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R. Susanna; Partial Tenon's Capsule Resection with Adjunctive Mitomicyn C in Ahmed Glaucoma Valve Insertion . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1181.
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Aim: To verify whether partial intraoperative Tenon's capsule resection (PTCR) with adjunctive Mitomycin C is effective in developing thin, avascular blebs in eyes undergoing Ahmed glaucoma valve insertion and to assess the efficacy and safety of this procedure. Methods: Design: A multicenter, prospective, randomized, investigator-unmasked, parallel-group, comparative interventional study. This study was conducted in four Latin America countries (Argentina, Brazil, Colombia and Peru). Ahmed glaucoma valve implant insertion with PTCR (group A) and without PCTR (group B) was performed in neovascular glaucoma eyes without previous surgery. Adjunctive Mitomycin C (MMC) was used in both groups. Patients were examined in one day, 10 days, one month, two months, 3 months, six months and one year after surgery. Intraocular pressure (IOP) and the appearance of the bleb were evaluated at each examination. The appearance of the bleb was classified at one month and at the last examination into one of the three groups: flat and vascularized; elevated avascular; or elevated and not avascular. Results: A total of 92 eyes of 92 patients were included in the study Preoperative mean IOP was 50,0 +10,5 mmHg in group A and 48,4 + 11,7 in group B (NS). Statistically significant IOP reductions were observed in all periods of follow-up. Twelve months after surgery, the mean IOP was 17,2 + 5,0mmHg in group A and 18,3 + 8,7 mmHg in group B (NS). The hypertensive phase (HP) occurred in 40.0% in group A and in 46.8% in group B (NS). At one month and at the end of follow-up, in all eyes the blebs were considered elevated and not avascular. The incidence of complications was similar in the two groups Conclusions: PCTR and adjunctive Intraoperative MMC at 1,00mg/ml for 3 minutes was not effective in the development of avascular blebs in eyes undergoing Ahmed glaucoma valve insertion. In terms of the final success rate, there was no significant difference between the two groups.
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