RESUMO
BACKGROUND AND OBJECTIVE: A randomized prospective comparison of sub-Tenon's administration of mitomycin-C (MMC) with intrascleral administration of MMC in trabeculectomy was performed to determine whether intrascleral application is superior to the standard sub-Tenon's application. PATIENTS AND METHODS: Twenty-four eyes of 23 patients were randomized to treatment with MMC (0.27 mg/ml for 5 minutes). The route of administration was subconjunctival in group A and intrascleral in group B. Preoperative and postoperative visual acuity (VA), intraocular pressure (IOP), number of medications, and complications were compared between the two groups. RESULTS: There was no statistically significant difference between the two groups preoperatively regarding VA, IOP, and number of medications. Postoperatively, IOP and number of medications required had decreased significantly in both groups. A significantly larger number of postoperative procedures were required in group B to control IOP (group A = 3, group B = 14, P = .002). CONCLUSION: Both methods of MMC application significantly decreased the IOP and the number of medicines required to control IOP after trabeculectomy. The intrascleral use of MMC resulted in the need for more surgery postoperatively (P = .002).
Assuntos
Glaucoma de Ângulo Aberto/cirurgia , Mitomicina/administração & dosagem , Inibidores da Síntese de Ácido Nucleico/administração & dosagem , Complicações Pós-Operatórias/prevenção & controle , Trabeculectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante , Túnica Conjuntiva , Vias de Administração de Medicamentos , Feminino , Seguimentos , Glaucoma de Ângulo Aberto/tratamento farmacológico , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Injeções , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/fisiopatologia , Estudos Prospectivos , Esclera , Acuidade VisualRESUMO
Surgical revision of a chronically-thinned filtering bleb with a leak at the limbus is described. After surgical excision of the scarred cystic conjunctiva and Tenon's fascia surrounding the leaking bleb, relatively uninvolved conjunctiva and Tenon's fascia are mobilized with the help of a large relaxing incision in the superior fornix and sutured over the area of filtration. We have used this technique successfully in five cases to provide fresh tissue to repair the bleb leak and restore adequate filtration.