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Pouya Alaghband, Nitin Anand; Deep Sclerectomy Outcomes over 15 years. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5245.
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© ARVO (1962-2015); The Authors (2016-present)
To report outcomes of primary Deep Sclerectomy over 15 years
A single-centre retrospective study. All surgeries were either performed or supervised by one experienced surgeon. Deep sclerectomy (DS) was performed in primary open angle glaucoma (POAG) eyes with no previous glaucoma surgery (except phacoemulsification) were included. 514 eyes of 411 patients were included. Intraoperative MMC (DS-MMC) was used in 350, subconjunctival Bevacizumab in 77 (DS-B) and no surgical augmentation agent was applied in 87 eyes (DS-N).
Mean follow-up after DS was 85.4 ± 41.6 months. Kaplan-Meier probability of maintaining an IOP of <22 mmHg or <16 mmHg was 73.8% and 62.1% without medication and 90% and 71.1% with medications at 5 years after surgery, respectively. A Cox’s Regression model for IOP < 16 mmHg showed a significant positive association between MMC augmentation and laser goniopuncture(LGP) ( p< 0.001) and negative association with needle revision (p= <0.001). Mean IOP was significantly lower in DS-MMC group (ANOVA, p < 0.001) and there was no difference between DS-B and DS-N groups.Serious complications included hypotony (IOP < 6 mmHg for 6 months or more) in 22 eyes (19 of DS-MMC group), endopthalmitis in 1 eye of DS-MMC group and blebitis in 3 eyes (2 from DS-MMC group). An IOP spike of >30 mmHg was seen in 17 eyes. Subsequent procedures, excluding LGP and needle revision to lower IOP were done in only 23 eyes.
Deep sclerectomy is an effective, safe and durable IOP-lowering surgical procedure. MMC augmentation enhances its potency but with a increased risk of complications.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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