Trabeculectomy with mitomycin-C in the treatment of pediatric glaucomas.
OBJECTIVE
To evaluate the effectiveness and safety of trabeculectomy with mitomycin-C (MMC) in the management of childhood glaucomas.


METHODS
Retrospective, noncomparative case series.


METHODS
All patients less than 18 years of age who underwent trabeculectomy with MMC from June 1991 through October 1997 were included.


METHODS
The medical records of 29 consecutive patients (29 eyes) were reviewed. Data collected during routine patient follow-up were analyzed. Surgical outcome was evaluated using Kaplan-Meier life-table analysis.


METHODS
Clinical outcome assessment included intraocular pressure (IOP) control, visual acuity, and identification of complications. Successful IOP control was defined as 5 mmHg < or = final IOP < or = 21 mmHg, with or without antiglaucoma medications and without further glaucoma surgery or loss of light perception. Outcomes for the group of patients with primary infantile glaucoma were compared with those for the group with secondary glaucomas.


RESULTS
Mean patient age was 6.4 +/- 4.4 years (range, 0.2-15.3 years). A variety of primary and secondary glaucomas were represented. Mitomycin-C (0.5 mg/ml) on a surgical sponge was applied to the episcleral surface for an average of 3.8 +/- 1.0 minutes (range, 1.5-5.0 minutes). Mean follow-up time for patients categorized as successes was 25.1 +/- 16.0 months (range, 5.5-59.7 months). The 12-, 24-, and 36-month life-table success rates for IOP control were 82%, 59%, and 59% respectively. There was no difference between the primary infantile glaucoma group and the secondary glaucoma group with respect to length of follow-up, rate of successful IOP control, and incidence of complications. Five patients (17%) experienced late bleb-related infection (BRI) at an average of 27.9 +/- 18.1 months (range, 5.4-55.5 months) after surgery. Other complications included hyphema, retinal detachment, late-onset bleb leak, flat anterior chamber, chronic hypotony, decompression retinopathy, suture abscess, and phthisis.


CONCLUSIONS
Trabeculectomy with MMC may be useful in the management of childhood glaucomas in which goniotomy, trabeculotomy, or both have failed. However, the high incidence of BRI in this series over an extended follow-up interval dictates caution in using MMC as an adjunct in pediatric trabeculectomy.
Sidoti
P A
PA
Department of Ophthalmology, The New York Eye and Ear Infirmary, New York 10003, USA. psidoti@nyee.edu
Belmonte
S J
SJ
Liebmann
J M
JM
Ritch
R
R
D000293:Adolescent; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000151:congenital / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007429:Intraocular Pressure; D008297:Male; D016685:Mitomycin / Q000627:therapeutic use*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012449:Safety; D012590:Sclera / Q000187:drug effects*; D014130:Trabeculectomy; D016896:Treatment Outcome; D014792:Visual Acuity
D000903:Antibiotics, Antineoplastic; D016685:Mitomycin