal-tension glaucoma (NTG) were 50% and 71% respectively, with no significant difference between the mitomycin-C (MMC) and non-MMC groups (p = 0.48 for complete success and p = 0.25 for qualified success).
No cases of hyphema, shallow anterior chamber, hypotony maculopathy, choroidal effusion, late bleb leakage, blebitis, endophthalmitis, or malignant glaucoma were encountered following deep sclerectomy with or without mitomycin-C in patients with normal-tension glaucoma (NTG).
Goniopuncture was performed in 87% of eyes in the mitomycin-C (MMC) group and 100% of eyes in the non-MMC group (p = 0.14) following deep sclerectomy in patients with normal-tension glaucoma (NTG).
Needling with mitomycin-C (MMC) injection was performed 0 (0-1) times in the MMC group and 0.5 (0-4) times in the non-MMC group (p = 0.056) following deep sclerectomy in patients with normal-tension glaucoma (NTG).
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