Clinical efficiency of Singh’s microtrack filtration (MTF) procedure in surgical management of refractory glaucoma

Poster Details

First Author: V.Kumar RUSSIA

Co Author(s):    M. Frolov   I. Makovetskaya   E. Bojhok   G. Dushina     

Abstract Details

Purpose:

To evaluate clinical efficiency of Singh’s MTF procedure in surgical management of refractory glaucoma.

Setting:

Ophthalmic unit of Skhodnya city hospital, Moscow region; Department of Ophthalmology, Russian People’s Friendship University (RPFU), Moscow, Russian Federation.

Methods:

Between October 2009 and October 2011, Singh’s MTF procedure was performed in 36 patients suffering from refractory glaucoma. Surgical technique: conjunctiva was slid toward the cornea and held down at the limbus. An activated 100 micron tip of Fugo blade was passed through conjunctiva, limbus and corneal tissue making a 1-1.5 mm long and 150 micron wide track into anterior chamber. Tenon’s tissue near the track outlet was infiltrated with 0.02% solution of mitomycine C. Conjunctival hole was closed with one suture. Main outcome measures were intraocular pressure (IOP) changes, complication rate, additional glaucoma medication and need for surgical revision. Decrease in intraocular pressure (IOP) >30% after 6 months after surgery without medication was considered as a complete success, with medication – partial success. Cases requiring 2nd surgery were failure cases. 2nd surgery was performed after dissecting a conjunctival flap.

Results:

Average preoperative IOP was 32.8+/-6.4mmHg. Average IOP decrease after MTF was 14.5+/-7.1 mmHg (42.6+/-15.2%; p<0.05). There were two cases with button hole in the conjunctiva, necessitating its suturing and creation of another MTF nearby. In early postoperative period, there were 7 cases (19.4%) of shallow anterior chamber, out of these in 2 cases scleral trephination was performed for persistent choroidal effusion. Inflammatory response to surgery in the form of fibrin in anterior chamber was observed in 7 cases (19.4%) and was managed medically. In late postoperative period there were 13 cases (36.1%) with blockage of inner track opening by iris tissue. A YAG laser shot at the opening reopened the track in all cases. Complete success was achieved in 24 cases (66.7%), partial – 5 (13.9%). In successful cases filtration blebs were diffuse and borderless. 2nd surgery was required in 7 cases making a failure rate of 19.4%. Avg. time between two surgeries was 7.7 weeks (range 1–24 weeks). Failure was due to complete fibrosis of track outlet. Repeat MTF was easy to perform and was successful in 5 cases. Remaining 2 cases required 3rd MTF procedure, which was required after 1 and 7 months after 2nd surgery.

Conclusions:

MTF procedure is safe and effective in eyes with refractive glaucoma. Intra-operative measures like use of different biologically inert materials along with antimetabolites to overcome postoperative fibrosis may further enhance its success rate. FINANCIAL DISCLOSURE?: No