Visual and surgical outcomes of MMC augmented combined non-penetrating deep sclerectomy and phacoemulsification in eyes with severe and end stage glaucoma

Abstract

To report the visual and surgical outcomes of mitomycin-C (MMC) augmented non-penetrating deep sclerectomy (NPDS) and phacoemulsification in patients with severe and end-stage glaucoma. A retrospective analysis of 349 eyes of 320 patients who underwent combined NPDS with phacoemulsification surgery between January 2018 to December 2020 were included. Best corrected visual acuity (BCVA), status of central visual fields, intra ocular pressure (IOP), number of antiglaucoma medications (AGM) were compared from baseline to post-operative visits, surgical complications and interventions were noted. Mean logMAR BCVA improved significantly from baseline of 0.54 ± 0.42 to 0.30 ± 0.37 & 0.29 ± 0.40 at 6(p < 0.001) & 12 months (p < 0.001) postoperatively. HFA 10-2 analysis revealed no significant post operative change in mean deviation from baseline at 6 & 12 months (p = 0.072, p = 0.143) respectively. Significant post-operative reduction in mean (SD) IOP was noted from baseline of 17.54(5.43) mmHg to 15.10(5.34) & 16.23(6.87) mmHg at 6 months(p < 0.001) and one year(p < 0.001) respectively. Similarly, the need for AGM also reduced significantly from 2.95(1.01) to 1.93(0.98) & 2.01 (0.99) at 6 (p < 0.001)& 12 months(p < 0.001) postoperatively. Cumulative surgical success was 95% and 93% at 6 months and 1 year respectively. Complications were seen in 17.8% patients and most were related to poor IOP control (8.3%). Two (0.6%) patients underwent tube surgery and 3 (0.9%) had undergone diode laser cyclophotocoagulation for refractory high IOP. MMC augmented NPDS combined with phacoemulsification surgery is a safe and a viable option in eyes with advanced glaucoma maintaining stable visual acuity and visual fields postoperatively.