Deep Sclerectomy-trabeculectomy with Mitomycin C in Treating Glaucoma: Postoperative Long-term Results

Overview

Journal Int J Ophthalmol

Specialty Ophthalmology

Date 2022 Dec 20

PMID 36536976

Authors

Chung Shen Chean

Li Jiang

Gayathri Kanchana Niroshani Pati Arambage

Punithawathy Ranjit

Affiliations

Soon will be listed here.

Abstract

Aim: To determine the long-term postoperative outcomes of deep sclerectomy-trabeculectomy (DST) with mitomycin C (MMC) in the treatment of glaucoma.

Methods: Patients who underwent DST with MMC between 2010 and 2017 were included in this retrospective observational study. Complete success was defined as postoperative intraocular pressure (IOP) ≤21 mm Hg or 30% reduction of IOP from baseline without any topical IOP-lowering agent, and qualified success defined as IOP≤21 mm Hg or 30% reduction of IOP from baseline with/without single topical agent. We evaluated the surgical success rates and complication rates of this procedure, as well as described the IOP profiles, best corrected visual acuity (BCVA) profiles and mean deviations (MD) of Humphrey visual field (HVF) 24-2 performance at each follow-up time point. Mixed linear regression models were constructed to determine estimated predictive values of demographic data, use of topical IOP-lowering agents, baseline and postoperative IOP and optical profiles (, BCVA and MD).

Results: Totally 98 eyes (mean postoperative follow-up 67.5mo) showed mean IOP reduction at every follow-up interval. Both median BCVA and MD of visual fields were maintained throughout the follow-up intervals when comparing to baseline. The number of IOP-lowering medications decreased from 2.8±0.8 to 0.3±0.7 (=0.068). Totally 84 (85.7%) eyes achieved complete success at final follow-up. Transient hyphaema and transient choroidal effusion developed in 15 eyes (15.3%) and 11 eyes (11.2%) respectively. Other complications included shallow anterior chamber in 5 eyes (5.1%), bleb leak in 4 eyes (4.1%), bleb revision in 7 eyes (7.1%), bleb needling in 9 eyes (9.2%) and repeat trabeculectomy in 1 eye (1.0%). There was no endophthalmitis, blebitis or macular oedema. There was no significant correlation between postoperative IOP control and postoperative BCVA.

Conclusion: DST with MMC demonstrates effective and sustained long-term outcomes in the treatment of glaucoma with no major complication.

Citing Articles

Transient Anterior Subcapsular Vacuolar Lens Opacities After Trabeculectomy Using a Dispersive Ophthalmic Viscosurgical Device: Report of Five Cases.

Shimizu H, Tanito M Cureus. 2025; 16(12):e76350.

PMID: 39867088 PMC: 11758258. DOI: 10.7759/cureus.76350.

References

Sugimoto K, Murata H, Yamashita T, Asaoka R . Bleb plication: a minimally invasive repair method for a leaking ischemic bleb after trabeculectomy. Sci Rep. 2020; 10(1):14978. PMC: 7486366. DOI: 10.1038/s41598-020-72056-w. View

Jiang L, Eaves S, Dhillon N, Ranjit P . Postoperative outcomes following trabeculectomy and nonpenetrating surgical procedures: a 5-year longitudinal study. Clin Ophthalmol. 2018; 12:995-1002. PMC: 5973473. DOI: 10.2147/OPTH.S163247. View

Gedde S, Feuer W, Lim K, Barton K, Goyal S, Ahmed I . Treatment Outcomes in the Primary Tube Versus Trabeculectomy Study after 3 Years of Follow-up. Ophthalmology. 2019; 127(3):333-345. DOI: 10.1016/j.ophtha.2019.10.002. View

Rabiolo A, Leadbetter D, Anand N . Hypotony-associated Complications After Deep Sclerectomy: Incidence, Risk Factors, and Long-term Outcomes. J Glaucoma. 2021; 30(7):e314-e326. DOI: 10.1097/IJG.0000000000001882. View

Aslan F, Yuce B, Oztas Z, Ates H . Evaluation of the learning curve of non-penetrating glaucoma surgery. Int Ophthalmol. 2017; 38(5):2005-2012. DOI: 10.1007/s10792-017-0691-3. View

Gedde S, Schiffman J, Feuer W, Herndon L, Brandt J, Budenz D . Three-year follow-up of the tube versus trabeculectomy study. Am J Ophthalmol. 2009; 148(5):670-84. DOI: 10.1016/j.ajo.2009.06.018. View

Mendrinos E, Mermoud A, Shaarawy T . Nonpenetrating glaucoma surgery. Surv Ophthalmol. 2008; 53(6):592-630. DOI: 10.1016/j.survophthal.2008.08.023. View

Kozobolis V, Kalogianni E, Sideroudi H . Penetrating deep sclerectomy in primary open-angle and pseudoexfoliative glaucoma. Eur J Ophthalmol. 2019; 30(2):264-268. DOI: 10.1177/1120672119827768. View

Dada T, Sharma A, Midha N, Angmo D, Gupta S, Sihota R . Efficacy of Trabeculectomy Combined With Limited Deep Sclerectomy Versus Trabeculectomy Alone: A Randomized-controlled Trial. J Glaucoma. 2021; 30(12):1065-1073. DOI: 10.1097/IJG.0000000000001896. View

10.

Sakamoto M, Matsumoto Y, Mori S, Ueda K, Inoue Y, Kurimoto T . Excessive scleral shrinkage, rather than choroidal thickening, is a major contributor to the development of hypotony maculopathy after trabeculectomy. PLoS One. 2018; 13(1):e0191862. PMC: 5786308. DOI: 10.1371/journal.pone.0191862. View

11.

Anand N, Atherley C . Deep sclerectomy augmented with mitomycin C. Eye (Lond). 2005; 19(4):442-50. DOI: 10.1038/sj.eye.6701403. View

12.

Sangtam T, Roy S, Mermoud A . Outcome and Complications of Combined Modified Deep Sclerectomy and Trabeculectomy for Surgical Management of Glaucoma: A Pilot Study. Clin Ophthalmol. 2020; 14:795-803. PMC: 7075434. DOI: 10.2147/OPTH.S244945. View

13.

Zhang H, Yan X, Li F, Ma L, Geng Y, Jiao K . Microcatheter-Assisted Trabeculotomy Combined With Deep Sclerectomy and Trabeculectomy in Young to Middle-Aged Adults With Advanced Primary Open-Angle Glaucoma: 1-Year Result. Front Med (Lausanne). 2021; 8:712332. PMC: 8446351. DOI: 10.3389/fmed.2021.712332. View

14.

Bayoumi N . Deep sclerectomy in pediatric glaucoma filtering surgery. Eye (Lond). 2012; 26(12):1548-53. PMC: 3522847. DOI: 10.1038/eye.2012.215. View

15.

Rulli E, Biagioli E, Riva I, Gambirasio G, De Simone I, Floriani I . Efficacy and safety of trabeculectomy vs nonpenetrating surgical procedures: a systematic review and meta-analysis. JAMA Ophthalmol. 2013; 131(12):1573-82. DOI: 10.1001/jamaophthalmol.2013.5059. View

16.

Matlach J, Freiberg F, Leippi S, Grehn F, Klink T . Comparison of phacotrabeculectomy versus phacocanaloplasty in the treatment of patients with concomitant cataract and glaucoma. BMC Ophthalmol. 2013; 13:1. PMC: 3564772. DOI: 10.1186/1471-2415-13-1. View

17.

Debry P, Perkins T, Heatley G, Kaufman P, Brumback L . Incidence of late-onset bleb-related complications following trabeculectomy with mitomycin. Arch Ophthalmol. 2002; 120(3):297-300. DOI: 10.1001/archopht.120.3.297. View

18.

Law S, Shih K, Tran D, Coleman A, Caprioli J . Long-term outcomes of repeat vs initial trabeculectomy in open-angle glaucoma. Am J Ophthalmol. 2009; 148(5):685-695.e1. DOI: 10.1016/j.ajo.2009.05.032. View

19.

Dwivedi R, Somerville T, Cheeseman R, Rogers C, Batterbury M, Choudhary A . Deep sclerectomy and trabeculectomy augmented with Mitomycin C: 2-year post-operative outcomes. Graefes Arch Clin Exp Ophthalmol. 2021; 259(7):1965-1974. PMC: 7938885. DOI: 10.1007/s00417-021-05144-w. View

20.

Mermoud A, Schnyder C, Sickenberg M, Chiou A, Hediguer S, Faggioni R . Comparison of deep sclerectomy with collagen implant and trabeculectomy in open-angle glaucoma. J Cataract Refract Surg. 1999; 25(3):323-31. DOI: 10.1016/s0886-3350(99)80079-0. View