Trabeculectomy with Mitomycin-C versus trabeculectomy with 5-Fluorouracil for the treatment of childhood glaucoma

Abstract

Background: Childhood Glaucoma (CG) is common in Saudi Arabia and challenging. Purpose: To compare efficacy and safety of trabeculectomy with Mitomycin-c (TMMC) and trabeculectomy with 5-Fluorouracil (T5FU) in children with CG. Materials and Methods: The charts of 35 children with CG who underwent T5FU or TMMC between January 1994 and December 2004, were retrospective reviewed. The efficacy and safety of the two procedures were compared. Results: 33 eyes of 20 children underwent T5FU and 24 eyes of 15 children underwent TMMC. There was no significant difference between the groups preoperatively, except for mean pre-operative age at the time of operation and medications. 25 (75.8%) eyes in T5FU and 18(75%) eyes in TMMC group were considered successful at mean follow up of 58.6 and 42.2 months respectively. 14 (56%) eyes in T5FU and 12 (66.7%) eyes in TMMC were on no antiglaucoma medications. 10 eyes in T5FU and 6 eyes in TMMC had previous failed procedures. No significant difference between the groups was present on last follow up, with respect to success rate ( P =1.00), follow up ( P =0.4012), medications ( P =0.3467), complications ( P =0.303)] and visual outcome ( P =0.593). Serious complications including, hypotony, retinal detachment, and flat anterior chamber occurred after T5FU and one eye in TMMC group developed bleb-related endophthalmitis. Intraoperative (topical and injection) use of 5FU was as effective as MMC. Conclusions: 5-Fluorouracil and Mitomycin-C are equally effective as adjuncts to trabeculectomy in CG. Their use can be associated with serious complications. Further study is needed to evaluate intraoperative 5-Fluorouracil augmented trabeculectomy in CG.