Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft · 1997
[Surgical revision for hypotonia after glaucoma operation with mitomycin C].
Аннотация на английскомСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Funk J
Аннотация
PURPOSE: Persistent hypotony with maculopathy is a severe complication of mitomycin C when used during filtration surgery. We wanted to know whether this complication can be controlled by a surgical reintervention yielding tight closure of the initial sclerostomy.
METHOD: In our clinic, 52 eyes underwent filtering surgery with intraoperative application of mitomycin C. Seven of them required a reoperation owing to persistent hypotony with maculopathy. During this reoperation, the scleral flap was tightly sutured (5x) or, if necessary, was closed with dehydrated human dura mater (2x).
RESULTS: In all cases the intraocular pressure increased immediately (i.e., within less than 24 h) after reoperation. This intraocular pressure increase was accompanied by a simultaneous regression of the maculopathy. Further details: mean intraocular pressure (mmHg): before initial operation with mitomycin C: 38.5 +/- 2.9; after initial operation: 3.7 +/- 0.6; before reoperation (= 8 months after initial operation): 3.3 +/- 0.7; 24 h after reoperation: 22.0 +/- 2.9; 9 months after reoperation: 16.7 +/- 1.7. Mean visual acuity: before initial operation with mitomycin C: 0.72 +/- 0.1; after initial operation: 0.34 +/- 0.1; before reoperation (= 8 months after initial operation): 0.17 +/- 0.05; 24 h after reoperation: 0.28 +/- 0.05; 9 months after reoperation: 0.55 +/- 0.1.
CONCLUSIONS: (1) Since the interval between reoperation and intraocular pressure increase was very short in all cases, overfiltration is at least one major reason for hypotony, not only ciliary body failure; (2) in cases of persistent hypotony after filtering surgery with mitomycin C, surgical reintervation can be recommended. During this reoperation, the initial sclerostomy should be closed tightly.
METHOD: In our clinic, 52 eyes underwent filtering surgery with intraoperative application of mitomycin C. Seven of them required a reoperation owing to persistent hypotony with maculopathy. During this reoperation, the scleral flap was tightly sutured (5x) or, if necessary, was closed with dehydrated human dura mater (2x).
RESULTS: In all cases the intraocular pressure increased immediately (i.e., within less than 24 h) after reoperation. This intraocular pressure increase was accompanied by a simultaneous regression of the maculopathy. Further details: mean intraocular pressure (mmHg): before initial operation with mitomycin C: 38.5 +/- 2.9; after initial operation: 3.7 +/- 0.6; before reoperation (= 8 months after initial operation): 3.3 +/- 0.7; 24 h after reoperation: 22.0 +/- 2.9; 9 months after reoperation: 16.7 +/- 1.7. Mean visual acuity: before initial operation with mitomycin C: 0.72 +/- 0.1; after initial operation: 0.34 +/- 0.1; before reoperation (= 8 months after initial operation): 0.17 +/- 0.05; 24 h after reoperation: 0.28 +/- 0.05; 9 months after reoperation: 0.55 +/- 0.1.
CONCLUSIONS: (1) Since the interval between reoperation and intraocular pressure increase was very short in all cases, overfiltration is at least one major reason for hypotony, not only ciliary body failure; (2) in cases of persistent hypotony after filtering surgery with mitomycin C, surgical reintervation can be recommended. During this reoperation, the initial sclerostomy should be closed tightly.