Exfoliation Syndrome and Exfoliative Glaucoma 211Although non-penetrating techniques rarely achieve sufficiently low IOP
to defer progression in patients with an aggressive glaucoma like XFG, they
may still be an attractive alternative in few selected patients due to their
favorable safety profile [82,83]. In a randomized trial that comprised both
POAG and XFG patients intraoperative use of mitomycin C increased the
effectiveness of deep sclerectomy [84]. Thirty-six months postoperatively the
mean IOP in eyes operated with and without adjunctive mitomycin C was
15.96 ± 1.71 mmHg and 18.71 ± 2.90 mmHg, respectively (P=0.001). In a
retrospective study that contained data on XFG eyes, the efficacy of the newly
developed technique of CO 2 laser-assisted deep sclerectomy was found
comparable to that of conventional deep sclerectomy [85]. The complete
success rates (IOP <18 mmHg without medication) were 73% in the CO 2
laser-assisted group and 71% in the control group, respectively, whereas the
total success rate (IOP <18 mmHg with/without medication) was 96% in the
CO 2 laser-assisted group and 89% in the control group. A prospective study
conducted on 24 XFG and 25 POAG patients investigated the efficacy of deep
sclerectomy combined with various space-maintaining implants [86]. With a
mean follow-up period of 19.9 months for the XFG group and 16.2 months for
the POAG group, the proportion of eyes with complete success (IOP <19
mmHg without medication) was 60.7% in the XFG group and 37.9% in the
POAG group.
The available evidence on the efficacy of viscocanalostomy in eyes with
XFG is limited. In a prospective, non-randomized case series comprising 57
glaucomatous eyes (14 of them had XFG) an IOP <21 mmHg without
medication was observed in 60% of eyes after 60 months following
viscocanalostomy [87]. Recently the efficacy of concurrent
phacoemulsification and viscocanalostomy in 30 eyes of 22 patients with
cataract and poorly controlled XFG has been investigated [88]. The mean
preoperative IOP was 25.3 mmHg. After a mean follow-up period of 18.6
months, success (IOP <21 mmHg with/without medication) was achieved in
all eyes and complete success (IOP <21 mmHg without medication) was
achieved in 90% of the eyes. In a subsequent prospective trial the efficacy of
phacoemulsification combined with viscocanalostomy was evaluated in
cataract patients with medically uncontrolled XFG or POAG [89]. The mean
preoperative IOP was 24.5 mmHg for the XFG group (n=30) and 21.7 mmHg
for the POAG group (n=30). The mean follow-up period was 19.7 months for
both groups. At the last postoperative visit the XFG patients had significantly
lower IOP than the POAG patients (49.7% vs. 30.9% IOP reduction,
respectively).