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Jose Paczka, Luz Giorgi-Sandoval, Miriam Ramos-Hernandez, Jesus Jimenez-Roman, Arie Merikansky; Surgical Outcomes of Augmented MMC Trabeculectomy After Failed Seton Surgery. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4482.
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To determine surgical rates in a consecutive series of cases of glaucoma treated with secondary trabeculectomy (supplemented with mitomycin C - MMC) in a setting of Ahmed glaucoma valve (AGV) failure.
In this retrospective non-comparative analysis, 24 consecutive cases affected by a mixture of glaucomas which failed after being surgically treated with AGV were assessed. In all cases, MMC (0.5 mg / 5 minutes of trans-operative subconjunctival exposure) supplemented the action of a “safe” trabeculectomy as a mean to control pressure. Using standard definition of surgical success / failure, Kaplan-Meier survival analysis was used to estimate surgical outcomes in cases which were followed up for at least 12 months.
Medical chart information derived from twenty four eyes of 20 patients (13 females, 7 males; mean age: 57.6 ± 11.3 years) was included in the analysis. All eyes had received an AGV as a primary procedure to treat different types of glaucoma. A diversity of reasons was evaluated by the treating surgeon to decide for a new glaucoma intervention. Cumulative causes of AGV failure included tube / plate exposure (n = 11), refractory hypertensive phase (n = 7), endothelium / lens tube contact (n = 4), miscellaneous (n = 8). Pre-trabeculectomy mean IOP was 16.8 ± 6.9 mm Hg. Overall success rate with secondary trabeculectomy was 96% and 92%, at the 6-month and 12-month post-operative moments, respectively. Mean post-operative IOP was 11.4 ± 2.4 mm Hg (P = 0.001) and 13.5 ± 3.3 mm Hg (P = 0.001) after 6 and 12 months after trabeculectomy, respectively. Cumulative complication rate was 12%.
Our findings demonstrated that secondary trabeculectomy supplemented with MMC is a very good surgical alternative to treat diverse types of AGV failure when this procedure was used as a primary operation.
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