Mid-term outcome of trabeculectomy with adjunctive mitomycin C in glaucoma patients

Abstract

PurposeTo quantify the 2-year success rate and complications of trabeculectomy with adjunctive mitomycin C (MMC). MethodsA retrospective chart review was undertaken of 147 eyes that had undergone trabeculectomy with adjunctive MMC (concentration from 0.1 to 0.27 mg/mL) and at least 2 years' follow-up between January 2001 and March 2010. Demographic and clinical data were collected from all patients at the time of surgery and subsequent follow-up visits. Complete success was defined as intraocular pressure (IOP) ≤ 21 mmHg without any additional medication, whereas qualified success was defined as IOP ≤21 mmHg with or without medication. ResultsAt 24 months, mean IOP was 16.4 ± 10.6 mmHg, with a mean IOP decrease of 19.8 ± 14.2 mmHg. In primary glaucoma patients (n = 66), 60.6% and 95.4% of eyes achieved complete success and qualified success, respectively, at 2-year follow-up. Sub-group analysis of the initial trabeculectomy in primary glaucoma patients (n = 49) showed that complete and qualified success increased to 65.3% and 98.0%, respectively. The success rate was lower in secondary glaucoma patients (n = 74), with complete success at 41.9% and qualified success at 67.6% at 2-year follow-up. Eighty-six eyes (58.5%) developed one or more complications, from mild, such as hyphema, to severe, such as bleb leakage, which could necessitate surgical intervention. Twenty-six eyes developed severe complications, such as wound gap after 5 postoperative days, hypotony, hypotony maculopathy, choroidal detachment, overhanging bleb, bleb leakage, and endophthalmitis. A comparison between eyes with severe complications and other eyes in relation to different MMC amount, defined as MMC concentration multiplied by application duration, revealed no significant difference (p = 0.136). Further glaucoma surgery was performed in 27 eyes (18.4%). ConclusionThe outcome of trabeculectomy with low-dose intraoperative MMC is favorable in primary glaucoma patients at 2-year follow-up. Severe complications are not significantly related to MMC amount. Factors associated with severe complications require further study. Careful selection of MMC concentration and application time based on preoperative and intraoperative risk factors may further improve surgical results.