Article
Deep sclerectomy augmented with mitomycin C.
Department of Ophthalmology, Calderdale & Huddersfield NHS Trust, Huddersfield Royal Infirmary, Huddersfield HD3 3EA, UK.
Eye (impact factor:
1.85).
05/2005;
19(4):442-50.
DOI:10.1038/sj.eye.6701403
Source: PubMed
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Citations (0)
- Cited In (5)
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Article: Efficacy and safety of deep sclerectomy in uveitic glaucoma.
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ABSTRACT: To evaluate the safety and efficacy of deep sclerectomy with implant and mitomycin C in uveitic glaucoma. Design Prospective, noncomparative case study. Nine patients (13 eyes) with uncontrolled uveitic glaucoma underwent deep sclerectomy with implant from 2002 to 2006. All patients had their uveitis controlled before and after surgery with anti-inflammatory therapy. Main outcome measures Control of intraocular pressure. A secondary outcome measure was the number of antiglaucoma medications required to achieve the desired intraocular pressure. Visual acuity and complication associated with the surgery were monitored. Mean follow-up was 21 months (range 12-54 months). Intraocular pressure (IOP) was reduced from a mean preoperative value of 28.7 mmHg to a mean postoperative value of 13.85 mmHg (Wilcoxon signed rank test P = 0.005). At the most recent visit, complete success was obtained in 84.6%, qualified success was obtained in 7.7%, and complete failure in 7.7%. Mean number of antiglaucoma medications was reduced from 3.07 to 0.2 (Wilcoxon signed rank test P = 0.001). Neodymium:YAG goniopuncture was performed in two eyes. Postoperative complications included transient hypotony with maculopathy in one eye, shallow choroidal effusions in two eyes, and progression of cataract in four eyes. Deep sclerectomy with implant in uveitic glaucoma appeared to be effective in controlling the IOP at short-term follow-up with no serious postoperative side-effects.International Ophthalmology 07/2008; 29(5):367-72. -
Article: The changing conceptual basis of trabeculectomy: a review of past and current surgical techniques.
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ABSTRACT: The original intent of glaucoma surgery was to allow aqueous humor to exit more easily either through the sclera or into the suprachoroidal space. The former came to be called, generically, a glaucoma filtering procedure. As this surgery evolved, some explored the concept of lowering pressure without producing a hole in the sclera, with its resultant "filtering bleb." For example, Cairns hoped that cutting open the edges of Schlemm's canal would allow aqueous to leave without producing a filtering bleb; however, it became apparent that Cairns's "trabeculectomy" only worked when a filtering bleb developed. The goal of today's trabeculectomy is the creation of a longlasting transscleral fistula. In fact, trabeculectomy is a misnomer as excision of trabecular meshwork is unimportant. Frequently, the tissue excised to create a trans-scleral fistula is sclera, cornea, or both. The current trabeculectomy is really a guarded sclerokeratectomy. Newer techniques hope to increase aqueous outflow through Schlemm's canal to avoid complications associated with subconjunctival filtering blebs. Non-penetrating glaucoma surgeries (deep sclerectomy, viscocanalostomy) and ab interno trabecular surgery attempt to lower intraocular pressure with bleb-less procedures. We describe the recent evolution of glaucoma surgery, particularly the idea that intraocular pressure may be lowered satisfactorily without creating a filtering bleb.Survey of Ophthalmology 01/2012; 57(1):1-25. · 2.35 Impact Factor -
Article: Deep sclerectomy and low dose mitomycin C: a randomised prospective trial in west Africa.
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ABSTRACT: To study the efficacy and safety of deep sclerectomy (DS) augmented with intraoperative low dose mitomycin C (MMC) in a west African population. Prospective, randomised, controlled trial. Trial participants were Nigerian patients with medically uncontrolled primary open angle glaucoma undergoing primary surgery at Maja Hospital, Lagos, Nigeria. 39 eyes of 39 patients undergoing DS were randomised into receiving intraoperative MMC 0.25 mg/ml for 2 minutes at the end of procedure (DS-MMC) and a control group (DS-noMMC). There were 21 patients in the DS-noMMC and 18 in the DS-MMC group with no difference in the preoperative characteristics of the groups. Mean follow up was 16.4 (SD 11.3) months. The probability of maintaining an intraocular pressure less than 18 mm Hg with or without additional medications (95% confidence intervals) at 1 year was 70% (47-92%, 95%) and 79% (57-100%), and at 18 months was 35% (8-62%) and 38% (7-69%) for the DS-noMMC and DS-MMC groups, respectively, with no difference in success rates (p = 0.6). An IOP of less than 18 mm Hg without additional medication was maintained in 65% (41-89%) and 73% (49-96%) at 1 year and 24% (8-48%) and 13% (13-46%) at 18 months for the DS-noMMC and DS-MMC groups, respectively (p = 0.5). There were no serious complications related to the procedure. The success rates of DS in black west African glaucoma patients, as performed in this study, were low. The study did not achieve sufficient power to detect whether low dose intraoperative MMC application can increase success rates of DS.British Journal of Ophthalmology 04/2006; 90(3):310-3. · 2.90 Impact Factor
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Keywords
1 year
4 months
71 consecutive patients
comparative efficacy
DS-MMC group
DS-noMMC
DS-noMMC group
glaucoma surgery
intraocular pressure
intraoperative mitomycin C
intraoperative MMC
low target IOPs
lower IOP
MMC use
ongoing prospective database
postoperative IOP
significant effect
survival rates
target IOP level
target IOPs
