Deep Sclerectomy Augmented With Combination Of Absorbable Biosynthetic Sodium Hyaluronate Scleral Implant And Mitomycin-C Or With Mitomycin-C Versus Trabeculectomy: Long Term Results

Deep sclerectomy augmented with combination of absorbable biosynthetic


Cem Mesci MD, Hasan H Erbil MD,

Yücel Karakurt MD, Aylin A Akçakaya MD

Wiley Online Library, Accepted Article, DOI: 10.1111/j.1442-9071.2011.02611.x




To evaluate the long term results following deep sclerectomy with mitomycin-C-SKgel implant (DSMMC-SKgel), mitomycin-C (DSMMC) and trabeculectomy.


Comparative case series, Göztepe Training and Educational Hospital.


Ninetyone open angle glaucoma patients


DSMMC–SKgel, DSMMC and trabeculectomy operations were performed in 28, 30 and 33 eyes respectively.

Main outcome measures:

Intraocular pressures (IOP), distance corrected visual acuities (DCVA) were measured preoperatively and postoperatively at days 1,7 and months 1,3,6,12,18,24,30,36,48.


At month 48, deep sclerectomy groups had better DCVAs, and in all groups mean IOPs, number of medications were significantly lower and DCVAs were worse than preoperative values. Mean IOPs in trabeculectomy group at week 1, month 1 and 3 were significantly lower than those in DSMMC group. Mean IOPs in DSMMC-SKGel group at week 1 and month 1 were significantly lower than those in DSMMC group. Mean preoperative IOPs, postoperative IOPs following 3rd month, complete (IOP ≤ 21 mmHg and ≤18mmHg without medication) and qualified (IOP ≤ 21 mmHg and ≤18mmHg with or without medication) success rates of all groups were not statistically different. Rate of complications such as hyphema, hypotony, shallow anterior chamber, bleb leak, bleb fibrosis, cataract, choroidal detachment and macular edema were found to be significantly higher in Trabeculectomy group (p < 0.05). No significant difference in the mean post-laser goniopuncture IOPs was found between the two deep sclerectomy groups during the follow-up.


DSMMC, DSMMC-SKgel and trabeculectomy operations were almost equally effective in lowering IOP at long term follow-up, but complication rates were higher after trabeculectomy operations.



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Author: Dr David Richardson

​David Richardson, M.D. is widely recognized as one of the top cataract and glaucoma surgeons in the US and is among an elite group of glaucoma surgeons in the country performing the highly specialized canaloplasty procedure. Dr. Richardson graduated Magna Cum Laude from University of Southern California and earned his Medical Degree from Harvard Medical School with scholarships from Phi Beta Kappa, Phi Kappa Phi, Harvard Medical Linnane and Harvard National. He completed his ophthalmology residency at the LAC+USC Medical Center/ Doheny Institute. Dr. David Richardson is also an Adjunct Assistant Professor of Clinical Ophthalmology at Keck School of Medicine of University of Southern California.​​

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