Modified deep sclerectomy (D-lectomy MMC) for primary open-angle glaucoma: preliminary results.

Abstract:

PURPOSE:To evaluate the outcome of modified deep sclerectomy [D-lectomy mitomycin C (MMC)] for medically refractory glaucoma patients. METHODS:In a retrospective comparative study, the surgical outcome in 1 eye each of 31 patients who underwent D-lectomy MMC was compared with that of 91 eyes of 91 patients who underwent trabeculectomy with adjunctive MMC. These eyes had a diagnosis of primary open-angle glaucoma or pseudoexfoliation glaucoma, a record of high intraocular pressure (IOP) exceeding 25 mm Hg, and planned for surgical intervention. In the D-lectomy MMC cases, a slit incision at the trabecular meshwork and peripheral iridectomy were created. The "lake" and trabeculo-Descemet membrane ("window") were examined by ultrasound biomicroscope, gonioscopy, and time-domain optical coherence tomography. RESULTS:Postsurgical IOP at 1, 3, 6, and 12 months after the D-lectomy MMC and trabeculectomy MMC were comparable (P=0.63-0.97). The filtering bleb was noted in 14 (45%) of the 31 D-lectomy MMC eyes at 3 months, and their survival was significantly less than trabeculectomy MMC subjects in which 81 of 91 eyes had the bleb at 3 months (P<0.0001). The lake was noted in 29 of 31 D-lectomy MMC eyes. The sealing of the once penetrated trabecular meshwork was complete at 3 months in 23 of 29 eyes by ultrasound biomicroscopic and/or gonioscopic examinations, whereas that was incomplete in 6 eyes. CONCLUSIONS:Addition of a slit incision to the trabecular meshwork and peripheral iridectomy (D-lectomy MMC) improved postsurgical IOP of the deep sclerectomy to the level comparable with trabeculectomy MMC, with a less frequency of the bleb formation.

journal_name

J Glaucoma

journal_title

Journal of glaucoma

authors

Chihara E,Okazaki K,Takahashi H,Shoji T,Adachi H,Hayashi K

doi

10.1097/IJG.0b013e3181752cc8

subject

Has Abstract

pub_date

2009-02-01 00:00:00

pages

132-9

issue

2

eissn

1057-0829

issn

1536-481X

pii

00061198-200902000-00008

journal_volume

18

pub_type

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