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A comparison of the intraocular pressure-lowering effect and safety of viscocanalostomy and trabeculectomy with mitomycin C in bilateral open-angle glaucoma

  • Clinical Investigation
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Abstract

Purpose

To compare the intraocular pressure-lowering effect and safety of viscocanalostomy and trabeculectomy with mitomycin C.

Methods

Twenty-five patients with bilateral primary open-angle glaucoma were enrolled in a prospective clinical study. The eyes of each patient were randomly assigned to receive viscocanalostomy in one eye and trabeculectomy with mitomycin C in the other eye. The patients were followed up for 12 months. At each visit, best-corrected visual acuity, intraocular pressure, and the appearance of the surgical wound, anterior chamber, and indirect ophthalmoscopy were recorded.

Results

The mean baseline intraocular pressure was 25.0±2.2 mmHg in viscocanalostomy-treated eyes and 24.8±2.6 mmHg in trabeculectomy-treated eyes. The mean postoperative intraocular pressure was 15.3±1.7 mmHg, 17.1±1.5 mmHg, and 17.1±1.5 mmHg in viscocanalostomy-treated eyes and 11.7±4.4 mmHg, 11.8±4.6 mmHg, and 12.6±4.3 mmHg in trabeculectomy-treated eyes at 3-, 6- and 12-month intervals, respectively. The mean intraocular pressure in viscocanalostomy-treated eyes was significantly higher than that in trabeculectomy-treated eyes at every visit (P<0.0001). At 12 months, 16 viscocanalostomy-treated eyes (64%) and 22 trabeculectomy-treated eyes (88%) achieved an intraocular pressure of less than or equal to 20 mmHg without medication; there was a significant difference between the two groups (P=0.0240). There were fewer complications in viscocanalostomy-treated eyes. Complications included four cases of shallow anterior chamber (16%) and five of hypotony (20%) in trabeculectomy-treated eyes, against intraoperative microperforation of Descemet's membrane in one of viscocanalostomy-treated eye (4%).

Conclusion

Trabeculectomy with mitomycin C may be more effective than viscocanalostomy in lowering intraocular pressure in patients with primary open-angle glaucoma, while eyes undergoing viscocanalostomy experience a lower incidence of complications. Further investigation of more cases is needed.

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References

  1. Cairns DE (1968) Trabeculectomy—a preliminary report of a new method. Am J Ophthalmol 66:673–679

    CAS  PubMed  Google Scholar 

  2. Carassa RG, Bettin P, Fiori M, Brancato R (1998) Viscocanalostomy: a pilot study. Eur J Ophthalmol 8:57–61

    CAS  Google Scholar 

  3. Carassa RG, Bettin P, Fiori M, et al (2000) Viscocanalostomy vs. trabeculectomy: a 12 month prospective trial. Invest Ophthalmol Vis Sci 41:s744

    Google Scholar 

  4. Chiselita D (2001) Nonpenetrating deep sclerectomy versus trabeculectomy in primary open angle glaucoma surgery. Eye 15:197–201

    CAS  PubMed  Google Scholar 

  5. Dahan E, Drusedau MUH (2000) Nonpenetrating filtration surgery for glaucoma: control by surgery only. J Cataract Refract Surg 26:695–701

    Article  CAS  PubMed  Google Scholar 

  6. DeBry PW, Perkins TW, Heatley G, Kaufman P, Brumback LC (2002) Incidence of late-onset bleb-related complications following trabeculectomy with mitomycin. Arch Ophthalmol 120:297–300

    CAS  PubMed  Google Scholar 

  7. Dietlein TS, Luke C, Jacobi PC, Konen W, Krieglstein GK (2001) Does the dissection depth and thickness of the deep scleral flap affect intraocular pressure after viscocanalostomy? A clinico-pathologic correlation. Klin Monatsbl Augenheilkd 218:168–173

    CAS  PubMed  Google Scholar 

  8. El Sayyad F, Helal M, El Kholify M, et al (2000) Nonpenetrating deep sclerectomy versus trabeculectomy in bilateral open angle glaucoma. Ophthalmology 107:1671–1674

    Article  PubMed  Google Scholar 

  9. Forrester JV, Balazs EA (1980) Effect of hyaluronic acid and vitreous on macrophage phagocytosis. Immunology 40:435–446

    CAS  PubMed  Google Scholar 

  10. Forrester JV, Wilkinson PC (1981) Inhibition of leukocyte locomotion by hualuronic acid. J Cell Sci 48:315–331

    CAS  Google Scholar 

  11. Jonescu-Cuypers C, Jacobi P, Konen W, Krieglstein G (2001) Primary viscocanalostomy versus trabeculectomy in white patients with open-angle glaucoma: a randomized clinical trial. Ophthalmology 108:254–258

    Article  CAS  PubMed  Google Scholar 

  12. Krasnov MM (1968) Externalization of Schlemm's canal (sinusotomy) in glaucoma. Br J Ophthalmol 52:157–161

    CAS  PubMed  Google Scholar 

  13. Lachkar Y (2001) Nonpenetrating deep sclerectomy with external trabeculectomy vs trabeculectomy, Invest Ophthalmol Vis Sci 42:s67

    Google Scholar 

  14. Lachkar Y, Hamard P (2002) Nonpenetrating filtering surgery. Curr Opin Ophthalmol 13:110–115

    Article  PubMed  Google Scholar 

  15. Lehmann OJ, Bunce C, Matheson MM, et al (2000) Risk factors for development of post-trabeculectomy endophthalmitis. Br J Ophthalmol 84:1349–1353

    Article  CAS  PubMed  Google Scholar 

  16. O'Brart DP, Rowlands E, Islam N, Noury AM (2002) A randomised, prospective study comparing trabeculectomy augmented with antimetabolites with a viscocanalostomy technique for the management of open angle glaucoma uncontrolled by medical therapy. Br J Ophthalmol 86:748–754

    Article  CAS  Google Scholar 

  17. Parc CE, Johnson DH, Oliver JE, Hattenhauer MG, Hodge DO (2001) The long-term outcome of glaucoma filtration surgery. Am J Ophthalmol 132:27–35

    Google Scholar 

  18. Poulsen EJ, Allingham RR (2000) Characteristics and risk factors of infections after glaucoma filtering surgery. J Glaucoma 9:438–443

    CAS  PubMed  Google Scholar 

  19. Schwenn O, Dick B, Pfeiffer N (1998) Trabeculotomy, deep sclerectomy and viscocanalostomy. Non-fistulating microsurgical glaucoma operation ab externo. Ophthalmologe 95:835–843

    Article  CAS  PubMed  Google Scholar 

  20. Smit BA, Johnstone MA (2000) Effects of viscocanalostomy on the histology of Schlemm's canal in primate eyes. Invest Ophthalmol Vis Sci 41:S578

    Google Scholar 

  21. Stegmann R, Pienaar A, Miller D (1999) Viscocanalostomy for open-angle glaucoma in black African patients. J Cataract Refract Surg 25:316–322

    CAS  PubMed  Google Scholar 

  22. Sunaric-Megevand G, Leuenberger PM (2001) Results of viscocanalostomy for primary open-angle glaucoma. Am J Ophthalmol 132:221–228

    Article  CAS  PubMed  Google Scholar 

  23. Van der Gaag R, Broersam L, Koorneef L (1987) The influence of high molecular weight sodium hyaluronate on the production of migration inhibitory factor. Curr Eye Res 6:1433–1440

    PubMed  Google Scholar 

  24. Wild GJ, Kent AR, Peng Q (2001) Dilation of Schlemm's canal in viscocanalostomy: comparison of 2 viscoelastic substances. J Cataract Refract Surg 27:1294–1297

    Article  CAS  PubMed  Google Scholar 

  25. Zimmerman TJ, Kooner KS, Ford VJ, et al (1984) Effectiveness of nonpenetrating trabeculectomy in aphakic patients with glaucoma. Ophthalmic Surg 15:332–336

    Google Scholar 

  26. Zimmerman TJ, Kooner KS, Ford VJ, et al (1984) Trabeculectomy vs. nonpenetrating trabeculectomy: a retrospective study of two procedures in phakic patients with glaucoma. Ophthalmic Surg 15:734–740

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Ophthalmology, Saga Medical School, 5-1-1 Nabeshima, 849-8501, Saga , Japan

    Hiroshi Kobayashi, Kaori Kobayashi & Satoshi Okinami

Authors
  1. Hiroshi Kobayashi
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  2. Kaori Kobayashi
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  3. Satoshi Okinami
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Correspondence to Hiroshi Kobayashi.

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There was no commercial sponsorship or support for this study

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Kobayashi, H., Kobayashi, K. & Okinami, S. A comparison of the intraocular pressure-lowering effect and safety of viscocanalostomy and trabeculectomy with mitomycin C in bilateral open-angle glaucoma. Graefe's Arch Clin Exp Ophthalmol 241, 359–366 (2003). https://doi.org/10.1007/s00417-003-0652-6

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  • DOI: https://doi.org/10.1007/s00417-003-0652-6

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