Mutlu Cihan DAĞLIOĞLU, Esra Ayhan TUZCU, Nilüfer İLHAN, Mesut COŞKUN, EMRE AYINTAP, Uğurcan KESKİN, Özgür İLHAN, Hilal KAHRAMAN

İleri evre glokomlu olgularda geniş alan mitomisin C uygulamalı trabekülektomi sonuçlarımız

Amaç: Maksimum tıbbi tedavi ile hedef göziçi basıncı (GİB) sağlanamayan ileri evre glokomlu hastalarda geniş alan Mitomisin-C (MMC) uygulamalı trabekülektomi sonuçlarının değerlendirilmesi amaçlandı. Yöntemler: Çalışmaya medikal tedavi ile kontrol altına alınamayan ileri evre glokomu olan 35 hastanın 41 gözü dahil edilmiştir. Geniş alan MMC uygulaması 0,2 mg/ml konsantrasyonda 2 dk süre ile uygulanmıştır. Ortalama izlem süresi 28 aydır (24-36). Olguların hepsi maksimum 3lü tedaviye rağmen GİB 21 mmHg altına düşmeyen ileri derecede glokomu olan hastalardır. Bulgular: Çalışmaya dahil edilen 35 hastanın 19u erkek 16sı kadın idi ve yaş ortalaması 52,5±1,8 yıl (45-73) olarak bulundu. Opere edilen gözlerin 27si primer açık açılı glokom, 11i psödoeksfolyatif glokom, 3ü açı kapanması glokomu idi. 5 (%12,1) gözde erken dönem hipotoni gelişmiştir. Hipotoni gelişen 2 göze ek sütür konulmuştur. İki göz sıkı bandaj kapama ile tedavi edilmiştir. Koroid effüzyonu gelişen 1 göze ek operasyonla sütür eklenmiştir. Dört gözde katarakt gelişmiştir. 3 gözde kistik bleb (%7,3) görülmüş iğneleme ile tedavi edilmiştir. On gözde (%24,4) ince avasküler bleb gelişmiştir. Diğer gözlerde (%68,3) ince diffüz ve fonksiyonel bleb izlenmiştir. Hedeflenen GİB 15mmHg olarak değerlendirildiğinde gözlerin 36sında (%87,8) hedeflenen GİB değerine ulaşılmıştır Sonuç: Maksimum tıbbi tedavi ile hedef GİB sağlanamayan ileri evre glokomlu hastalarda, geniş alan MMC uygulamalı trabekülektomi yönteminin etkili bir seçenek olabileceği düşünüldü.

Our results of large area mitomycin C application trabeculectomy in cases with advanced glaucoma

Objective: To evaluate large area Mitomycin-C (MMC) applied trabeculectomy results in advanced glaucoma patients in which targeted intraocular pressure (IOP) can not be achieved with maximum medical therapy. Methods: 41 eyes of 35 advanced glaucoma patients that can not be controlled with medical treatment were included to the study. Large area MMC application was applied for 2 minutes in 0.2 mg/ml concentration. The mean follow-up period was 28 months (24-36). All of the cases were advanced glaucoma patients and 21mmHg IOP level could not be achieved in spite of maximum treatment with three drugs. Results: Of the 35 patients that were included to study, 19 were male and 16 were female and the mean age was 52.5±1.8 years (range, 45-73). Twenty-seven of eyes were primary open angle glaucoma, 11 was pseudoexfoliative glaucoma, 3 were angle closure glaucoma. In 5 eyes (12.1%) there were early hypotonia. Additional suturation was made in 2 eyes with hypotonia. Two eyes were treated with tight patching. Suture addition was made in 1 eye with choroid effusion. Cataract was developed in 4 eyes. There were 3 cystic bleb (7.3%) and they were treated with needle application. Thin avascular bleb was developed in 10 eyes (24.4%). In other eyes (68.3%) there were thin diffuse bleb formations. When targeted IOP was considered as 15 mmHg, targeted IOP was achieved in 36 (87.8%) eyes. Conclusion: We suggest that trabeculectomy with large area MMC application is an effective choice in advanced glaucoma patients in which targeted IOP can not be achieved with maximum medical treatment.

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