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  • Title: Deep sclerectomy in normal-tension glaucoma with and without mitomycin-c.
    Author: Suominen S, Harju M, Kurvinen L, Vesti E.
    Journal: Acta Ophthalmol; 2014 Nov; 92(7):701-6. PubMed ID: 24373326.
    Abstract:
    PURPOSE: To compare the outcome of deep sclerectomy (DS) with and without mitomycin-C (MMC) in patients with normal-tension glaucoma (NTG). METHODS: We prospectively analysed the results of 37 eyes of 37 consecutive patients with NTG (age; mean ± SD; 64 ± 7 years) who underwent DS with a collagen implant. Patients were randomized to the MMC and non-MMC groups. Subconjunctival MMC (0.4 mg/ml for 3 min) was used intraoperatively in 15 of 37 eyes. We defined total success as 25% reduction in intraocular pressure (IOP) without medication. Follow-up time was 12 months. RESULTS: The mean preoperative IOP was significantly reduced from 15.2 ± 2.8 mmHg to 9.3 ± 2.7 (p < 0.001) in the MMC group after 12-month follow-up and from 15.1 ± 2.9 mmHg to 11.8 ± 2.0 (p < 0.001) in the non-MMC group. At 12 months, the mean IOP was significantly lower in the MMC group (p = 0.003) compared with the non-MMC group. Total success was achieved in 10 of 15 eyes (67%) in MMC group and in nine of 22 eyes (41%) in non-MMC group (p = 0.12). The number of glaucoma medications was decreased from 2.2 ± 0.8 to 0.5 ± 1.2 in MMC group (p = 0.001) and from 2.6 ± 1.0 to 0.5 ± 0.7 in non-MMC group (p < 0.001). Goniopuncture was performed in seven eyes (47%) in the MMC group, compared with 16 eyes (73%) in the non-MMC group (p = 0.13). IOP < 10 mmHg was achieved in seven of 15 eyes in the MMC group and in two of 22 in the non-MMC group (p = 0.009). Complication rate was low, and no difference between groups was evident. CONCLUSION: Deep sclerectomy seems to be effective and safe in reducing IOP in patients with NTG. Intraoperative use of MMC results in lower postoperative IOP 12-month postoperatively without increased rate of complications.
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