Efficacy and Safety of Trabeculectomy with Mitomycin C for Childhood Glaucoma: A Study of Results with Long-Term Follow-Up

Abstract

OBJECTIVETo evaluate the safety and effectiveness of trabeculectomy with mitomycin C in the management of childhood glaucoma.INTRODUCTIONThe use of antifibrotic agents enhances the success of trabeculectomy performed in both adults and children.METHODSA retrospective chart review (1991–2001) of 114 patients (114 eyes) from 0–14 years of age with congenital or developmental glaucoma. These patients underwent trabeculectomy with mitomycin but had not been previously treated with any antifibrotic agent.RESULTSThe mean patient age was 57.36 +/− 51.14 months (range: 0.5–168 months). Treatment was considered successful in 63 eyes (55.26%), with a mean intraocular pressure of 12.11 +/− 3.98 mmHg. For patients categorized as successfully treated, the mean follow-up time was 61.16 +/− 26.13 months (range 12–113 months). A post-surgical intraocular pressure of < 16 was observed in 47 eyes. The life-table success rates for intraocular pressure control at 24, 36, 48, and 60 months were 90.2%, 78.7%, 60.7% and 50.8%, respectively. The cumulative probability of failure was 40.8% at 12 months. Following surgery, endophthalmitis appeared in eight eyes (4.88%) after an average 36.96 months (range: 1.7–106 months). Other complications included expulsive hemorrhage, flat anterior chamber and bleb leak.DISCUSSIONIt has been reported in pediatric patients that trabeculectomy without adjunctive antimetabolites achieves a successful outcome in 30% to 50% of cases. In our study, treatment was considered successful in 63 eyes (55.26%) within 61.16 +/− 26.13 months of follow-up.CONCLUSIONSTrabeculectomy with mitomycin is safe and effective for short-term or long-term treatment of congenital or developmental glaucoma. The frequency of bleb-related endophthalmitis was no higher in these patients than that described in adults.

Pediatric Infectious Endophthalmitis

“…The results reported by Giampani et al . [21] showed that trabeculectomy with mitomycin C was safe and effective for the treatment of congenital glaucoma, and that the frequency of bleb-related endophthalmitis was no higher than that described in adults. In some studies in developed countries, postoperative endophthalmitis was the most common form, and Benz et al .…”

Trabeculectomy-Related Complications in Olmsted County, Minnesota, 1985 Through 2010

“…Recent studies reported bleb leaks as the most common complication of trabeculectomy with mitomycin 19,20,22,25,27 and as a predisposing factor for blebitis and endophthalmitis. 17,20,21,29,30 Soltau et al 31 reported a likelihood of late-onset bleb leakage in bleb-related infection 25.8 times that of a noninfected eye for having a late-onset bleb leak in the postoperative period.…”

Long-Term Surgical Outcomes of Primary Congenital Glaucoma in China

“…In Turkey in 2007, Yalvac et al8 reported that the success rates of trabeculotomy after 12, 24, and 36 months were 92%, 82%, and 74%, respectively. In 2008, a study in Brazil reported trabeculectomy success rates at 24, 36, 48, and 60 months of 90.2%, 78.7%, 60.7%, and 50.8%, respectively 5. In the U.S., Mendicino et al25 compared 360° trabeculotomy and goniotomy and concluded that 360° trabeculotomy is a highly effective procedure that results in excellent pressure control and better vision than is reported in the literature for standard angle procedures 25, 31.…”

“…In a study from Brazil that evaluated 3,210 visually impaired children, congenital glaucoma was responsible for 10.8% of the visual impairments 3. The incidence of congenital glaucoma varied between counties, ranging from 1/10,000-1/30,200 4,5. Since at least 50% of eyes presenting with primary congenital glaucoma (PCG) at birth will become legally blind, patients with PCG require not only prompt treatment but also follow-up examinations and care throughout their lives.…”

“…Trabeculotomy and goniotomy are considered to be the procedures of first choice, and if they are not adequately controlled by IOP, trabeculectomy is usually the next course of action. Many studies have assessed the short and/or long-term visual outcomes associated with the various surgical options, as well as indications such as the type and severity of glaucoma 5–35. Surgical treatments can usually achieve safe and effective results with congenital glaucoma if performed promptly and appropriately.…”