Comparison of the Clinical Results of Combined Phacoemulsification and Deep Sclerectomy with the Use of Mitomycin C at Different Sites

Abstract

To evaluate the clinical results combined phacoemulsification and deep sclerectomy (PDS) with the use of mitomicin C (MMC) at different sites. PDS with MMC was performed in patients with open angle glaucoma and cataract. The patients were divided into two groups. In 16 eyes of the first group, MMC (0.2 mg/ml) was applied to subconjunctival area and under the superficial scleral flap. In 16 eyes of the second group, MMC was applied only to the place under the superficial scleral flap. It was compared the effects of different MMC applications in between the groups. Preoperative mean intraocular pressure (IOP) was significantly decreased from 25.84±3.78 mmHg to 16.34±3.33 mmHg (p

Keywords

• Glaucoma, cataract, deep sclerectomy, phacoemulsification, mitomycine C

Comparison of the Clinical Results of Combined Phacoemulsification and Deep Sclerectomy with the Use of Mitomycin C at Different Sites

Öz

Fakoemulsifikasyon ile kombine derin sklerektomide (FDS) farklı alanlara uygulanan Mitomisin C’nin (MMC) klinik sonuçlarının değerlendirilmesi. Primer açık açılı glokom ile birlikte kataraktı olan hastalara MMC’li FDS ameliyatı yapıldı. Hastalar iki gruba ayrıldı. İlk gruptaki 16 göze, MMC (0,2 mg/ml) subkonjonktival alana ve yüzeysel skleral flebin altına uygulandı. İkinci gruptaki 16 göze ise bu uygulama sadece yüzeysel skleral flep altına yapıldı. Farklı MMC uygulamalarının iki gruptaki etkileri karşılaştırıldı. Bütün gözler ele alındığında ortalama preoperatif GİB antiglokomatöz medikasyon ile 25,84±3,78 mmHg iken postoperatif son kontrollerde ortalama GİB 16,34±3,33 mm Hg idi (p<0,001). Preoperatif dönemde en iyi düzeltilmiş görme keskinliği (EİDGK) ortalama 0,2 iken postoperatif dönemde 0,7 idi. Tam başarı oranları birinci grupta %67,3; ikinci grupta ise %54,2 idi. MMC’ye bağlı olarak görülen en sık komplikasyon avasküler bleb gelişimi idi. Birinci grupta beş gözde (% 31,25) avasküler bleb görüldü. İkinci grupta ise iki gözde (%12,5) avasküler bleb görüldü. İkinci grupta bir hastada kistik bleb görüldü. Bu iki grup karşılaştırıldığında başarı ve komplikasyon oranlarındaki farkın istatistiksel olarak anlamlı olduğu görüldü (p<0,05) . Yüzeysel skleral flep altına ek olarak subkonjonktival alana uygulanan MMC, cerrahinin başarısını arttırırken daha fazla avasküler bleb gelişimine neden olmaktadır

Anahtar Kelimeler

• Glokom, katarakt, derin sklerektomi, fakoemülsifikasyon, mitomicin C

References

1. Fyodorov SN, Loffe DI, Ronkina TI. Deep sclerectomy technique and mechanism of a new antiglaucomatous procedure. Glaucoma 1984;6:281-3.
2. Carassa RG, Bettin P, Fiori M, Brancato R. Viscocanalostoy: A pilot study. Eur J Ophthalmol 1998;8:57-61.
3. Epstein E. Fibrosing responses to aqueous; it’s relation to glaucoma. Br J Ophthalmol 1959;43:641-7.
4. Krasnov MM. Sinusotomy: Foundations, results, prospect. Trans Am Ophthalmol Otolaryngol 1972;76:369-74.
5. De Laage P. La trabeculectomie a minima (T.A.M.) (tech- nique, indications, resultats). Bull Soc Ophtalmol Fr 1978;78:121-7.
6. Zimmerman TJ, Kooner KS, Ford VJ, Olander KW, Mandlekorn RM, Rawlings EF, Leader BJ, Koskan AJ. Trabeculectomy vs. nonpenetrating trabeculectomy: A retrospective study of two procedures in phakic patients with glaucoma. Ophthalmic Surg 1984; 15:734-40.
7. Gierek A, Szymansky A. Results of deep sclerectomy for open-angle glaucoma. Folia Ophthalmol 1987; 12:227-9.
8. Hara T. Deep sclerectomy with Nd:YAG laser trabeculec- tomy ab interno: Two-stage procedure. Ophthalmic Surg 1998; 19:101-6.

9. The Fluorouracil Filtering Surgery Study Group. Five-year follow-up of the Fluorourcil Filtering Surgery Study. Am J Ophthalmol 1996;121:349-66.
10. Kozobolis VP, Christodoulakis EV, Tzanakis N, Zacharopoulos I, Pallikaris IG. Primary deep sclerectomy versus primary deep sclerectomy with the use of mito- mycin C in primary open-angle glaucoma. J Glaucoma. 2002;1:287-93.
11. Drake M. Complications of glaucoma filtration surgery. Int Ophthalmol Clin 1992;4:115-30.
12. Sourdille P. Nonpenetrating trabecular surgery: It’s worth the change (review). J Cataract Reract Surg 1999;25:298- 300.
13. Aminlari A. Postoperative complications of glaucoma fil- tering procedures. Glaucoma 1990;12:101-16.
14. Obstbaum S. New approaches to trabecular surgery. J Cataract Refract Surg 1999;25:297.
15. Sourdille P, Santiago P-Y, Villain F, et al. Reticulated hyal- uronic acid implant in nonperforating trabecular surgery. J Cataract Refract Surg 1999;25:332-9.
16. Ateş H, Uretmen O, Andac K, Azarsiz SS. Deep sclerec- tomy with a nonabsorbable implant (T-Flux): Preliminary results. Can J Ophthalmol 2003;38:482-8.
17. Khaw PT, Sherwood MB, Doyle JW, Smith MF, Grierson I, McGorray S, Schultz GS. Intraoperative and post opera- tive treatment with 5-fluorouracil and mitomycin-c: Long term effects in vivo on subconjunctival and scleral fibro- blasts. Int Ophthalmol 1992;16:381-5.
18. Nuyts RM, Felten PC, Pels E, Langerhorst CT, Geijssen HC, Grossniklaus HE, Greve EL. Histopathologic effects of mitomycin C after trabeculectomy in human glauco- matous eyes with persistent hypotony. Am J Ophthalmol 1994;15;118:225-37.
19. Lamping KA, Belkin JK. 5- fluorouracil and mitomycin C in pseudophakic patients. Ophthalmology 1995;102:70-5.
20. Anand S, Anand N. Combined phacoemulsification and deep sclerectomy (PDS) with intraoperative mitomycin C (MMC) augmentation. Eye (Lond) 2008;22:1040-9.
21. Jampel HD, Pasquale LR, Dibernardo C. Hypotony macu- lopathy following trabeculectomy with mitomycin C. Arch Ophthalmol 1992;110:1049-53.
22. Marchini G, Marrafa M, Brunelli Ch, et al. Ultrasound biomicroscopy and intraocular –pressure-lowering mecha- nisms of deep sclerectomy with reticulated hyaluronic acid implant. J Cataract Refract Surg 2001;27:507-17.