DEEP SCLERECTOMY WITH LOW DOSE MITOMYCIN C IN PRIMARY OPEN-ANGLE GLAUCOMA

Anh Tuan Vu

Aim: To study the efficacy and safety of deep sclerectomy augmented with intraoperative low dose mitomycin C in Vietnamese POAG patient.

Method: Prospective, clinical trial study. A series of 48 eyes (38 patients) with medically uncontrolled primary open-angle glaucoma undergoing primary surgery of deep sclerectomy. A superficial scleral flap was raised and a deep sclerectomy was performed in the scleral bed. The deep scleral flap was dipped in MMC 0.4 mg/ml for 3 minutes. Schlemm's canal was opened, the inner wall of Schlemm's canal and juxtacanalicular trabeculum was removed. The auto-scleral implant was sutured radially in the scleral bed and the superficial scleral flap was repositioned. Visual acuity, intraocular pressure (IOP) measurements, and slit lamp examinations were performed before surgery and after surgery at 1 and 7 days, and 1, 3, 6, 9, 12, 18, 24 months.

Results: The mean follow up period was 19.7 (SD 8.2) months. The mean preoperative IOP was 32.7 (9.6) mm Hg; the mean postoperative IOP was 14.2 (4.2) at month 1, 15.4 (4.5) at month 12, and 16.3 (4.8) at month 24.

An IOP of less than 21 mmHg without additional medication was maintained in 65.8% at 24 month. This ratio with medication was 86.5%. There were no serious complications related to the procedure.

Conclusions: Deep sclerectomy with low dose intraoperative MMC is an effective procedure while minimising the risk of postoperative complications.