Deep Sclerectomy With Mitomycin C and With or Without Hyaluronic Acid Implant: Comparative Study
Narrative Responses:
Purpose
To assess the comparative efficacy and safety of primary deep sclerectomy (DS) with intraoperative Mitomycin C (MMC) and with or without cross linked Hyaluronic acid implant in subcunjunctival space and in decompression chamber space.
Methods
Retrospective, comparative series of consecutive primary DS between January 2008 and December 2010. 141 eyes of 114 patients were included, with 63 eyes with only MMC and 78 with MMC and hyaluronic implant. MMC (0.2 mg/mL for 1 min) was applied subconjunctivally just after superficial scleral flap dissection and put in the posterior sub tenon space. Hyaluronic implant was injected subconjunctivally and in the decompression chamber space at the end of surgery. We compared at each follow-up the mean ocular pressure and the amount of topical medication needed to reach the target pressure.
Results
There were no really baseline differences between the groups except for the follow-up. Follow-up after DS was 40 months in the non implanted group and 31 months in the implanted group. The mean preoperative IOP was 24 mmHg vs 22 mmHg. At the end of the follow-up the mean pressure and mean topical medication were slightly better in the hyaluronic group (13.3 mmHg with 0.47 topical medication) compared to the non implanted group (14.5 mmHg with 0.61 mean topical medication). A goniopuncture was required in nearly 60 % of the eyes in each group.
Conclusion
The intraoperative subconjonctival and in decompression chamber application of cross linked hyaluronic acid gel appears to improve the results of primary deep sclerectomy with low dose of MitomycinC without additional side effects.