Mitomycin-C-augmented trabeculectomy for neovascular glaucoma. A preliminary report.
OBJECTIVE
This study aimed to investigate the safety and efficacy of trabeculectomy with intraoperative mitomycin C (MMC) in the management of eyes with neovascular glaucoma (NVG).


METHODS
Fifteen eyes of 14 patients with NVG were included in the study. NVG was secondary to central retinal vein occlusion (3 eyes), hemiretinal vein occlusion (2 eyes), proliferative diabetic retinopathy (8 eyes), branch retinal vein occlusion (1 eye) and idiopathic (1 eye). Preoperative retinal ablation was performed in eyes with evidence of posterior segment ischaemia. Following this, all eyes underwent trabeculectomy with intraoperative MMC (0.4 mg/ml for 3 minutes). Clinical outcome assessment included visual acuity, intraocular pressure (IOP), bleb appearance, identification of complications and antiglaucoma medications required to control IOP.


RESULTS
The mean IOP decreased from 38.6 +/- 12.9 mmHg (range, 15-64 mmHg) to 17.4 +/- 9.33 mmHg (range, 4-34 mmHg) (P = 0.001). Preoperative visual acuity ranged from light perception to 6/9 in the affected eye. Thirteen (86.6%) of 15 eyes improved vision or retained preoperative vision, one (6.7%) eye lost light perception and one (6.7%) eye developed tractional retinal detachment two years after trabeculectomy. Ten (66.7%) of 15 eyes were classified as surgical success with a mean follow-up of 28.6 +/- 26.3 months (range, 2-82 months). None of the patients developed choroidal haemorrhage, hypotony maculopathy, late onset bleb leak or endophthalmitis.


CONCLUSIONS
Trabeculectomy with intraoperative MMC is a good treatment modality in the management of eyes with NVG.
Mandal
Anil K
AK
VST Centre for Glaucoma Care, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad 500 034, India. mandal@lvpeye.stph.net
Majji
Ajit B
AB
Mandal
Soma P
SP
Das
Taraprasad
T
Jalali
Subhadra
S
Gothwal
Vijaya K
VK
Jain
Sunil S
SS
Nutheti
Rishita
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D005260:Female; D015355:Glaucoma, Neovascular / Q000628:therapy*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use*; D010865:Pilot Projects; D011183:Postoperative Complications; D011446:Prospective Studies; D012449:Safety; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity
D000903:Antibiotics, Antineoplastic; D016685:Mitomycin