Non-penetrating glaucoma surgery augmented with mitomycin C or 5-fluorouracil in eyes at high risk of failure of filtration surgery: long-term results.
OBJECTIVE
To investigate the long-term efficacy and safety of non-penetrating glaucoma surgery (NPGS) augmented with mitomycin C (MMC) or 5-fluorouracil (5FU) in eyes at high risk of failure of glaucoma filtration surgery.


METHODS
Prospective study of all eyes, undergoing NPGS with 0.04% MMC (1 to 2 min topical or 0.04 mL subconjunctival injection into the superior fornix) or 5FU (25 mg/mL topically for 5 min). Complete success was an intraocular pressure (IOP)<or=21 mmHg on no medication and qualified success an IOP<or=21 mmHg with topical medication. An additional criterion for success was a >or=20% drop in IOP or a reduction of at least two medications.


RESULTS
Twenty-three eyes of 22 patients with a mean follow up of 41.4 months were reviewed. Fifteen eyes had failed trabeculectomy and seven had uveitic glaucoma. Mean preoperative IOP reduced from 25.8+/-7.8 to 15.4+/-4.9 mmHg at final visit, a mean change of 41%. Median number of preoperative medications decreased from 3 to 0 postoperatively. Cumulative probability of success was 100% at 2 years, 94% at 3 years and 85% at 4 years. No patient developed any long-term complications. Complete success was achieved in 11 eyes and qualified success in 10 eyes. Two eyes failed and required further surgery.


CONCLUSIONS
NPGS augmented with small-volume MMC/5FU provides good long-term IOP control in eyes at high risk of failure with a lower incidence of complications compared with augmented trabeculectomy and eliminates the need for postoperative bleb or suture manipulation.
Choudhary
Anshoo
A
St. Paul's Eye Unit, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK.
Wishart
Peter K
PK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000477:Alkylating Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005260:Female; D018463:Filtering Surgery; D005472:Fluorouracil / Q000008:administration & dosage*; D005902:Glaucoma, Open-Angle / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D011183:Postoperative Complications; D011446:Prospective Studies; D012599:Sclerostomy; D014065:Tonometry, Ocular; D014129:Trabecular Meshwork / Q000187:drug effects* / Q000601:surgery*; D017211:Treatment Failure; D016896:Treatment Outcome; D014792:Visual Acuity
D000477:Alkylating Agents; D016685:Mitomycin; D005472:Fluorouracil