Efficacy and safety of trabeculectomy with mitomycin C for childhood glaucoma: a study of results with long-term follow-up.
OBJECTIVE
To evaluate the safety and effectiveness of trabeculectomy with mitomycin C in the management of childhood glaucoma.


BACKGROUND
The use of antifibrotic agents enhances the success of trabeculectomy performed in both adults and children.


METHODS
A retrospective chart review (1991-2001) of 114 patients (114 eyes) from 0-14 years of age with congenital or developmental glaucoma. These patients underwent trabeculectomy with mitomycin but had not been previously treated with any antifibrotic agent.


RESULTS
The mean patient age was 57.36+/-51.14 months (range: 0.5-168 months). Treatment was considered successful in 63 eyes (55.26%), with a mean intraocular pressure of 12.11+/-3.98 mmHg. For patients categorized as successfully treated, the mean follow-up time was 61.16+/-26.13 months (range 12-113 months). A post-surgical intraocular pressure of <16 was observed in 47 eyes. The life-table success rates for intraocular pressure control at 24, 36, 48, and 60 months were 90.2%, 78.7%, 60.7% and 50.8%, respectively. The cumulative probability of failure was 40.8% at 12 months. Following surgery, endophthalmitis appeared in eight eyes (4.88%) after an average 36.96 months (range: 1.7-106 months). Other complications included expulsive hemorrhage, flat anterior chamber and bleb leak.


CONCLUSIONS
It has been reported in pediatric patients that trabeculectomy without adjunctive antimetabolites achieves a successful outcome in 30% to 50% of cases. In our study, treatment was considered successful in 63 eyes (55.26%) within 61.16+/-26.13 months of follow-up.


CONCLUSIONS
Trabeculectomy with mitomycin is safe and effective for short-term or long-term treatment of congenital or developmental glaucoma. The frequency of bleb-related endophthalmitis was no higher in these patients than that described in adults.
Giampani
Jair
J
Department of Ophthalmology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil. jgiampani@ig.com.br
Borges-Giampani
Adriana Silva
AS
Carani
José Carlos Eudes
JC
Oltrogge
Ernst Werner
EW
Susanna
Remo
R
D000293:Adolescent; D017677:Age Distribution; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D009877:Endophthalmitis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000151:congenital / Q000628:therapy*; D006801:Humans; D007223:Infant; D007429:Intraocular Pressure; D008297:Male; D016685:Mitomycin / Q000627:therapeutic use*; D012189:Retrospective Studies; D014130:Trabeculectomy / Q000009:adverse effects; D016896:Treatment Outcome
D000903:Antibiotics, Antineoplastic; D016685:Mitomycin