Laser suture lysis after mitomycin C trabeculectomy.
OBJECTIVE
To evaluate the timing, efficacy, and complications of laser suture lysis (LSL) after mitomycin C trabeculectomy in patients with glaucoma at high risk for failure of filtering surgery.


METHODS
The authors retrospectively reviewed the charts of 62 consecutive patients who underwent a total of 66 sessions of LSL after trabeculectomy with mitomycin C.


RESULTS
The interval from surgery to LSL ranged from 2 to 65 days (mean +/- standard deviation, 17.9 +/- 14.9 days). The average intraocular pressure (IOP) reduction after LSL was 11.9 +/- 8.9 mmHg (range, 3-40 mmHg). A longer interval to LSL was correlated with a lesser degree of pressure reduction (P=0.0004, Wilcoxon rank-sum test). After LSL, hypotony developed in 13 (21%) patients (IOP < 6 mmHg on 2 consecutive measurements at least 24 hours apart). This resolved spontaneously after 7 to 304 days (104.1 +/- 109.1 days) in 12 (92%) of the 13 patients. Life-table success rates (success defined as 6 mmHg </= final IOP </= 21 mmHg) for the hypotony and no hypotony groups were 100% and 86% (at 6 months) and 96% and 86% (at 12 months), respectively. The final visual acuity worsened in a significantly greater percentage of patients in the hypotony group (46%) compared with the no-hypotony group (18%) (P = 0.06), Fisher's exact test).


CONCLUSIONS
Laser suture lysis is safe and effective in augmenting aqueous filtration after mitomycin C trabeculectomy. A longer time interval between surgery and LSL may result in both a lesser degree of IOP reduction and a lower incidence of subsequent hypotony.
Morinelli
E N
EN
Department of Ophthalmology, University of Southern California School of Medicine, Los Angeles, CA 90033-4666, USA.
Sidoti
P A
PA
Heuer
D K
DK
Minckler
D S
DS
Baerveldt
G
G
LaBree
L
L
Lee
P P
PP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002648:Child; D005260:Female; D005901:Glaucoma / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007429:Intraocular Pressure; D053685:Laser Therapy / Q000009:adverse effects; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use*; D015814:Ocular Hypotension / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D013536:Suture Techniques; D014130:Trabeculectomy; D014792:Visual Acuity
D000903:Antibiotics, Antineoplastic; D016685:Mitomycin