Deep Sclerectomy with Mitomycin C for Glaucoma Secondary to Uveitis

Abstract

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.