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A.M. Miller, Y. Liu, W.E. Sponsel; Non-Penetrating Deep Sclerectomy with Mitomycin C and Trabeculectomy with Mitomycin C: A Comparison of Efficacy and Complications . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3310.
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Purpose: To assess the efficacy and complications of non-penetrating deep sclerectomy (NPDS) with mitomycin C (MMC). Methods: 16 eyes of the first 13 consecutive patients with medically uncontrolled glaucoma had NPDS with MMC. An age and race matched group had trabeculectomy with MMC (TRAB). A sponge soaked with 0.2 mg of MMC was applied to the scleral bed for 30 seconds x2 followed by irrigation with balanced salt solutions. A superficial scleral flap was raised and a deep sclerectomy performed. Schlemm’s canal was opened, the cornea was dissected to Descemet’s membrane, and the trabecular membrane was partially peeled off. After aqueous was noted to filter through the remaining trabeculo-Descemet’s membrane, the scleral flap and conjunctiva was closed. Exams were performed before surgery and at averaged postoperative intervals of 3, 6, 12, and 18 months. Results: All patients used 2 to 5 topical anti-glaucoma medications preoperatively. Only 2 patients required medicine at 3 months for both groups. In the NPDS group, 4 patients were noted to have transient hypotony, but without choroidal effusion. No other complications occurred. In the TRAB group, complications included initial IOP spike, hypotony with choroidal effusions, hyphemata, and flat ACs requiring viscoelastic reformation. Overall, mean IOP control in both groups was excellent. A majority of individuals in each group had a mean IOP <15mmHg at 12 months, but by 18 months, 5 in NPDS and 2 in TRAB had IOP >18mmHg. Comparison of mean IOP values (Mean IOP ± SEM), significance of IOP difference relative to baseline IOP (pΔBL), and mean IOP difference significance between surgical treatment goups (pΔTX) at time intervals ranging from 3 to 18 months are shown in the table listed below. No significant difference existed between baseline IOP, but mean values differed by 4mmHg. Relative to each group's own baseline, both surgical methods produced significant reductions of IOP at 6, 12, and 18 months. Conclusions: NPDS had the advantage of fewer complications but overall was less effective than trabeculectomy in reducing IOP, particularly at the 3 and 6 month postoperative periods. View OriginalDownload SlideView OriginalDownload Slide
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