PDS + MMC = better results

Augmenting combined phacoemulsification and deep sclerectomy (PDS) with intraoperative mitomycin C (MMC) is safe and likely to produce lower intraocular pressure (IOP) values than conducting PDS without MMC, according to the results of a study published in the August 2008 issue of Eye.

The research, which was initially presented as a poster at the 2005 meeting of the American Academy of Ophthalmology (AAO), was conducted by Seema Anand, FRCSEd of St James's University Hospital, Leeds, UK and Nitin Anand, FRCOphth of Huddersfield Royal Infirmary, Huddersfield, UK. The team conducted a retrospective, non-randomized, comparative case study of eyes undergoing PDS with (n=63) and without (n=56) MMC augmentation. The study period was from September 2001 to April 2004, with a mean follow-up period of 23 months (range: 12–41 months).

Two years postoperatively, the team calculated that subjects in the PDS with MMC augmentation group had a 76% likelihood of maintaining IOP of 19–15 mmHg without glaucoma medication; without needle revision, the likelihood was 62%. For the PDS without MMC group, these probabilities were 62% and 45%, respectively. For the non-MMC group, Nd:YAG laser goniopuncture and needle revision were required in 71.4% and 21.4% of cases, respectively. Nd:YAG laser goniopuncture and needle revision were required for 61.9% and 17.4%, respectively, of patients treated with MMC. For MMC treatment and no-MMC treatment, transconjunctival oozing was noted in 9.5% and 5.4%, respectively. Across both groups, 8.4% of subjects (n=10) lost two lines during the follow-up period; there was no statistically significant difference between the two groups.

The team concluded that the use of MMC to augment PDS is safe and likely to increase the likelihood of achieving a lower target IOP.