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Abstract #9047 Published in IGR 5-2
Partial tenon's capsule resection with adjunctive mitomycin C in Ahmed glaucoma valve implant surgery
Susanna R Jr; Latin American Glaucoma Society InvestigatorsBritish Journal of Ophthalmology 2003; 87: 994-998
AIM: To verify if partial intraoperative tenon's capsule resection (PTCR) with adjunctive mitomycin C is effective in developing thin, avascular blebs in eyes undergoing Ahmed glaucoma valve insertion, and to assess the efficacy and safety of this procedure. METHODS: A multicenter, prospective, alternating case assignment, investigator unmasked, parallel group, comparative interventional study was conducted in four Latin American countries (Argentina, Brazil, Colombia, and Peru). Ahmed glaucoma valve implant insertion with PTCR (group A) and without PCTR (group B) was performed in neovascular glaucomatous eyes without previous surgery. Adjunctive mitomycin C (MMC) was used in both groups. Patients were examined at one and ten days, and at one, two, three, six and 12 months following surgery. Intraocular pressure (IOP) and the appearance of the bleb were evaluated at each examination. Appearance of the bleb was classified at both the one month mark and last examinations into one of three groups: flat and vascularized; elevated avascular; or elevated and not avascular. RESULTS: Ninety-two eyes of 92 patients were included in the study. The preoperative mean IOP was 50.0 (SD 10.5) mmHg in group A and 48.4 (11.7) in group B (p > 0.05). Statistically significant IOP reductions were observed at all periods of follow-up. Twelve months after surgery, the mean IOP was 17.2 (5.0) mmHg in group A and 18.3 (8.7) mmHg in group B (p > 0.05). A hypertensive phase occurred in 40.0% in group A and in 46.8% in group B (p > 0.05). At the one-month and final follow-up, the blebs in all eyes were considered elevated and not avascular. The success rate (IOP 21 mmHg) at one year after surgery was 70.4% in group A and 77.7% in group B (p > 0.05). Overall, 74.2% of the patients achieved an IOP of 21 mmHg and 55.2% an IOP of 17 mmHg, with or without additional medication being administered to lower IOP. The incidence of complications was similar in both groups. CONCLUSIONS: In eyes undergoing Ahmed valve implantation for neovascular glaucoma, PCTR with MMC augmentation showed no additional benefits or complications over MMC augmentation alone; no avascular bleb was obtained with this technique. The incidence of a hypertensive phase was lower than reported in previous studies.
Dr. R. Susanna Jr, Centro de Oftalmologia Especializada, Av São Gualter 99, 05455-000, São Paulo, Brazil. rsusanna@terra.com.br
Classification:
12.8.2 With tube implant or other drainage devices (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
