Cumulative effect of risk factors on short-term surgical success of mitomycin augmented trabeculectomy.
BACKGROUND
Risk factors for failure of trabeculectomy may have a cumulative effect on the outcome.


OBJECTIVE
To study the effect of preoperative ocular risk factors on the surgical outcome of trabeculectomy augmented with 2 commonly used doses of Mitomycin C.


METHODS
In a prospective cohort study, cases were recruited over an 18 month period. 92 eyes of 83 patients with one to three known risk factors for failure of trabeculectomy underwent Mitomycin-C (MMC) augmented trabeculectomy.


METHODS
Trabeculectomy was done with a randomly chosen MMC dose of 0.2 mg/ml or 0.4 mg/ml. All cases were followed up for a period of at least 3 months. Surgical success was defined as the lowering of intraocular pressure (IOP) below 21 mmHg during the follow up period.


METHODS
Chi square test, paired t test, odds ratio, effect size.


RESULTS
Eyes with two or three risk factors (out of aphakic glaucoma, failed trabeculectomy, neovascular glaucoma, post uveitic glaucoma, traumatic glaucoma, adherent leucoma, juvenile glaucoma, prolonged medical therapy, steroid induced glaucoma, post penetrating keratoplasty glaucoma and developmental glaucoma) had a significantly poorer surgical success rate (88% and 78%) than eyes with one risk factor (100%). 0.4 mg/ml MMC used sub-sclerally had a statistically similar effect on lowering the IOP as 0.2 mg/ml in all groups. The rate of complications was significantly higher in the 0.4 mg/ml subgroup.


CONCLUSIONS
The presence of more than one preoperative ocular risk factor, affects the surgical success of MMC augmented trabeculectomy in high-risk cases. Because of the significantly higher rate of complications with the higher dose of MMC, this should be used sparingly, only in cases with more than two risk factors.
Agarwal
H C
HC
RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi - 110 029, India.
Sharma
T K
TK
Sihota
R
R
Gulati
V
V
D000328:Adult; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D016017:Odds Ratio; D011183:Postoperative Complications; D011300:Preoperative Care; D011336:Probability; D011446:Prospective Studies; D012307:Risk Factors; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome
D016685:Mitomycin