Enhancement of the success rate in trabeculectomy: large-area mitomycin-C application.
BACKGROUND
To compare the effects of variable mitomycin-C (MMC) applications during trabeculectomy on target intraocular pressure (IOP), number of antiglaucomatous therapy, bleb morphology and surgical complications.


METHODS
66 glaucoma cases who underwent trabeculectomy combined with small-area (Group 1) or large-area (Group 2) MMC application were included. This study is a retrospective case series comparison. In Group 1, MMC had only been applied to the scleral flap area, whereas additional MMC applications were performed on upper temporal and nasal quadrant in Group 2. The cases with diabetes, narrow angle glaucoma, secondary glaucoma, history of previous ocular surgery and follow-up period less than 2 years were exluded from the study. A routine ophthalmological examination was performed in all cases and IOP measurements, morphology and the function of the blebs, necessity for antiglaucomatous medications and complications at first month and second year were evaluated.


RESULTS
There were 32 cases (48.5%) in Group 1 and 34 cases (51.5%) in Group 2. The mean IOPs were 12.6 +/- 5.5 and 10.8 +/- 5.3 mmHg at first month (P > 0.05), whereas 14.4 +/- 2.8 and 10.1 +/- 2.6 mmHg at second year, respectively (P < 0.05). The mean number of medications were 3.3 +/- 1.6 and 3.2 +/- 0.2 preoperatively (P > 0.05), whereas 0.8 +/- 1.2 and 0.26 +/- 0.70 at second year (P < 0.05). The number of diffuse blebs was higher in Group 2 whereas the number of cystic blebs was higher in Group 1 (P > 0.05). There was no difference between two groups with regards to the number of eyes with hypotonia (P > 0.05).


CONCLUSIONS
Large-area MMC application seems to increase long-term success without increasing the complication rates in trabeculectomy.
Onol
Merih
M
Department of Ophthalmology, School of Medicine, Gazi University, Besevler, Ankara, Turkey.
Aktaş
Zeynep
Z
Hasanreisoğlu
Berati
B
D000368:Aged; D001768:Blister / Q000453:epidemiology / Q000209:etiology; D005901:Glaucoma / Q000188:drug therapy / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007429:Intraocular Pressure / Q000187:drug effects*; D007430:Intraoperative Care; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage* / Q000627:therapeutic use; D019384:Nucleic Acid Synthesis Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D011184:Postoperative Period; D012189:Retrospective Studies; D012590:Sclera / Q000601:surgery; D013524:Surgical Flaps; D013997:Time Factors; D014130:Trabeculectomy / Q000009:adverse effects; D016896:Treatment Outcome
D019384:Nucleic Acid Synthesis Inhibitors; D016685:Mitomycin