|Efficacy of Combined Phacoemulsification Plus Intraocular Lens Implantation with Deep Sclerectomy Augmented with Mitomycin C and Modified Spacer in Patients with Uncontrolled, Chronic, Primary Open-Angle Glaucoma and Cataract|
|Ali Mostafaie1, Zanyar Yousefi2|
|1Department of ophthalmology, Research center for evidence based medicine, Tabriz University of Medical Sciences, Tabriz,Iran
2Cornea and Glaucoma fellow in Nikookari teaching hospital, Ophthalmology research team, Tabriz University of Medical Sciences, Tabriz,Iran
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Keywords : Non-penetrating glaucoma surgery, Intra ocular pressure, Mitomycin C
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Objective: Non-penetrating glaucoma surgery (NPGS) is determined as a safe alternative to trabeculectomy with lower rate of complications. The decision on implementation of these techniques is demanding especially for its cost in lower income developing countries. The present study describes a new surgical method, used a small piece of Ahmed glaucoma shunt tube (silicon type) as a spacer to maintain intrascleral lake. The aim of this study was to determine the efficacy and safety of the implantation of a piece of Ahmed valve tube in addition to using MitomycinC (MMC) in improving the surgical outcome of combined phacoemulsification with deep sclerectomy.
Materials and Method: The inclusion criteria were as fallows: cataract with significant visual impairment and open angle glaucoma with inadequate control of intra ocular pressure (IOP) with maximal tolerable medical therapy, without any history of related surgery, on the basis of clinical exam. Current modified NPGS was performed using a small piece of Ahmed valve and augmented with MMC. postoperative data were collected prospectively and outcomes were assessed by 6 monthly census.
Results: Thirteen patients (mean age 68 years) underwent modified NPGS plus MMC between March 2016 and October 2016. The median operation time was 55 min. IOP reduced from 22+/- 7.9 mm Hg to 11.07+/- 2.7 mmHg after surgery (P <0.002). Number of eye drops decreased from 3 medications before surgery to 0.4 after surgery (table-3). Before surgery visual acuity was from hand motion to 2/10 and six months after surgery was from counting fingers to10/10. Only one patient was suffered from capsular phimosis syndrome and no other morbidity was seen.
Conclusion: Modified NPGS plus MMC is a safe procedure associated with a low probability for co-morbidities and sustained lower IOP in 6 months follow up. We believe that this technique can become an alternative approach in these patients to reduce the complications and lower the cost and increasing the sustainability of the results.
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