NON-PENETRAN GLOKOM CERRAHİSİ SONUÇLARININ İNCELENMESİ
Title:
Results of Mitomycin-C Augmented Viscocanalostomy for Open-angle Glaucoma
Açık Açılı Glokomlu Gözlerde Mitomisin-C’li Viskokanalostomi Sonuçları
Running Title:
Mitomycin-C Augmented Viscocanalostomy Results
INTRODUCTİON
High intraocular pressure (IOP) is the only curable risk factor of glaucoma and the primary goal of the glaucoma treatment is to find out the ideal target IOP in which optical nervous damage hasn’t progressed. Eyes diagnosed to have glaucoma can be cured medical, laser, and surgical treatment methods, respectively.1 Among surgical alternatives, providing the most effective IOP decrease is trabeculectomy.2 But, nowaadays, because of serious and sight-threatening complications that may be associated with trabeculectomy, non-penetrating glaucoma surgeries (NPGS) are trending topic. Lots of studies have shown that NPGS decreased IOP safely and effectively.3-5
Viscocanalostomy is a non-penetrating glaucoma surgery that allows filtration through a thin trabeculo-Descemet’s membrane (TDM).6 When the surgical method first described, antimetaboite usage wasn’t preferred because of the high complication rates. However, we know that fibrosis is the most important cause of surgical failure at late period. During visconalostomy surgery, antimetabolite usage can provide more effective IOP decrease by increasing humor aqueous drainage from subconjonctival pathway.7,8
The purpose of this study to evaluate the results of mitomycin-C (MMC) augmented viscocanalostomy in the patients with open angle glaucoma, resistant to maximum tolerated medical therapy.
METHODS
Medical records of 155 open-angle glaucoma (OAG) patients who underwent viscocanalostomy surgery between December 2007 and March 2014 were evaluated retrospectively. The patients were identified from surgical logbooks and clinical databases. The study was approved by the local ethics committee, according to the tenets of the Declaration of Helsinki
Pre and postoperative IOP, number of glaucoma medication, visual acuity, complications, adjunctive procedure (laser goniopuncture with/or glaucoma medication) and success rate were recorded. The eyes with history of trauma, with previously undergone glaucoma surgery and insufficient data were excluded.
Presurgery data included best-corrected visual acuity (BCVA), assessed with the Snellen chart, Goldmann aplanation tonometry, slit lamp biomicroscopy and fundoscopy. All the patients had uncontrolled glaucoma that was defined as progressive glaucomatous optic nerve morphology, on maximum tolerated medical therapy.
Surgical technique:
All surgeries were performed by one surgeon (MB) and were performed under peribulbar anesthesia. Surgical technique is shown in Figure-1.
Postoperative management
Postoperatively, all the patients were treated with prednisolone aceate 1% four times a day for one month and topical antibiotics three times a day until the conjonctival polyglactin suture was melted. After surgery, all the previously mentioned examinations were performed on one day, one week as well as at 1, 3, 6 months and than every 6 months. Complete success rate was defined as an IOP of lower than 21 mm HG without additional medication and qualified success rate was defined as an IOP of less than or equal to 21 mm HG with or without glaucoma medication.
Additional treatments
Postoperative LGP was firstly preferred to perform in cases of shallow filtering bleb and higher postoperative intraocular pressures (IOPs) than targeted. World Glaucoma Association guidelines refer to LGP as a complementary adjunct to non-penetrating glaucoma surgery, not as part of postoperative failure (5). The target of LGP is to decrease TDM resistance and lower IOP. Both Nd:YAG laser (conventional 1064-nm, free-running, Q-switched, Lpulsa SYL 9000; Lightmed, San Clemente, CA) and SLT (532-nm, frequency-doubled, Q-switched, Solo Laser; Ellex, Adelaide, Australia)have been used for LGP. The laser was applied under topical anesthesia, over the surgical area only (TDM), by the same surgeon who carried out the viscocanalostomy (author MB). Using a glass CGAL gonioscopy contact lens (Haag-Streit AG, Koeniz, Switzerland), the conventional Nd:YAG laser goniopuncture was conducted with energy levels of 2–6 mJ, spot size of 8 µm, and 8–10 shots; the SLT goniopuncture was performed with energy levels of 0.6–1 mJ, spot size of 400 µm, and 4–6 shots. Success was defined as maintenance of intraocular pressure ................
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