Abstract
Aim
To report the safety and efficacy of intraoperative mitomycin (MMC) augmentation of combined phacoemulsification and deep sclerectomy (PDS).
Methods
Retrospective, non-randomized, comparative, interventional case series of 119 eyes (63 with and 56 without MMC augmentation) of 119 patients who had PDS between September 2001 and April 2004.
Results
The mean follow-up was 23 months (range 12–41 months). There were no differences in the baseline characteristics of the two groups except that patients from the phacoemulsification and deep sclerectomy with mitomycin C (PDS-MMC) group were on average, younger by 3 years (P=0.01). Two years after surgery, the probability of maintaining an IOP below 19 and 15 mmHg without glaucoma medications or needle revision was 76 and 62% in the PDS-MMC group and 62 and 45% in the PDS-no MMC group (P=0.02 and 0.04, respectively). Nd:YAG laser goniopuncture was performed in 71.4% of eyes in the PDS-no MMC and 61.9% of the PD-MMC group (P=0.33). Needle revision was performed in 21.4% of the PDS-no MMC and 17.4% of the PDS-MMC group (P=0.65). Ten patients (8.4%) lost more than two lines of Snellen's visual acuity during follow-up, with no difference between the groups. There were few serious complications related to MMC use (hypotony in one eye after laser goniopuncture). The overall incidence of transconjunctival oozing in the PDS-MMC group was 9.5% compared with 5.4% in the PDS-no MMC group.
Conclusion
This study demonstrates that augmentation of PDS with MMC is safe. MMC augmentation appears to increase the probability of achieving lower target intraocular pressures after combined PDS.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Ambresin A, Shaarawy T, Mermoud A . Deep sclerectomy with collagen implant in one eye compared with trabeculectomy in the other eye of the same patient. J Glaucoma 2002; 11: 214–220.
Mermoud A, Schnyder CC . Nonpenetrating filtering surgery in glaucoma. Curr Opin Ophthalmol 2000; 11: 151–157.
Cillino S, Pace FD, Casuccio A, Calvaruso L, Morreale D, Vadala M et al. Deep sclerectomy vs punch trabeculectomy with or without phacoemulsification: a randomized clinical trial. J Glaucoma 2004; 13: 500–506.
El Sayyad F, Helal M, El Kholify H, Khalil M, El Maghraby A . Nonpenetrating deep sclerectomy vs trabeculectomy in bilateral primary open-angle glaucoma. Ophthalmology 2000; 107: 1671–1674.
Friedman DS, Jampel HD, Lubomski LH, Kempen JH, Quigley H, Congdon N et al. Surgical strategies for coexisting glaucoma and cataract: an evidence-based update. Ophthalmology 2002; 109: 1902–1913.
Gianoli F, Schnyder CC, Bovey E, Mermoud A . Combined surgery for cataract and glaucoma: phacoemulsification and deep sclerectomy compared with phacoemulsification and trabeculectomy. J Cataract Refract Surg 1999; 25: 340–346.
Bindlish R, Condon GP, Schlosser JD, D'Antonio J, Lauer KB, Lehrer R . Efficacy and safety of mitomycin-C in primary trabeculectomy: five-year follow-up. Ophthalmology 2002; 109: 1336–1341.
DeBry PW, Perkins TW, Heatley G, Kaufman P, Brumback LC . Incidence of late-onset bleb-related complications following trabeculectomy with mitomycin. Arch Ophthalmol 2002; 120: 297–300.
Funnell CL, Clowes M, Anand N . Combined cataract and glaucoma surgery with mitomycin C: phacoemulsification-trabeculectomy compared to phacoemulsification-deep sclerectomy. Br J Ophthalmol 2005; 89: 694–698.
Wells AP, Cordeiro MF, Bunce C, Khaw PT . Cystic bleb formation and related complications in limbus- vs fornix-based conjunctival flaps in pediatric and young adult trabeculectomy with mitomycin C. Ophthalmology 2003; 110: 2192–2197.
Shin DH, Tsai CS, Kupin TH, Olivier MM . Retained cellulose sponge after trabeculectomy with adjunctive subconjunctival mitomycin C. Am J Ophthalmol 1994; 118: 111–112.
Poole TRG, Gillespie IH, Knee G, Whitworth J . Microscopic fragmentation of ophthalmic surgical sponge spears used for delivery of antiproliferative agents in glaucoma filtering surgery. Br J Ophthalmol 2002; 86: 1448–1449.
Matsuo H, Tomidokoro A, Suzuki Y, Shirato S, Araie M . Late-onset transconjunctival oozing and point leak of aqueous humor from filtering bleb after trabeculectomy. Am J Ophthalmol 2002; 133: 456–462.
Anand N, Arora S, Clowes M . Mitomycin C augmented glaucoma surgery: evolution of filtering bleb avascularity, transconjunctival oozing, and leaks. Br J Ophthalmol 2006; 90: 175–180.
Anand N, Atherley C . Deep sclerectomy augmented with mitomycin C. Eye 2005; 19: 442–450.
The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration. The AGIS investigators. Am J Ophthalmol 2000; 130: 429–440.
Collaborative Normal-Tension Glaucoma Study Group. The effectiveness of intraocular pressure reduction in the treatment of normal-tension glaucoma. Am J Ophthalmol 1998; 126: 498–505.
Mermoud A, Karlen ME, Schnyder CC, Sickenberg M, Chiou AG, Hediguer SE et al. Nd:Yag goniopuncture after deep sclerectomy with collagen implant. Ophthalmic Surg Lasers 1999; 30: 120–125.
Lachkar Y, Neverauskiene J, Jeanteur-Lunel MN, Gracies H, Berkani M, Ecoffet M et al. Nonpenetrating deep sclerectomy: a 6-year retrospective study. Eur J Ophthalmol 2004; 14: 26–36.
Hyams M, Geyer O . Iris prolapse at the surgical site: a late complication of nonpenetrating deep sclerectomy. Ophthalmic Surg Lasers Imaging 2003; 34: 132–135.
Kim CY, Hong YJ, Seong GJ, Koh HJ, Kim SS . Iris synechia after laser goniopuncture in a patient having deep sclerectomy with a collagen implant. J Cataract Refract Surg 2002; 28: 900–902.
Vuori ML . Complications of Neodymium:YAG laser goniopuncture after deep sclerectomy. Acta Ophthalmol Scand 2003; 81: 573–576.
Vuori ML . Gonioscopic view of the trabeculo-Descemet's membrane after deep sclerectomy. Acta Ophthalmol Scand 2004; 82: 154–157.
Wilkins M, Indar A, Wormald R . Intra-operative mitomycin C for glaucoma surgery. Cochrane Database Syst Rev 2005; CD002897.
Kozobolis VP, Christodoulakis EV, Tzanakis N, Zacharopoulos I, Pallikaris IG . Primary deep sclerectomy vs primary deep sclerectomy with the use of mitomycin C in primary open-angle glaucoma. J Glaucoma 2002; 11: 287–293.
Neudorfer M, Sadetzki S, Anisimova S, Geyer O . Nonpenetrating deep sclerectomy with the use of adjunctive mitomycin C. Ophthalmic Surg Lasers Imaging 2004; 35: 6–12.
Cillino S, Di PF, Casuccio A, Lodato G . Deep sclerectomy vs punch trabeculectomy: effect of low-dosage mitomycin C. Ophthalmologica 2005; 219: 281–286.
Jampel HD, Friedman DS, Lubomski LH, Kempen JH, Quigley H, Congdon N et al. Effect of technique on intraocular pressure after combined cataract and glaucoma surgery: an evidence-based review. Ophthalmology 2002; 109: 2215–2224.
Cohen JS, Greff LJ, Novack GD, Wind BE . A placebo-controlled, double-masked evaluation of mitomycin C in combined glaucoma and cataract procedures. Ophthalmology 1996; 103: 1934–1942.
Shin DH, Kim YY, Sheth N, Ren J, Shah M, Kim C et al. The role of adjunctive mitomycin C in secondary glaucoma triple procedure as compared to primary glaucoma triple procedure. Ophthalmology 1998; 105: 740–745.
Shin DH, Ren J, Juzych MS, Hughes BA, Kim C, Song MS et al. Primary glaucoma triple procedure in patients with primary open-angle glaucoma: the effect of mitomycin C in patients with and without prognostic factors for filtration failure. Am J Ophthalmol 1998; 125: 346–352.
Hu CY, Matsuo H, Tomita G, Suzuki Y, Araie M, Shirato S, Tanaka S . Clinical characteristics and leakage of functioning blebs after trabeculectomy with mitomycin-C in primary glaucoma patients. Ophthalmology 2003; 110: 345–352.
Author information
Authors and Affiliations
Corresponding author
Additional information
Presented as a scientific poster at the 2005 annual meeting of American Academy of Ophthalmology
Rights and permissions
About this article
Cite this article
Anand, S., Anand, N. Combined phacoemulsification and deep sclerectomy (PDS) with intraoperative mitomycin C (MMC) augmentation. Eye 22, 1040–1049 (2008). https://doi.org/10.1038/sj.eye.6702833
Received:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sj.eye.6702833
