Abstract
Purpose :
Several surgical approaches have been used to treat refractory glaucomas.The aim of this study is to investigate comparative efficacy and safety surgical outcomes in refractory glaucoma cases which underwent either micropulsed cyclophotocoagulation (MPCPC) versus Ahmed valve implantation with mitomycin C (AVI+MMC)
Methods :
Retrospective review of medical records. Data from 53 eyes of 47 patients with diverse types of refractory glaucoma with at least 6 months of follow-up and complete information were included. Consecutive cases were divided into two groups: MPCPC (n=28) and AVI+MMC (n=25). Surgical success met the following criteria: (1) the postoperative IOP remained in a range of 5-21 mmHg and was reduced at least 30% compared to the baseline with or without medication (complete or qualified success), (2) there was no loss of light perception or vision-threatening severe complications, and (3) no additional glaucoma surgery was required. Any complications as well as their outcomes were registered.
Results :
Follow-up range was 6-9 months for the MPCPC group and 13-21 months for the AVI+MMC group. Mean preop IOP, 37.6±9.6 mmHg (MPCPC) and 39.3±11.8 mmHg (AVI+MMC) (P=0.56), and the mean postop IOP, at 6 months follow-up, 14.1±3.6 mm Hg (MPCPC) and 16.3±4.9 mmHg (AVI+MMC) (P=0.06), were significantly different from baseline in both groups (P< 0.0001). Preop mean number of glaucoma medications were not significantly different between groups (P=0.72); the mean number of postop IOP-lowering medications was significantly lower in the MPCPC group compared with the AVI+MMC group at 6 months (P=0.002). No statistically significant difference between groups in postop BCVA and IOP was observed. Qualified success rate was 88.9% and 83.3% at 6 months after MPCPC and AVI+MMC, respectively. Kaplan–Meier survival analysis demonstrated no significant difference in success rates between groups (P=0.69). Transient hypotony was the most common complication in both groups (10.7% vs. 16%; MPCPC vs. AVI+MMC). One corneal decompensation was registered in the AVI+MMC group.
Conclusions :
This report on the short-term clinical efficacy comparing MPCPC vs. AVI+MMC demonstrated similar results in eyes with refractory glaucoma although a trend to have lower IOP values in the MPCPC group over its contrast group was shown. Incidence of complications yielded almost equivalent results.
This is a 2020 ARVO Annual Meeting abstract.