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J. Mura, C.F. Kranemann, A.S. Crandall, I.I. Ahmed; Mitomycin–C Augmented Deep Sclerectomy With Collagen Wick Implantation for High–risk Glaucoma: A Long Term Follow–up . Invest. Ophthalmol. Vis. Sci. 2005;46(13):103.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To prospectively study the efficacy and side effect profile of deep sclerectomy with collagen wick implantation (DSCI) augmented with Mitomycin–C (MMC) for high–risk surgical cases. Methods: A non–randomized, prospective, multi–center study of Mitomycin–C augmented deep sclerectomy with collagen wick implantation in 56 eyes of 54 patients with high risk for filtration failure, with a minimum follow up period of 36 months was conducted. Intraocular pressure, slit lamp examination and medication use were recorded before and after surgery at 1 and 7 days and 1, 3, 6, 12, 18, 24, 36, 48 and 60 months. Success rate, defined as intraocular pressure (IOP) less than 18 mmHg without medications and greater than 30% reduction of preoperative IOP, was evaluated. In addition, reoperations, adjunctive procedures (goniopuncture, needling, use of postoperative antimetabolites, iridoplasty), early and late complications, bleb morphology and use of medications were documented. Results: The mean follow–up was 39.8 months ± 5.5 (SD). The mean preoperative IOP was 24.1 ± 5.5 mm Hg, at day one 7.2 ± 3.7 mm Hg, at month 12 was 12.7 ± 3.4 mm Hg and at month 36 was 13.9 ± 3.0 mm Hg. Preoperatively, the mean medication use was 3.5 ± 0.9 and at 36 months postoperatively was 0.6 ± 1.1. Goniopuncture was performed in 34 (60.7%), needling in 8 (14.3%) and iridoplasty in 3 (5.4%) of the patients. One patient developed blebitis (1.8%) which resolved on medical therapy. Four patients required a reoperation (7.1%). Diffuse posterior non–cystic blebs were found in 49 eyes (87.5 %) and cystic blebs in 3 (5.4 %). Complete success was achieved in 38 eyes (67.9%) and qualified success in 47 (83.9%). Conclusions: Deep sclerectomy with collagen wick implantation may be safely and effectively augmented with Mitomycin–C in high–risk glaucoma cases, with comparable efficacy to published results with Mitomycin–C trabeculectomy and fewer postoperative complications.
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