Deep sclerectomy augmented with combination of absorbable biosynthetic sodium hyaluronate scleral implant and mitomycin C or with mitomycin C versus trabeculectomy: long‐term results

Background:  To evaluate the long-term results following deep sclerectomy with mitomycin C-SKgel implant (DSMMC-SKgel), mitomycin C (DSMMC) and trabeculectomy. Design:  Comparative case series, Goztepe Training and Educational Hospital. Participants:  Ninety-one open-angle glaucoma patients. Methods:  DSMMC-SKgel, DSMMC and trabeculectomy operations were performed in 28, 30 and 33 eyes, respectively. Main Outcome Measures:  Intraocular pressures (IOP) and distance corrected visual acuities (DCVA) were measured preoperatively and postoperatively at days 1, 7 and months 1, 3, 6, 12, 18, 24, 30, 36, 48. Results:  At month 48, deep sclerectomy groups had better DCVAs, and in all groups mean IOPs and number of medications were significantly lower and DCVAs were worse than preoperative values. Mean IOPs in trabeculectomy group at week 1, months 1 and 3 were significantly lower than those in DSMMC group. Mean IOPs in DSMMC-SKgel group at week 1 and month 1 were significantly lower than those in DSMMC group. Mean preoperative IOPs, postoperative IOPs following 3rd month, complete (IOP ≤ 21 mmHg and ≤18 mmHg without medication) and qualified (IOP ≤ 21 mmHg and ≤18 mmHg with or without medication) success rates of all groups were not statistically different. Rate of complications such as hyphema, hypotony, shallow anterior chamber, bleb leak, bleb fibrosis, cataract, choroidal detachment and macular oedema were found to be significantly higher in trabeculectomy group (P < 0.05). No significant difference in the mean post-laser goniopuncture IOPs was found between the two deep sclerectomy groups during the follow up. Conclusions:  DSMMC, DSMMC-SKgel and trabeculectomy operations were almost equally effective in lowering IOP at long-term follow up, but complication rates were higher after trabeculectomy operations.