Primary Phakic Deep Sclerectomy Augmented With Mitomycin C Long-term Outcomes

Aim: To report the long-term outcomes of deep sclerectomy (DS) with intraoperative mitomycin C in eyes with no previous ocular surgery. Methods: One hundred ninety-four eyes of 160 consecutive patients who had primary phakic DS between August 2001 and April 2005 were included from a database on all glaucoma surgery in our department. The mean follow-up was 48 +/- 15 months (median, 49 mo). Results: The probability of a final intraocular pressure (IOP) of less than 19, 16, and 13mm Hg without medications or needle revisions at 1 year was 85% (80% to 90%, 95% confidence intervals), 83% (78% to 88%), and 68% (62% to 75%). At 3 years was 78% (73% to 85%), 76% (60% to 82%), and 60% (53% to 67%), respectively. The probability of performing Nd: YAG laser goniopuncture (LGP) was 66% (59% to 74%) 3 years after DS. Further glaucoma surgery was undertaken in 16 eyes (8.2%). Intraoperative perforations occurred in 28 eyes (14.4%). Iris synechiae or incarceration in the goniopuncture were observed in 54 (27.8%) during follow-up and were associated with an acute symptomatic rise in IOP in 6 eyes (3.1%). Hypotony with maculopathy was seen after LGP and needling in 3 eyes (1.5%). Blebitis developed in 2 eyes (1%) after LGP and endophthalmitis in 1 eye (0.5%), which had an intraoperative perforation. Conclusions: Mitomycin C-enhanced primary DS effectively reduces IOP in primary phakic open-angle glaucoma. Most eyes required LGP to maintain IOP control. However, complications associated with partial-thickness procedures, like bleb-related infections and hypotonic maculopathy were observed.