title: Transconjunctival Revision With Mitomycin-C Following Failed Trabeculectomy.
abstract: To evaluate the efficacy of transconjunctival revision (TCR) with mitomycin-C (MMC) following failed trabeculectomy.
  
  
  
  The medical records of 27 patients (27 eyes) who underwent TCR with subconjunctival injection of MMC by a single surgeon between September 2001 and August 2013 were retrospectively reviewed. The same surgical protocol was followed for all patients. Revision was performed using a microvitreoretinal blade through a small conjunctival incision. Main outcome measures included visual acuity, intraocular pressure (IOP), and number of glaucoma medications. Failure was defined as an IOP<5 or >14 mm Hg, loss of light perception, or need for additional glaucoma surgery.
  
  
  
  Mean interval between trabeculectomy and TCR was 56.4±57.2 months. Mean preoperative IOP was 21.9±6.8 mm Hg using 4.0±1.2 glaucoma medications. Fifteen (55.6%) patients met success criteria. At most recent follow-up, mean IOP and number of glaucoma medications for successful patients were 9.7±3.8 mm Hg and 0.6±1.1, respectively. Kaplan-Meier analysis revealed 1-, 2-, and 3-year success rates of 62%, 58%, and 53%, respectively. Three additional patients achieved success after undergoing a second TCR, and 1 patient achieved success after a third TCR. Postoperative complications included transient choroidal effusion (n=8), shallow anterior chamber requiring reformation (n=5), 5-fluorouracil-related corneal epitheliopathy (n=10), and bleb leak (n=1).
  
  
  
  TCR with adjunctive MMC is a safe and effective procedure following failure of a trabeculectomy. More than 1 revision may be necessary to achieve long-term IOP reduction.
authors.affiliation: Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai and Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Panarelli
authors.forename: Kateki
authors.initials: K
authors.lastname: Vinod
authors.forename: Gintien
authors.initials: G
authors.lastname: Huang
authors.forename: Paul A
authors.initials: PA
authors.lastname: Sidoti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000477:Alkylating Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D003228:Conjunctiva / Q000601:surgery*; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D012086:Reoperation; D012189:Retrospective Studies; D058475:Tenon Capsule / Q000187:drug effects; D014065:Tonometry, Ocular; D014130:Trabeculectomy / Q000379:methods*; D017211:Treatment Failure; D016896:Treatment Outcome; D014792:Visual Acuity
chemical_list: D000477:Alkylating Agents; D016685:Mitomycin; D005472:Fluorouracil