In the last several years, the field of glaucoma has seen several newcomers changing and improving the way we manage our patients both pharmacologically and surgically. We are always looking for new and innovative ways to better care for our patients. The reason we do this is because traditional gold standard procedures, such as trabeculectomies with mitomycin C, are very good with pressure reduction but can have a significant side effect profile.
Methods of improving our options for surgical intervention, in particular deep sclerectomy with mitomycin C, are being developed to see if we can get similar, if not better, results of traditional trabeculectomy surgery while minimizing the side effect profile of hypotony, choroidal detachment and endophthalmitis. However, despite the use of a deep sclerectomy in patients, we run into similar issues with standard trabeculectomy surgeries. These include bleb leaks or overfiltration as a result of the surgical interventions. If patients are found to have either of these two issues, the question is whether the use of human cadaver pericardium grafts in the form of Tutoplasts will be effective when it comes to revising leaking or overfiltering blebs following deep sclerectomy with mitomycin C.
This study attempts a retrospective chart review to address this question. In this study, 15 cases were reviewed, with 10 coming from overfiltration and five coming from bleb leak, to see if the use of Tutoplast patch grafts as a revision for deep sclerectomy with prior mitomycin C would improve the side effect profile compared with other options. The study reveals the side effect profile is approximately the same compared with traditional trabeculectomies with mitomycin C; however, it did show a fairly good success rate in addressing the underlying overfiltration or bleb leak.
One of the primary issues with this intervention using the Tutoplast is cost, as this needs to be factored into all procedures when physicians are deciding which surgical interventions to manage in terms of benefits to risk and effectiveness of options. Is the addition of Tutoplast and its relative cost worth the extra investment if it were to result in better outcomes for each patient? This study shows, much like in most glaucoma surgical interventions, outcomes are heavily dependent on surgeon performance and preference. At the end of the day, physicians are always left to what is more comfortable to them when they are dealing with particular glaucoma procedures.
The use of Tutoplast in patients who had prior deep sclerectomy with mitomycin C is going to be dependent on how effective the surgeon feels with their procedure in terms of getting a good outcome. At the end of the day, it will be left in the patient’s and physician’s hands to decide what is in the patient’s best outcome in terms of which method to move forward with.
This discussion of how to address postoperative issues in glaucoma patients is an important one because they are always considering how to advance and improve our treatments for patients. I am happy to see this provides an additional option for glaucoma doctors to provide additional care for patients and it gives them additional resources in how to address issues that may come up in the future. Now it will be left for the physician and patient to decide on which procedure is best moving forward.
Savak “Sev” Teymoorian, MD, MBA
OSN Glaucoma Board Member
Disclosures: Teymoorian reports no relevant financial disclosures.