Surgical results and complications of mitomycin C-augmented trabeculectomy in refractory developmental glaucoma.
OBJECTIVE
To evaluate the surgical results and complications of mitomycin C-augmented trabeculectomy in refractory developmental glaucoma.


METHODS
The authors reviewed the charts of all patients of refractory developmental glaucoma who underwent mitomycin C-augmented trabeculectomy (0.4 mg/ml for 3 minutes) between September 1990 and August 1995. Thirty-eight eyes of 29 patients were included in the study; 34 eyes (89.5%) had refractory primary congenital glaucoma with documented failure of primary surgery, 2 eyes (5.3%) had Axenfeld-Rieger syndrome and 2 eyes (5.3%) had aniridia. The main outcome measures in this study were preoperative and postoperative intraocular pressures (IOPs),visual acuities, bleb characteristics, success rate, time of surgical failure, and complications.


RESULTS
The IOP (mean +/- SD) reduced from a preoperative level of 32.6 +/- 11.8 mm Hg to 12.3 +/- 7.3 mm Hg (P <0.0001) with the percentage reduction in IOP being 56%. Kaplan-Meier survival analysis showed that the success probability at 18 months was 65%, which was maintained till 30 months of follow-up. The bleb was characterized by its large, elevated, avascular, transparent appearance in all the eyes. There were no intraoperative complications. The postoperative complications included hyphema (absorbed one week) in 8 eyes (21%), uncontrolled IOP in 8 eyes (21%), shallow anterior chamber in 3 eyes (7.9%), hypotony without visual loss in one eye (2.6%) and retinal detachment in 2 eyes (5.2%) which was surgically repaired successfully. Visual acuity was maintained in all cases after surgery. None of the patients developed mitomycin-C related late bleb-leakage or endophthalmitis.


CONCLUSIONS
Treatment of refractory developmental glaucoma with mitomycin C-augmented trabeculectomy is effective and safe with an acceptable rate of complications.
VST Centre for Glaucoma Care, Hyderabad, India. mandal@lvpeye.stph.net
A K
AK
Mandal
K
K
Prasad
T J
TJ
Naduvilath
D000293:Adolescent; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D005260:Female; D005901:Glaucoma / Q000151:congenital* / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D007223:Infant; D007429:Intraocular Pressure; D007431:Intraoperative Complications / Q000000981:diagnostic imaging; D008297:Male; D016685:Mitomycin / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D012449:Safety; D014130:Trabeculectomy / Q000009:adverse effects; D016896:Treatment Outcome; D014463:Ultrasonography; D014792:Visual Acuity
D016685:Mitomycin