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Comparative Results of Deep Sclerectomy with Mitomycin C (MMC) using a Dry Cross-linked Hyaluronate and Trabeculectomy with MMC
Schwenn O., Springer C., Vogel A., Yun R., Pfeiffer N.,
Johannes-Gutenberg-Universität Mainz, Universitäts-Augenklinik (Mainz)
Purpose: The Advanced Glaucoma Intervention Study (1) proved that a very low intraocular pressure (IOP) is necessary to avoid further progression in eyes with open angle glaucoma. Taking aim at a very low target pressure we compared two aggressive surgical procedures.
Methods: 22 eyes of 22 patients with advanced open angle glaucoma were randomly assigned to receive a deep sclerectomy or a trabeculectomy. Both groups received MMC 0.02% under the conjunctiva prior to preparation of the scleral flap. In the deep sclerectomy group at least parts of the outer trabecular meshwork were removed until an apparent filtration was achieved. A dry crosslinked hyaluronate (2) served as an implant. In the other group a classical trabeculectomy was performed.
Results: Both procedures proved to be successful concerning the IOP-lowering effect: 12 months postoperatively the median of IOP valued 11.5 mmHg in the deep sclerectomy group (minimum: 7, maximum: 21, mean value±standard deviation: 12.5±4.2 mmHg), compared to 11 mmHg (min: 3, max: 18, MV±SD: 11.3±4.7 mmHg) in the trabeculectomy group; the median of the relative IOP reduction was -47% (min: -77, max: -10, MV±SD: -47±21%) in the deep sclerectomy group, -57% (min: -81, max: -27, MV±SD: -54±18%) in der trabeculectomy group. The median of the change in best corrected visual acuity (logarithmic scale) 12 months postoperatively was 0 in both groups (deep sclerectomy group: min: -5, max: +2, MV±SD: -1.1±2.2; trabeculectomy group: min: -3, max: +2, MV±SD: +0.1±1.3). There were less complications and interventions in the trabeculectomy group compared to the deep sclerectomy group. No statistically significant differences were observed between the two groups.
Conclusions: As a more aggressive IOP-lowering procedure deep sclerectomy proved to be as effective as trabeculectomy. Nevertheless, the advantages of the more difficult surgical procedure concerning visual acuity, complications and surgical interventions postoperatively were lost.
(1) AGIS: Am J Ophthalmol 2000; 130: 429-440 (2) Schwenn et al: Trabekulotomie, tiefe Sklerektomie und Viskokanalostomie. Ophthalmologe 1998; 95: 835-843