1. LONG-TERM RESULTS OF DEEP SCLERECTOMY IN NORMAL-TENSION GLAUCOMA
Mika Harju MD, Ph.D, Sakari Suominen, MD, Pasi Allinen, MD, Eija Vesti, MD, Ph.D*
Department of Ophthalmology, University of Helsinki and Helsinki University Hospital
*Department of Ophthalmology, University of Turku and Turku University Hospital
INTRODUCTION
To the best of our knowledge, there are only two reports on the efficacy of deep sclerectomy in studies that included NTG eyes only. Our previously published retrospective outcomes (1) encouraged us to do a prospective study on deep sclerectomy in NTG eyes randomised for MMC augmentation. The 1-year-results were reported previously (2)
PURPOSE
To study the long-term outcome of deep sclerectomy with and without Mitomycin-C (MMC) in normal-tension glaucoma (NTG) patients.
METHODS
We prospectively analysed consecutive patients randomized to surgery performed either with (MMC group) or without (non-MMC) MMC.
Deep sclerectomy with a collagen implant was performed on all eyes.
Surgery was considered totally successfully if, after surgery, the preoperative intraocular pressure (IOP) level was reduced by 25% without medication, and a qualified success if medication was required to achieve the same limits
Failure were eyes with additional hypotensive surgery for glaucoma, IOP reduction <25% after surgery, loss of >2 lines of visual acuity unrelated to other ocular pathology, and IOP ≤ 4 mmHg together with reduced visual acuity, shallow anterior chamber, hypotony maculopathy, or choroidal effusion.
RESULTS
Enrolled were 37 patients (mean age 64 ± 7 years); 15 patients in the MMC group and 22 in the non-MMC group, and the mean ±SD follow-up time 7.2±1.7 (range ) years.
Needling was repeated more often in the non-MMC group; needling was performed a 0.5±0.8 times in the MMC group, and 1.4±1.6 times in the non-MMC group, (p=0.025).
Needling with MMC injection was performed 0.2±0.4 times in the MMC group, and 1.1±1.4 times in the non-MMC group (P=0.005).
At the 6- to 9-years follow-up, the overall (both groups together) complete and qualified success rates were 50% and 71%, with no significant difference between groups (p=0.48, and p=0.25).
Four eyes had VA reduced by 2 lines or more. Three of them were in the MMC group and had other pathologies explaining their drop in visual acuity; 1 eye with ONH C/D developed cataract, 1 eye had macular degeneration and preretinal fibrosis; 1 eye had diabetic maculopathy and vitreous traction, and was treated with vitrectomy and recurrent intra-vitreal injections with vascular endothelial growth factor inhibitors. One eye in the non-MMC group had VA acuity reduced from 1.0 to 0.63 in Snellen, and at least some cataract formation.
Iris incarceration of the trabeculo-Descemet’s membrane was detectable in 4 of 15 (27%) in the MMC group, and in 8 of 22 (36%) in the non-MMC group (P=0.64). In all cases but one, the iris incarceration was treated with laser iridoplasty.
ACKNOWLEDGEMENTS
CONCLUSION
Glaucoma Foundation LUX
In NTG, long-term significant IOP reduction can be achieved with deep sclerectomy with a low incidence of sight-threatening complications.
Mary and Georg C. Ehrnrooth Foundation
We accounted no cases of hyphema, shallow anterior chamber, hypotony maculopathy, choroidal effusion, late bleb leakage, blebitis, endophthalmitis, or malignant glaucoma.
Finnish Eye Foundation
CORRESPONDENCE To
MMC augmentation resulted in lower IOP up to 5 years post-operatively, but the difference between the groups attenuated because of higher frequencies of goniopunctures and needling procedures in the non-MMC group.
1. Suominen S, Harju M, Ihanamäki T, Vesti E. The effect of deep sclerectomy on intraocular pressure of normal-tension glaucoma patients: 1-year results. Acta Ophthalmol 2010;88:27-32.
2. Suominen S, Harju M, Kurvinen L & Vesti E. Deep sclerectomy in normal-tension glaucoma with and without mitomycin-c. Acta Ophthalmol 2014;92:701–6.
Fig Fig 2
Cumulative survival of the total (Fig 1) and qualified (Fig 2) success in mitomycin-C (MMC) and non-MMC groups. Difference between groups not significant (p=0.23, and p=0.13).