Outcomes of Primary Trabeculectomy With the Use of Adjunctive Mitomycin

Abstract

To investigate the efficacy and safety of adjunctive mitomycin when used during a primary trabeculectomy within a series of 89 consecutive patients at 1 and 2 years postoperatively. Design: A cohort study of all patients who underwent primary trabeculectomy, performed by one of us (P.F.P.), between April 1, 1991, and December 31, 1994. Patients received topical mitomycin in conjunction with a corneal safety valve incision. A trabeculectomy was considered "successful" if it resulted in an intraocular pressure (IOP) of 21 mm Hg or lower and a 30% or greater reduction in the IOP at and after 1 year of follow-up, with or without medications and without a reoperation for an elevated IOP. Survival analysis was used to calculate success rates. Results: The 1-and 2-year success rates were 85.4% and 77.9%, respectively. The mean IOP was reduced from 26.3 to 11.3 mm Hg at 1 year (n=68) and to 11.9 mm Hg at 2 years (n=56), with 60 (88.2%) of 68 patients off medication at 1 year and 47 (83.9%) of 56 patients off medication at 2 years. Trabeculectomy success rates were significantly lower in black compared with nonblack patients (76.2% vs 87.5% at 1 year, P=.03). Trabeculectomy failure occurred throughout the follow-up period. Endophthalmitis occurred in 2 (2.2%) of the patients, and hypotonia requiring revision occurred in 4 (4.5%) of the patients. Conclusions: Primary trabeculectomy with the use of intraoperative mitomycin lowered the IOP by 30% or more in 78% (at 2 years) to 86% (at 1 year) of the cases and is associated with a marked reduction in the percentage of patients who require glaucoma medication. Success rates must be evaluated in light of such risks as endophthalmitis and hypotony.

Intermediate-term comparison of trabeculectomy with intraoperative mitomycin-C between Asian American and Caucasian glaucoma patients: a case-controlled comparison

“…[20][21][22][23] Studies on Asian patients in South East Asia have also reported a lower success rate of trabeculectomy than the success rate reported on Caucasian populations in the western literature. 10,11,16 However, the survival of trabeculectomy improved with use of intraoperative antimetabolite as adjuvant, and the more liberal use of intraoperative antimetabolites was advocated in the Asian population.…”

“…10,11,16 Wong et al reported a 3-year success rate of only 36% for trabeculectomy in Asians with POAG, but the rate was higher if antimetabolite was used and approached the rate observed in Caucasians reported in the western studies. 12,[16][17][18][19][20] However, comparison of glaucoma surgical management in Asian and Caucasian populations is difficult because of the different surgical techniques, ophthalmic practice and medical care environments, and glaucoma managements in different countries.…”

Efficacy and Safety of Low Target Pressure Trabeculectomy: 2-Year Clinical Results

“…Despite increasing use of mitomycin-C or 5-fluorouracil, several studies have reported that the rate of bleb failure is 10% -20% [11] [12]. The most common causes of bleb failure are scar formation and closure of the fistula [13].…”

Matrix metalloproteinase gelatinase B (MMP-9) is associated with leaking glaucoma filtering blebs

“…This improves the early surgical outcome, but appears to increase the likelihood of late bleb leaks (Lamping et al, 1986;Wilensky, 1992;Chen et al, 1997;Scott et al, 1998). A number of modalities exist to treat bleb leaks (Gehring and Ciccarelli, 1972;Awan and Spaeth, 1974;Joiner et al, 1989;Pederson, 1989;Weber and Baker, 1989), including surgical procedures such as conjunctival patch grafts (Wilson and Kotas-Neumann, 1994), and scleral patch grafts in association with conjunctival advancement (Dunnington, 1950;Melamed et al, 1991;O'Connor et al, 1992;Morris et al, 1998).…”