Visual and surgical outcomes of MMC augmented combined non-penetrating deep sclerectomy and phacoemulsification in eyes with severe and end stage glaucoma

Purpose: To report the visual and surgical outcomes of mitomycin-C (MMC) augmented non-penetrating deep sclerectomy (NPDS) and phacoemulsification in patients with severe and end-stage glaucoma. Materials and methods: A retrospective analysis of 349 eyes of 320 patients who underwent combined NPDS with phacoemulsification surgery between January 2018 to December 2020 were included. Main outcome measures: Best corrected visual acuity (BCVA), status of central visual fields, intra ocular pressure (IOP), number of antiglaucoma medications (AGM) were compared from baseline to post-operative visits, surgical complications and interventions were noted. Results: Mean logMAR BCVA improved significantly from baseline of 0.54 +/- 0.42 to 0.30 +/- 0.37 & 0.29 +/- 0.40 at 6(p < 0.001) & 12 months (p < 0.001) postoperatively. HFA 10-2 analysis revealed no significant post operative change in mean deviation from baseline at 6 & 12 months (p = 0.072, p = 0.143) respectively. Significant post-operative reduction in mean (SD) IOP was noted from baseline of 17.54(5.43) mmHg to 15.10(5.34) & 16.23(6.87) mmHg at 6 months(p < 0.001) and one year(p < 0.001) respectively. Similarly, the need for AGM also reduced significantly from 2.95(1.01) to 1.93(0.98) & 2.01 (0.99) at 6 (p < 0.001)& 12 months(p < 0.001) postoperatively. Cumulative surgical success was 95% and 93% at 6 months and 1 year respectively. Complications were seen in 17.8% patients and most were related to poor IOP control (8.3%). Two (0.6%) patients underwent tube surgery and 3 (0.9%) had undergone diode laser cyclophotocoagulation for refractory high IOP. Conclusion: MMC augmented NPDS combined with phacoemulsification surgery is a safe and a viable option in eyes with advanced glaucoma maintaining stable visual acuity and visual fields postoperatively.