E-PTFE (Gore-Tex) implant with or without low-dosage mitomycin-C as an adjuvant in penetrating glaucoma surgery: 2 year randomized clinical trial.
OBJECTIVE
To test the expanded polytetrafluoroethylene (ePTFE) as a new adjuvant in trabeculectomy.


METHODS
Consecutive glaucoma surgical inpatients were observed at the Department of Ophthalmology of Palermo University. Sixty patients (60 eyes) were randomly assigned to undergo trabeculectomy (T), trabeculectomy with mitomycin-C (TMMC), with ePTFE (TG) or with mitomycin-C and ePTFE (TGMMC). Postoperative visits were scheduled at 24 hr, 7 days, 1, 3, 6, 12, 18 and 24 months. Complete success and qualified success were assessed at two target intraocular pressure (IOP) levels -< or =21 and < or =17 mmHg - by Kaplan-Meier curves.


RESULTS
The postoperative IOP reduction was significant (P < 0.01) at the endpoint in all groups, with a mean IOP of 16.9 (+/-2.9), 16.2 (+/-2.7), 15.3 (+/-3.4) and 15.2 (+/-4.3) mmHg in T, TMMC, TG and TGMMC eyes, respectively. No intergroup difference was found at either IOP targets. The Kaplan-Meier curves relating to either the < or =21 mmHg or the < or =17 mmHg target IOP did not show significant intergroup differences for complete and qualified success rate. When ePTFE was used, a trend favouring the medium-term survival rate was noted. No adverse reaction to the ePTFE was present, and no membrane extrusion or conjuctival erosion were noted in any cases. Hypotony was significantly more frequent (P = 0.035) in groups without ePTFE. Moreover, the late MMC-related complications were more frequent when MMC was applied.


CONCLUSIONS
Expanded polytetrafluoroethylene implant in trabeculectomy is well tolerated and could act as a filtration modulating device. Therefore, it is useful in reducing early hypotony-related complications and contributes to attaining medium-term IOP control that is comparable to the low-dosage MMC.
Cillino
Salvatore
S
Department of Clinical Neuroscience, Section of Ophthalmology, University of Palermo, Italy. casuccio@unipa.it
Zeppa
Lucio
L
Di Pace
Francesco
F
Casuccio
Alessandra
A
Morreale
Daniele
D
Bocchetta
Fabio
F
Lodato
Gaetano
G
D000368:Aged; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D005260:Female; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D015814:Ocular Hypotension / Q000209:etiology; D011138:Polytetrafluoroethylene; D011184:Postoperative Period; D019736:Prostheses and Implants; D014130:Trabeculectomy / Q000009:adverse effects
D016685:Mitomycin; D011138:Polytetrafluoroethylene