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Deep sclerectomy and trabeculectomy augmented with Mitomycin C: 2-year post-operative outcomes

PURPOSE: Two-year post-operative outcomes of both deep sclerectomy (DS) and trabeculectomy surgery (Trab) augmented with Mitomycin C (MMC) at a single tertiary eye centre. METHODS: Retrospective review of DS + MMC and trabeculectomy + MMC at a single centre between February 2015 and March 2018. Pati...

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Autores principales: Dwivedi, Rahul, Somerville, Tobi, Cheeseman, Robert, Rogers, Clare, Batterbury, Mark, Choudhary, Anshoo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7938885/
https://www.ncbi.nlm.nih.gov/pubmed/33683432
http://dx.doi.org/10.1007/s00417-021-05144-w
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author Dwivedi, Rahul
Somerville, Tobi
Cheeseman, Robert
Rogers, Clare
Batterbury, Mark
Choudhary, Anshoo
author_facet Dwivedi, Rahul
Somerville, Tobi
Cheeseman, Robert
Rogers, Clare
Batterbury, Mark
Choudhary, Anshoo
author_sort Dwivedi, Rahul
collection PubMed
description PURPOSE: Two-year post-operative outcomes of both deep sclerectomy (DS) and trabeculectomy surgery (Trab) augmented with Mitomycin C (MMC) at a single tertiary eye centre. METHODS: Retrospective review of DS + MMC and trabeculectomy + MMC at a single centre between February 2015 and March 2018. Patients with a minimum of 12-month follow-up were included. Post-operative follow-up: day 1, week 1, months 1/3/6/12/18/24. Primary outcomes: changes in intraocular pressure (IOP) and changes in LogMAR visual acuity (BCVA) pre- and post-procedure. Secondary outcomes: changes in number of eye drops, number of follow-up clinic visits, post-operative complications and further surgical interventions. Complete success: IOP ≤ 21 mmHg off all IOP-lowering medications. Qualified success: IOP ≤ 21 mmHg on medication. Failure: IOP > 21 mmHg at 24 months or ≤ 5 mmHg on 2 consecutive follow-up visits after 3 months +/− additional incisional glaucoma surgery +/− loss of light perception. Statistical analysis performed using Microsoft Excel + SPSS. RESULTS: 90 eyes: DS + MMC = 46 eyes, Trab + MMC = 44 eyes. DS + MMC v Trab + MMC: mean pre-op IOP = 19.57 mmHg v 18.89 mmHg, significantly reduced at all post-operative time-points for both groups (p < 0.001). Mean IOP reduction from baseline = 33.94% v 38.39%; > 30% IOP reduction = 54.35% v 68.18%. IOP ≤ 16 mmHg = 82.61% (38/46) v 95.46% (42/44), IOP ≤ 12 mmHg = 52.17% (24/46) v 72.72% (32/44). Complete success = 67.39% v 61.36%, qualified success = 26.09% v 29.55%, failure = 6.52% v 9.09%. Post-op BCVA: no statistically significant differences between two groups (p = 0.09). Mean pre-op drops v post-op drops = 2.98 v 0.38 (DS + MMC; p < 0.001); 2.68 v 0.39 (Trab + MMC; p < 0.001). Further surgical intervention = 13% v 29.55%. Mean number of post-op clinic visits DS + MMC v Trab + MMC = 10.09 v 13.02 (p = 0.005). CONCLUSION: Both procedures achieve sustained intraocular pressure and drop reduction at 2 years post-op. DS + MMC has lower complication rates requiring less intervention and significantly fewer clinic visits, which may be an important factor for deciding surgical management of glaucoma patients in the era of Covid-19 to reduce patient/clinician exposure to the virus.
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spelling pubmed-79388852021-03-09 Deep sclerectomy and trabeculectomy augmented with Mitomycin C: 2-year post-operative outcomes Dwivedi, Rahul Somerville, Tobi Cheeseman, Robert Rogers, Clare Batterbury, Mark Choudhary, Anshoo Graefes Arch Clin Exp Ophthalmol Glaucoma PURPOSE: Two-year post-operative outcomes of both deep sclerectomy (DS) and trabeculectomy surgery (Trab) augmented with Mitomycin C (MMC) at a single tertiary eye centre. METHODS: Retrospective review of DS + MMC and trabeculectomy + MMC at a single centre between February 2015 and March 2018. Patients with a minimum of 12-month follow-up were included. Post-operative follow-up: day 1, week 1, months 1/3/6/12/18/24. Primary outcomes: changes in intraocular pressure (IOP) and changes in LogMAR visual acuity (BCVA) pre- and post-procedure. Secondary outcomes: changes in number of eye drops, number of follow-up clinic visits, post-operative complications and further surgical interventions. Complete success: IOP ≤ 21 mmHg off all IOP-lowering medications. Qualified success: IOP ≤ 21 mmHg on medication. Failure: IOP > 21 mmHg at 24 months or ≤ 5 mmHg on 2 consecutive follow-up visits after 3 months +/− additional incisional glaucoma surgery +/− loss of light perception. Statistical analysis performed using Microsoft Excel + SPSS. RESULTS: 90 eyes: DS + MMC = 46 eyes, Trab + MMC = 44 eyes. DS + MMC v Trab + MMC: mean pre-op IOP = 19.57 mmHg v 18.89 mmHg, significantly reduced at all post-operative time-points for both groups (p < 0.001). Mean IOP reduction from baseline = 33.94% v 38.39%; > 30% IOP reduction = 54.35% v 68.18%. IOP ≤ 16 mmHg = 82.61% (38/46) v 95.46% (42/44), IOP ≤ 12 mmHg = 52.17% (24/46) v 72.72% (32/44). Complete success = 67.39% v 61.36%, qualified success = 26.09% v 29.55%, failure = 6.52% v 9.09%. Post-op BCVA: no statistically significant differences between two groups (p = 0.09). Mean pre-op drops v post-op drops = 2.98 v 0.38 (DS + MMC; p < 0.001); 2.68 v 0.39 (Trab + MMC; p < 0.001). Further surgical intervention = 13% v 29.55%. Mean number of post-op clinic visits DS + MMC v Trab + MMC = 10.09 v 13.02 (p = 0.005). CONCLUSION: Both procedures achieve sustained intraocular pressure and drop reduction at 2 years post-op. DS + MMC has lower complication rates requiring less intervention and significantly fewer clinic visits, which may be an important factor for deciding surgical management of glaucoma patients in the era of Covid-19 to reduce patient/clinician exposure to the virus. Springer Berlin Heidelberg 2021-03-08 2021 /pmc/articles/PMC7938885/ /pubmed/33683432 http://dx.doi.org/10.1007/s00417-021-05144-w Text en © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Glaucoma
Dwivedi, Rahul
Somerville, Tobi
Cheeseman, Robert
Rogers, Clare
Batterbury, Mark
Choudhary, Anshoo
Deep sclerectomy and trabeculectomy augmented with Mitomycin C: 2-year post-operative outcomes
title Deep sclerectomy and trabeculectomy augmented with Mitomycin C: 2-year post-operative outcomes
title_full Deep sclerectomy and trabeculectomy augmented with Mitomycin C: 2-year post-operative outcomes
title_fullStr Deep sclerectomy and trabeculectomy augmented with Mitomycin C: 2-year post-operative outcomes
title_full_unstemmed Deep sclerectomy and trabeculectomy augmented with Mitomycin C: 2-year post-operative outcomes
title_short Deep sclerectomy and trabeculectomy augmented with Mitomycin C: 2-year post-operative outcomes
title_sort deep sclerectomy and trabeculectomy augmented with mitomycin c: 2-year post-operative outcomes
topic Glaucoma
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7938885/
https://www.ncbi.nlm.nih.gov/pubmed/33683432
http://dx.doi.org/10.1007/s00417-021-05144-w
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