Abstract
Purpose :
Trabeculectomy with Mitomycin C combined with deep sclerectomy (DST) is a relatively new procedure with few studies evaluating its outcomes. We would like to determine the long-term postoperative outcomes of DST in the treatment of glaucoma.
Methods :
This retrospective cohort observational study included patients who underwent DST between 2008 and 2017 by a single surgeon. Complete success was defined as postoperative IOP <20 mmHg or 30% reduction of IOP from baseline without any topic anti-glaucoma agent. Qualified success defined as IOP <20 mmHg or 30% reduction of IOP from baseline with single topical agent. Cases requiring more than one topical agent and/or repeat glaucoma surgery were considered as failure.
Results :
98 eyes were included with mean age of 77.4 (SD 10.5). Follow-up ranged from 12 to 84 months (Mean 67.5 months). A significant decrease in IOP compared to pre-operative level of approximately 44-47% at each follow-up time point was achieved. The proportion of patients with IOP<12mmHg at one, three, five and seven years after surgery were 51.5%, 45.1%, 39.2%, and 43.3% respectively. At similar time-points as above, 71.1%, 72.5%, 72.2% and 70.0% had IOP <15mmHg, whereas 92.8%, 92.3%, 96.2% and 96.7% had IOP <20mmHg respectively. At final follow up, the complete success rate was 85.7%. The overall number of glaucoma medications decreased from 2.1 ± 0.7 to 0.2 ± 0.5 by last follow up. At last follow up, 84 eyes achieved complete success and 6 eyes achieved qualified success. Transient hyphaema developed in 15 eyes (15.3%). 13 patients (13.3%) had transient choroidal effusion. Other complications included shallow AC in 5 eyes (5.1%), laser suturelysis or removal of releasable sutures in 13 eyes (13.3%), bleb leak in 4 eyes (4.1%), bleb revision for hypotony in 10 eyes (10.2%), bleb needling with 5-Fluorouracil injection in 16 eyes (16.3%) and repeat trabeculectomy in 2 eyes (2.0%). There was no endophthalmitis, blebitis or cystoid macular oedema. Mixed linear regression model showed that presenting demographic and ocular characteristics (use of topical agents, profile of IOP, BCVA, and MD) were not statistically significant. There was no significant correlation between postoperative IOP control and postoperative BCVA.
Conclusions :
DST reported reasonable outcomes for the treatment of glaucoma with no major complications encountered.
This is a 2020 ARVO Annual Meeting abstract.