Prospective Evaluation of the First Mitomycin-C (MMC)-Augmented Needle Revision in Patients with Failed Nonpenetrating Deep Sclerectomy

Purpose. To report outcomes of deep sclerectomy augmented with mitomycin C (MMC) in eyes with raised intraocular pressure (IOP) secondary to uveitis. Methods. This was a retrospective case series of 26 eyes of 26 patients with uveitic glaucoma. Mitomycin C 0.2–0.4 mg/mL was applied subconjunctivally prior to scleral flap dissection for 2–3 minutes. Results. Mean follow-up was 46.5±22 months (range 12–83). Fifteen eyes (58%) had previous intraocular surgery. Preoperative IOP was 33±12 mmHg. Intraocular pressure at 1, 2, and 3 years after surgery was 13±4 mmHg, 13±4 mmHg, and 14±4 mmHg, respectively. The probability of IOP <21 and 18 mmHg with needle revision and laser goniopuncture but without medications or further glaucoma procedure was 89% and 84%, respectively, at 3 years. The cumulative probability for performing laser goniopuncture was 42% at 1 year, 50% at 2 years, and 64% at 3 years. Needle revision was performed in 6 eyes (23%). Three (12%) patients required further glaucoma surgery. The number of glaucoma medications decreased from 3.3±1.2 to 0.3±0.8 by last follow-up (p<0.001). Four eyes (15%) were on medications to control IOP Intraoperative perforation of trabeculo-Descemetic membrane occurred in 3 eyes (12%) and late iris entrapment in perforation or goniopuncture in 4 eyes (15%). Recurrence of uveitis was seen in 11 eyes (42%) with no loss in IOP control. Conclusions. Deep sclerectomy with MMC appears to be a safe and effective procedure to lower IOP in uveitic glaucoma with a low rate of complications.

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Same-Site Deep Sclerectomy Re-Operation with Subconjunctival and Subscleral Collagen Matrix (Ologen™) and Minimal use of Mitomycin C

The Open Ophthalmology Journal ◽

10.2174/1874364101913010043 ◽

2019 ◽

Vol 13 (1) ◽

pp. 43-50

Author(s):

Pablo Díaz-Aljaro ◽

Jordi Loscos-Arenas ◽

Pau Romera-Romero ◽

Nevena Romanic-Bubalo ◽

Stefano Grixolli-Mazzon ◽

...

Keyword(s):

Mitomycin C ◽

Collagen Matrix ◽

Final Visit ◽

Deep Sclerectomy ◽

Prospective Evaluation ◽

Safety And Efficacy ◽

Surgical Success ◽

Late Failure ◽

Second Surgery ◽

Topical Medications

Purpose:This study aimed to evaluate the safety and efficacy of same-site Deep Sclerectomy (DS) re-operation with subconjunctival and subscleral collagen matrix (Ologen™) and minimal use of mitomycin C in cases of late failure blebs.Methods:A prospective evaluation of consecutive patients on which same-site DS was performed with subconjunctival and subscleral collagen matrix (Ologen™) and minimal use of mitomycin C; all performed at a single university institution. Intraocular pressure (IOP), number of glaucoma medications, postoperative interventions, postoperative complications and surgical success were registered at 24 hours, 1, 6 and 12 months after the surgery.Results:Twenty-five eyes of 25 patients were included in this study. Time from first DS was 55.08 ± 28.16 months. Mean preoperative IOP was 20.88 ± 6.06 mmHg and it was reduced to 16.64 ± 4.02 mmHg, at 12 months after re-operation (p 0,007). At this final visit, requirements for topical medications dropped from a mean of 2.2 ± 1.0 to 0.72 ± 1.0 per patient and no medications were required in 60% of patients. Success was 36 % in criteria A (IOP ≤15mmHg), 72% in criteria B (IOP ≤18 mmHg) and 80 % in criteria C (IOP ≤15 mmHg), 12 months after the second surgery.Conclusion:The same-site DS re-operation with subconjunctival and subscleral collagen matrix (Ologen®) and minimal use of mitomycin C is a safe and adequate technique for the reduction of IOP, especially when targeted IOP is not lower than 15mmHg.

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Needling revision with marking maneuver to locate the scleral flap

European Journal of Ophthalmology ◽

10.1177/1120672120959548 ◽

2020 ◽

pp. 112067212095954

Author(s):

Consuelo Gutiérrez-Ortiz ◽

Sara Rodrigo-Rey

Keyword(s):

Pilot Study ◽

Mitomycin C ◽

Deep Sclerectomy ◽

Scleral Flap ◽

Surgical Success ◽

Prospective Pilot Study ◽

Ophthalmologic Examination ◽

Bleb Formation ◽

Needle Revision

Purpose: To report a variation of the classical needle revision maneuver with an external marking of the scleral flap, augmented with mitomycin C (MMC) in failed non penetrating deep sclerectomy (NPDS). Method: This observational prospective pilot study included five consecutive patients who underwent an MMC needling revision of failed NPDS with the external marking of the scleral flap. All participants underwent a complete ophthalmologic examination and data were collected preoperatively as well as 1 day, 1 week and 1 month after the surgery. The surgical site was also evaluated during the procedure. Results: A significant reduction of IOP and antiglaucomatous medication from preoperative levels was detected at the end of the follow-up period. Regarding the surgical site, we succeed in locating the scleral flap and observing the bleb formation in all cases. No significant subconjunctival bleeding was detected. Conclusion: This variation of the classical needling technique seems to improve intrasurgical visualization and reduces complications, which might lead to an improvement in surgical success.

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