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Antigoni KOUKKOULLI, Fayyaz Musa, Nitin Anand; To Report On Long-term Comparative Outcomes For Mitomycin C Augmented Needle Revisions For Failing Deep Sclerectomies And Trabeculectomies. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5943.
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Deep Sclerectomy (DS) is a conjunctival filtration bleb- dependent non-penetrating glaucoma procedure. Like trabeculectomy, needle revision (NR) can be done to rejuvenate failing blebs. There are no reports in the literature on the outcomes of NR with DS.Our aim is to report on long-term comparative outcomes for Mitomycin C (MMC)augmented NR of failing DS and trabeculectomy cases.
Retrospective database search of all needle revisions with MMC for trabeculectomy and DS procedures at our centre between 2002 and 2008. 111 eyes of 109 patients, 66 of DS and 45 of trabecultectomy group were identified. Subconjunctival MMC 0.01- 0.02 mg was injected 15 minutes before NR. Complete success was defined as an IOP less than 18mmHg or a 20% decrease from baseline with no glaucoma medications or further surgical procedures to lower IOP.
Mean follow-up was 60.1 ± 22.5 months with no difference between groups. Mean baseline IOPs were 23.2 ± 6.9 mmHg in the DS and 22.4 ± 6.8mmHg in the trabeculectomy group (p= 0.5). Kaplan-Meier success rates were 64% and 73% at 6 months, 53% and 64% at 1 year and 47% and 45% at 3 years in the DS and trabeculectomy groups respectively (p=0.8). Early NRs, within 6 months of index glaucoma surgery, were more likely to fail by Cox’s regression analyses (Hazards Ratio 2.8, 95% CI 1.6- 5.0, p=0.0003). There was no significant difference in the number of complications between the groups, 51.5% for DS and 44.4% for trabeculectomy (p=0.9).
The long-term success rates and complication rates of NR with MMC in DS and trabeculectomy cases are statistically similar.
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