The increasingly iatrogenic indications for mitomycin C trabeculectomy over 10 years.
OBJECTIVE
The success of trabeculectomy can be adversely affected by certain risk factors. In these cases, the outcome can be improved by the intraoperative use of mitomycin C (MMC). We aimed to investigate the impression that this operation was being performed more often in our unit and that the risk factors were changing.


METHODS
Retrospective review.


METHODS
The study involved 107 MMC trabeculectomies during the 2 separate study periods.


METHODS
Operating theatre logbooks were used to identify patients who had undergone MMC trabeculectomy during 2 separate periods of 32 months, 10 years apart. Patient characteristics, the indication for surgery (previously failed trabeculectomy; aphakic/pseudophakic glaucoma; uveitic, developmental, or rubeotic glaucoma; post-vitreoretinal (VR) surgery glaucoma; postkeratoplasty glaucoma; and other), and follow-up data regarding intraocular pressure control were recorded.


RESULTS
In the later period, 71 MMC trabeculectomies were performed, compared with 36 in the earlier period, a significant rise (p < or = 0.05). The most obvious change in indication was an increase for postkeratoplasty and post-VR surgery glaucoma, which accounted for 77.1% of the additional operations. Intraocular pressure control at 1 year following surgery was good, particularly in the later period, with 88.8% controlled with the addition of topical medication where necessary. Complications in both periods were rare.


CONCLUSIONS
The frequency of MMC trabeculectomies has doubled over a 10-year period in our unit. Postkeratoplasty and post-VR surgery glaucomas are increasingly contributing to the caseload of complex glaucoma in our hospital. These cases may be managed effectively with MMC trabeculectomy.
Macdonald
Elisabeth
E
Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK. b_mckillop@hotmail.com
Mukherjee
Sumona
S
Jay
Jeffrey
J
D000477:Alkylating Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D016039:Corneal Transplantation; D005260:Female; D005901:Glaucoma / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007049:Iatrogenic Disease; D007429:Intraocular Pressure; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D011183:Postoperative Complications; D012086:Reoperation; D012164:Retinal Diseases / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D014130:Trabeculectomy / Q000706:statistics & numerical data*; D014821:Vitrectomy; D014945:Wound Healing / Q000187:drug effects
D000477:Alkylating Agents; D016685:Mitomycin