Purpose:
To compare the outcome of deep sclerectomy (DS) with and without Mitomycin-C (MMC) in normal tension glaucoma (NTG) patients.
Methods:
We prospectively analysed the results of 37 eyes of 37 consecutive patients with NTG (age; median, range; 63 years, 48-79) who underwent DS with a collagen implant. Patients were randomized to the Mitomycin-C (MMC) and non-MMC groups; subconjunctival MMC (0.4 mg/ml for 3 minutes) was used intra-operatively in 15 of 37 eyes. Patients were followed for 12 months.
Results:
Intraocular pressure (IOP; median, range; 15.2 mmHg, 10.2 - 21.3) was significantly reduced after 12 months (11.3, 5-16, P<0.001).The median postoperative IOP was significantly lower in the MMC group (10.0mmHg, 5-13) compared to the non-MMC group (11.4 mmHg, 8-16, P=0.005). A 25% reduction in IOP without medication was achieved overall in 19/37 eyes (51%), in 10/15 eyes (67%) in MMC group and in 9/22 eyes (41%) in non-MMC group (P=0.13).After 12 months, 27 eyes (73%) were without glaucoma medication and goniopuncture had been performed in 7 eyes (47%) in the MMC group, compared to 16 eyes (73%) in the non-MMC group (P=0.13).Altogether, complications included loss of three or more snellen lines in visual acuity (4 patients), microperforation (1), re-suturation of conjunctiva (6) and dellen formation (2). No patient had shallow anterior chamber, choroideal ablation or late bleb leak.
Conclusions:
Clinically and statistically significant IOP reduction was shown after deep sclerectomy in both groups. Intra-operative use of MMC results in lower post-operative IOP after one year. DS seems to be effective and safe in reducing IOP in patients with NTG.
Clinical Trial:
Helsinki University, 486/E9/E06
Keywords: intraocular pressure • clinical (human) or epidemiologic studies: systems/equipment/techniques • wound healing