Deep sclerectomy-trabeculectomy with mitomycin C in treating glaucoma: postoperative long-term results

Abstract

AIM: To determine the long-term postoperative outcomes of deep sclerectomy-trabeculectomy (DST) with mitomycin C (MMC) in the treatment of glaucoma. METHODS: Patients who underwent DST with MMC between 2010 and 2017 were included in this retrospective observational study. Complete success was defined as postoperative intraocular pressure (IOP) ≤21 mm Hg or 30% reduction of IOP from baseline without any topical IOP-lowering agent, and qualified success defined as IOP≤21 mm Hg or 30% reduction of IOP from baseline with/without single topical agent. We evaluated the surgical success rates and complication rates of this procedure, as well as described the IOP profiles, best corrected visual acuity (BCVA) profiles and mean deviations (MD) of Humphrey visual field (HVF) 24-2 performance at each follow-up time point. Mixed linear regression models were constructed to determine estimated predictive values of demographic data, use of topical IOP-lowering agents, baseline and postoperative IOP and optical profiles (e.g., BCVA and MD). RESULTS: Totally 98 eyes (mean postoperative follow-up 67.5mo) showed mean IOP reduction at every follow-up interval. Both median BCVA and MD of visual fields were maintained throughout the follow-up intervals when comparing to baseline. The number of IOP-lowering medications decreased from 2.8±0.8 to 0.3±0.7 (P=0.068). Totally 84 (85.7%) eyes achieved complete success at final follow-up. Transient hyphaema and transient choroidal effusion developed in 15 eyes (15.3%) and 11 eyes (11.2%) respectively. Other complications included shallow anterior chamber in 5 eyes (5.1%), bleb leak in 4 eyes (4.1%), bleb revision in 7 eyes (7.1%), bleb needling in 9 eyes (9.2%) and repeat trabeculectomy in 1 eye (1.0%). There was no endophthalmitis, blebitis or macular oedema. There was no significant correlation between postoperative IOP control and postoperative BCVA. CONCLUSION: DST with MMC demonstrates effective and sustained long-term outcomes in the treatment of glaucoma with no major complication.