Visante anterior segment optical coherence tomography analysis of morphologic changes after deep sclerectomy with intraoperative mitomycin-C and no implant use

Abstract

Purpose: To assess long-term intrascleral space maintenance after nonpenetrating deep sclerectomy (NPDS) without implant placement and with application of intraoperative mitomycin-C, using Visante anterior segment optical coherence tomography (AS-OCT).

Patients and methods: This cross-sectional, observational, case series study examined 47 eyes from 47 consecutive patients who had undergone NPDS 58.34±23.77 months earlier. All participants underwent a complete ophthalmologic examination. The presence of intrascleral space and its maximum anteroposterior and transverse lengths, maximum height, and volume were evaluated. The thickness of the trabeculo-Descemet membrane, presence and type of any subconjunctival filtering bleb, as well as scleral and suprachoroidal hyporeflectivity were analyzed. Relationships between intraocular pressure (IOP) levels and AS-OCT parameters were established.

Results: AS-OCT examinations revealed an open intrascleral space in all cases. The IOP was negatively correlated with the maximum anteroposterior length, maximum height, and volume of intrascleral space. Significant differences in IOP were found between eyes with low-reflective blebs and eyes with other subconjunctival bleb types. The overall surgical success rate was 89.4%.

Conclusions: NPDS without implant placement and with intraoperative mitomycin C application seems to be an effective and well-tolerated method to reduce IOP with long-term effectiveness, casting doubt on the mandatory use of intrascleral implants in nonpenetrating glaucoma surgery.