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PubMedDate not supplied

Trabeculectomy: a retrospective follow-up of 700 eyes.

A major focus of our study was to determine the value of postoperative intraocular pressure (IOP) in predicting the outcome of trabeculectomy (TE). The medical charts of 547 patients undergoing glaucoma filtering surgery at the Department of Ophthalmology of the University of Cologne from 1987 to 1996 were reviewed. The status of the visual field, level of visual acuity, appearance of the bleb, cup/disc ratio and IOP were studied. Pre- and post-operative glaucoma medication was recorded. The eyes with congenital glaucoma and those treated with antimetabolites were excluded. The results are presented with particular emphasis being placed not only on intraocular pressure (IOP) control but also on the progression of glaucomatous damage (deterioration of visual field or disc damage) and the decrease of visual acuity. The tonometric success rate of TE in controlling the IOP < 21 mmHg was 61%. Defining the rigid criteria for success of trabeculectomy as an IOP < 21 mmHg, no further visual field loss, no disc damage and no additionally required surgical intervention due to glaucoma, the success rate decreased to 44%. The results indicate that other factors than normalization of IOP determine the success rate of TE. Should trabeculectomy be the therapy of first choice in the early stage of glaucoma? Should trabeculectomy fail to control the IOP in the first eye, would this allow options, such as the use of antimetabolites in the second eye?

Female↗
PubMed2001

Combined phacoemulsification, intraocular lens implantation and trabeculectomy for chronic angle closure glaucoma.

PURPOSE: To investigate the results of combined phacoemulsification, intraocular lens implantation and trabeculectomy in Asian patients with chronic angle closure glaucoma (CACG). METHODS: This was a retrospective non-comparative case series of 55 consecutive patients (57 eyes) who underwent phacoemulsification, posterior chamber intraocular lens implantation and trabeculectomy for CACG at the Singapore National Eye Centre between 1997-1998. The surgical outcome was assessed in terms of intraocular pressure (IOP), the incidence of complications and the visual acuity at last follow-up. Success was defined as final IOP < or = 21 mmHg without medication and qualified success as final IOP < or = 21 mmHg with medication. Patients with final IOP > 21 mmHg who required further glaucoma surgery, lost light perception or became pthisical, were classified as failures. The eyes were further categorized into two groups according to whether single-site or separate-site surgery was performed. The outcome was also compared among eyes in which per-operative antimetabolites were applied to the trabeculectomy site and those without antimetabolites. RESULTS: The mean follow up was 22.0 +/- 5.6 months (mean +/- SD). Success was achieved in 46 (81%) eyes, qualified success in 10 (17%) eyes, and failure in 1 (2%) eye. In terms of IOP outcome, the success rate was similar in the two surgical groups (single-site or separate-site). There was no significant difference in IOP outcome among eyes in which per-operative antimetabolites were used and eyes with no per-operative antimetabolites use. Forty-one eyes (72%) had 6/12 or better vision. There were no cases of intraoperative complications and the incidence of postoperative complications was low. CONCLUSIONS: Combined phacoemulsification, intraocular lens implantation and trabeculectomy is associated with good intraocular pressure control and visual outcome in patients with CACG.

Aged↗
PubMed2001

A murine cell culture model for post-trabeculectomy anfibrotic treatment: Induction of apoptosis by Cyclosporin.

PURPOSE: Experimental trials aimed at the research of selective antifibrotic agents are under development for the alternative treatment of glaucoma patients who are usually considered high-risk post-surgical individuals after trabeculectomy. Authors present here an in vitro model system for the treatment of post-trabeculectomy patients. The study is aimed at the evaluation of different drugs in a mouse fibroblast model. METHODS: The antifibrotic activity of Cyclosporin A, Interferon 2alpha, 5-Fluorouracyl was investigated on 3T6 cells in culture. Cell viability and proliferation was assessed after drug treatment. Molecular analysis of DNA degradation was evaluated by means of radioactive labeling and gel electrophoresis. RESULTS: The three drugs were shown to affect cell proliferation and viability in a differential fashion. However, only Cyclosporin A was able to control cell proliferation, inducing apoptosis. This phenomenon was reduced by supplementation of trolox, a compound known to inhibit programmed cell death. These results strongly suggest that this model system might be useful as a test of pharmacological functionality. CONCLUSION: A rapid and efficient model system is described for the assessment of cell viability and proliferation after treatment with agents of potential pharmacological use. Cyclosporin A induces a significant apoptosis. This is important for the negative control of fibrotic degeneration in post-trabeculectomy that is required for successful surgery in glaucoma patients. Therefore, Cyclosporin A might become a clinically interesting drug for the antifibrotic treatment of post-trabeculectomy.

3T3 Cells↗
PubMed2002

Long-term outcome of trabeculectomy in terms of intraocular pressure.

PURPOSE: To evaluate the outcome, long-term results and contributing prognostic factors of trabeculectomy in terms of intraocular pressure (IOP) and to compare the results in primary open-angle glaucoma (POAG) and exfoliation glaucoma (EG). METHODS: This study involved retrospective evaluation of 138 consecutive patients (138 eyes) with either POAG or EG. All patients had undergone primary trabeculectomy performed by the same surgeon between November 1994 and August 1996. Only one eye per patient was included. Operations performed with the use of antimetabolites were excluded. All patients were aged over 40 years and were white. Follow-up for all subjects lasted at least 2 years. Successful control of IOP was defined as achieving IOP < or = 21 mmHg without medication (complete success) or with a single topical medication (qualified success). Success rates were determined using the Kaplan-Meier survival curve, and risk factors were analysed with proportional hazards regression. RESULTS: According to the Kaplan-Meier survival curve, success rates (complete or qualified) were 82% at 1 year, 70% at 2 years, 64% at 3 years and 52% at 4 years. A total of 63% were complete successes at 1 year, 54% at 2 years, 45% at 3 years and 40% at 4 years. Complete success rates were significantly better in the POAG group than in the EG group. Proportional hazards regression analysis showed that the presence of EG and early postoperative IOP > 30 mmHg decreased the possibility of complete success, while a cataract operation performed during follow-up improved it. CONCLUSION: The IOP-reducing effect of trabeculectomy decreases gradually. After 4 years, 52% of operated eyes had IOP < or = 21 mmHg with or without a single topical medication. Diagnosis of EG implied a worse long-term outcome for trabeculectomy in terms of IOP.

Adult↗
PubMed1993

Is high initial aqueous outflow of benefit in trabeculectomy?

A modification of the trabeculectomy technique was designed in an attempt to increase the outflow of aqueous into the subconjunctival space in the early post-operative period. This 'high flow' method was compared with a control group of eyes undergoing a standard trabeculectomy. Fifty-three eyes of 44 patients were recruited to this study. Follow-up was for a minimum of 12 months (mean 20 months). The high flow method resulted in lower intraocular pressures (IOP) on days 1 and 2 and shallower anterior chambers without increased incidence of conjunctival wound leak, suggesting that high outflow was indeed achieved. However, long-term control of IOP was not better than that achieved by the conventional technique. IOP control (IOP < 21 mmHg) was achieved in 64.2% of eyes (34 eyes) without additional topical medication. IOP control with topical medication was satisfactory in the remaining 19 eyes, and no patient required further drainage surgery. Further analysis of the data showed that the most important factor determining success or failure of trabeculectomy in controlling IOP was the duration and number of prior topical medications. The success rate for trabeculectomy was significantly higher in those eyes with a shorter duration and quantity of prior topical therapy.

Aged↗
PubMed1994

Simultaneous bilateral trabeculectomy.

In a retrospective study, 24 patients who had undergone simultaneous bilateral trabeculectomy over a 6-year period were reviewed. The duration of disease was at least 2 years, indicating that surgery was not performed as a primary procedure. No patients suffered complications leading to bilateral blindness, although 6 (25%) patients had reduced vision in both eyes at the first postoperative visit, with 3 (13%) worse than 6/36 binocularly. There was no evidence of an asymmetric response in the fall in intraocular pressure following trabeculectomy, after a mean follow-up of over 3 years. Compared with a matched group of patients undergoing unilateral trabeculectomy, the simultaneous bilateral group had a similar period of hospital stay. However, this was no shorter than that found in a group having staged bilateral surgery during the same admission, over the same study period. When separate admissions were required for bilateral drainage operations, though, there was a significant increase in the total length of inpatient stay. No convincing advantage was found for simultaneous bilateral trabeculectomy.

Aged↗
PubMed2001

Non-enhanced trabeculectomy by non-glaucoma specialists: are results related to risk factors for failure?

PURPOSE: To determine the 1 year success rate of non-enhanced trabeculectomy under the care of non-glaucoma specialists and the effects of risk factors on the surgical outcome as measured by intraocular pressure (IOP) control. METHODS: A retrospective study of 167 patients undergoing trabeculectomy was performed. One hundred and four cases were performed in a teaching hospital and 63 in a district general hospital (DGH). Non-glaucoma specialists performed all the operations, enhanced trabeculectomy with antimetabolites being excluded. Information was recorded from a retrospective review of case notes, and post-operative IOPs at 12 months follow-up were analysed. Risk factors for failure were defined as: (1) age less than 40 years old, (2) black race, (3) diabetes mellitus, (4) miotic therapy > or = 18 months, (5) sympathomimetic therapy > or = 6 months, (6) pseudophakia or aphakia, (7) previous failed filtration procedure, (8) argon laser trabeculoplasty, (9) previous ocular surgery and (10) high-risk glaucoma (angle recession glaucoma, uveitic glaucoma and neovascular glaucoma). A success was defined to be a post-operative IOP at 1 year of less than 21 mmHg and at least 20% less than the presenting IOP on no medication. RESULTS: The overall success rate was 139 of 167 (83.2%). Eighty-seven of 104 eyes (83.7%) were classified as a success in the teaching hospital group and 52 of 63 (82.5%) were classified as a success in the DGH group. There was no significant difference in the number of risk factors between the success and failure groups. Eyes with two or more risk factors had significantly higher IOPs at 1 year when compared with eyes with 0 or 1 risk factor (mean +/- SD: 17.4 +/- 6.34 mmHg vs 14.2 +/- 5.0 mmHg, p = 0.022). When only 'successful eyes' were analysed, those with two or more risk factors still had significantly higher IOPs at 1 year (mean +/- SD: 15.0 +/- 3.0 mmHg vs 12.8 +/- 3.9 mmHg, p = 0.046). There were significantly fewer eyes in the two or more risk factor group with IOPs < 16 mmHg at 1 year (26.1% vs 60.4%, p = 0.021). CONCLUSIONS: Eyes at relatively low risk for failure operated upon by non-glaucoma specialists appeared to have success rates similar to previously published series. Eyes with two or more risk factors for failure have higher IOPs at 1 year in non-enchanced trabeculectomy. Adjunctive anti-scarring agents may be considered for these patients when filtration surgery is scheduled.

Aged↗
PubMed2001

Is the role of trabeculectomy in glaucoma management changing?

BACKGROUND: In recent years there have been significant developments in the diagnosis and treatment of glaucoma. We conducted a study to determine whether there has been an associated change in trabeculectomy rates in England over this period. METHODS: Figures for the total number of trabeculectomies and cataract operations performed in England for each year from 1989/90 to 1999/2000 were obtained from the Department of Health, Hospital Episode Statistics Division. RESULTS: The available data show that the number of trabeculectomies and cataract operations increased year on year from 1990/91 until 1995/96. Since then, the number of cataract procedures has continued to rise dramatically, whereas the number of trabeculectomies has fallen progressively by 7%, 23%, 37% and 53% in the last 4 years. CONCLUSION: The perceived need for surgical intervention would appear to have been delayed or prevented. We postulate that several factors underlie this trend and that there are a number of implications regarding the future management of glaucoma patients.

Cataract Extraction↗
PubMed2006

Pig eye trabeculectomy-a wet-lab teaching model.

PURPOSE: A teaching model for trabeculectomy is described using pig eyes prepared in formalin. METHOD: The model enables trainee surgeons to practice various aspects of tissue handling required for successful trabeculectomy including the construction of a fornix-based conjunctival flap, scleral flap with buried releasable sutures, and water-tight conjunctival closure. RESULTS: Exposure to the necessary skills required to perform trabeculectomy surgery can be improved by the use of wet laboratory practice. CONCLUSIONS: Trabeculectomy surgery experience is becoming more limited as fewer procedures are being performed due to the efficacy of recent medications. Wet laboratories will become an increasingly important aspect of a comprehensive ophthalmology training programme.

Animals↗
PubMed2005

Intermediate-term comparison of trabeculectomy with intraoperative mitomycin-C between Asian American and Caucasian glaucoma patients: a case-controlled comparison.

PURPOSE: Compare the efficacy and survival of trabeculectomy with intraoperative mitomycin-C (MMC) between Asian American and Caucasian patients in the same clinical setting. METHODS: In total, 29 Asian American patients (29 eyes) with trabeculectomies were matched case to case with 29 Caucasian patients (29 eyes) retrospectively. Matching criteria included age, glaucoma subtype, and preoperative intraocular pressure (IOP), gender, surgeon, ocular history, and glaucoma medications. Criteria of success included: (1) Final IOP>5 and <22 mmHg, (2) IOP reduction>or=20%, or final IOP<or=10 mmHg, and (3) without additional glaucoma surgery, loss of light perception, or complication. RESULTS: Mean follow-up durations of Asian American and Caucasian group were 40.11+/-22.5 months and 38.8+/-17.7 months, respectively (P=0.81). At the final visits, IOP decreased from 18.7+/-6.1 to 10.9+/-4.0 mmHg (P<0.0001) in the Asian American group, and from 19.0+/-5.5 to 11.0+/-3.8 mmHg (P<0.0001) in the Caucasian group. There were no significant differences between the two groups in IOP levels at 6 months, 1 year, and final visits. The probabilities of trabeculectomy survival (continuing to meet definition of success criteria) at 12 and 48 months were 75.9 and 56.6% in the Asian American group and 82.8 and 66.6% in the Caucasian group, respectively. (P=0.46) There were no significant differences for rates of surgical success, failure, complication, vision decrease, hypotony, and cataract development. Patients who had episodes of hypotony had a higher rate of diagnosis of low-tension glaucoma subtype (P=0.02). CONCLUSIONS: In a case-controlled comparison of an intermediate-term follow-up of trabeculectomy with intraoperative MMC, Asian American patients have a similar efficacy and survival probability as Caucasian patients.

Adult↗
PubMed2006

Phacoemulsification in patients with previous trabeculectomy: role of 5-fluorouracil.

UNLABELLED: Cataract surgery in a patient with previous trabeculectomy is considered to have an adverse effect on the long-term survival of the filtering bleb. 5-Fluorouracil (5-FU) has been used in patients with a pre-existing bleb, undergoing cataract surgery, but there are no published reports for or against its use in such cases. This study was carried out to evaluate the protective role of subconjunctival 5-FU on the pre-existing bleb from trabeculectomy in patients undergoing phacoemulsification. METHODS: This retrospective study was carried out on patients with pre-existing filtering bleb from trabeculectomy for primary open-angle glaucoma who then underwent phacoemulsification at least 12 months after trabeculectomy. Data were collected for two groups of patients. Group 1 (22 patients) received 5-FU at the end of successful phacoemulsification, whereas group 2 (25 patients) did not receive it. The two groups were comparable with respect to age, gender, intraocular pressure (IOP), type of glaucoma, number of adverse risk factors present, and duration of follow-up. Any worsening of IOP control was analysed using mean IOP and mean change in the treatment for glaucoma. RESULTS: Mean IOP was comparable in the two groups, but there was a significant difference in mean change in glaucoma treatment between the two groups at 12 months postoperatively. Worsening of IOP control was seen in 13.6% of the patients in group 1 and in 36.4% in group 2 (P-value=0.03). CONCLUSION: Our study suggests that 5-FU has a protective effect on the functioning bleb and may be used routinely at the end of phacoemulsification in such cases.

Aged↗
PubMed1998

[Outcome of combined trabeculectomy with cataract operation and intraocular lens implantation].

BACKGROUND: When trabeculectomy and cataract extraction with intraocular lens insertion are combined, do the success and complication rates add. MATERIAL AND METHODS: Follow-up of 47 eyes of 34 patients with combined trabeculectomy and cataract extraction with intraocular lens implantation after 12 to 42 months. RESULTS: With a low perioperative complication rate the intraocular pressure after one year was below 22 mm Hg in 90% without any medication and in 98% additional glaucoma therapy. After 2 and 3 years the intraocular pressure was normal without any additional therapy in 83% of the eyes. The visual acuity was better or equal to the preoperative value in 89% of the cases. CONCLUSIONS: The combination of trabeculectomy and of cataract extraction with intraocular lens implantation has a low complication rate and gives good results regarding intraocular pressure and visual rehabilitation. When a trabeculectomy is indicated, the indication for a simultaneous cataract extraction with intraocular lens implantation should not be to restricted.

Aged↗
PubMed1998

[Risk factors for trabeculectomy failure].

BACKGROUND: Trabeculectomy is today the filtering procedure of choice, because complications are rare and success-rates high. A modification of our technique (fornix-based conjunctival flap closed by a running suture) introduced 3 years ago, has lead us to this retrospective assessment of complications and success-rates. Some of the risk factors for failure are known, others however remain obscure. This retrospective series was also used to further identify some of these risk factors for trabeculectomy failure. PATIENTS AND METHODS: All 388 trabeculectomies performed between January 1992 and June 1994 at our hospital were included in the study. Important pre- and postoperative data were retrospectively assessed from patients case notes, with a special interest in the course of post-operative intra-ocular pressure (IOP). Two major groups were differentiated: Those with open-angle glaucoma (OAG) (i.e. primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEX) and pigment dispersion syndrome (PDS)), and other various glaucoma diagnoses. Risk factors were assessed using Cox-proportional hazard model adopting three different criteria for success. RESULTS: The best success-rate after 12 months of follow-up had patients with narrow angle glaucoma (93.1%)(at least those suitable for filtering surgery), followed by patients with POAG (92.8%), 2 degrees open-angle glaucoma (81.8%), aphakic (75%), juvenile (70.6%) and PDS (52.9%). Pseudophakia and development of an encapsulated bleb (Tenon' cyst) were identified as significant (p < 0.05) risk factors for failure. In addition, YAG-Laser Iridotomy in OAG-group and Aphakia in the group of various glaucoma diagnoses were identified as risk factors for successful post-operative IOP control. CONCLUSIONS: Filtering surgery (trabeculectomy) is a potent method to reduce IOP. Pseudophakia and an encapsulated bleb are the main risk factors for surgical failure. Because of amazingly high success-rates we tend to perform filtering surgery today earlier than ten years ago, especially as previous long-term topical antiglaucoma treatment may reduce filtering surgery success.

Adolescent↗
PubMed1997

[Results after combined phacoemulsification and trabeculectomy by scleral tunnel incision and goniotrepanation alone].

PURPOSE: We retrospectively evaluated the results of combined phacoemulsification and trabeculectomy through scleral tunnel incision in comparison with those of goniotrephination alone. PATIENTS AND METHODS: 27 eyes of 20 patients (78.3 +/- 7.45 years) underwent a combined trabeculectomy and phacoemulsification with IOL-implantation (PT-group). The trabeculectomy was performed by excision of 2 mm middle part of the lower tunnel lip. In comparison with the TP-group 29 eyes of 28 patients (69.3 +/- 8.1 years) underwent a goniotrephination (Fronimopoulos), (G-group). The median of follow up was 8 weeks. RESULTS: In both groups a significant reduction of the IOP was achieved; in the PT-group the IOP was reduced from 31.0 +/- 5.42 to 15.0 +/- 4.5 mm Hg, in the G-group from 31.4 +/- 6.3 to 11.6 +/- 4.12 mmHg. In the PT-group the visual acuity increased significantly from 0.25 +/- 0.14 to 0.37 +/- 0.27 and decreased significantly from 0.46 +/- 0.28 to 0.32 +/- 0.25 in the G-group. 3 patients (= 11%) needed topical medication in the PT-group and 6 (= 24%) in the G-group. Four patients (= 15%) of the PT-group underwent a secondary surgery and 7 (= 24%) of the G-group. CONCLUSIONS: The combined phacoemulsification and trabeculectomy is a successful method of IOP control and visual rehabilitation. Due to the decrease of visual acuity and a higher frequency of secondary surgery after goniotrephination alone the combined procedure should be preferred even in presence of a moderately visual acuity reducing cataract.

Aged↗
PubMed2001

Advanced nonpenetrating trabeculectomy (advanced NPT) and combined surgery of advanced NPT and phacoemulsification and intraocular lens implantation.

We have devised a new glaucoma surgery combining deep sclerectomy with nonpenetrating trabeculectomy (NPT); we call this surgery advanced NPT. We evaluated intraocular pressure (IOP) control, postoperative complication and visual acuity after combined advanced NPT and phacoemulsification and intraocular lens implantation (combined surgery), and advanced NPT alone. The mean preoperative IOP for the trabeculectomy only group was 22.4 +/- 6.3 mmHg(bleb+), 23.0 +/- 4.9 mmHg(bleb-), and that of the combined surgery group was 18.1 +/- 4.5 mmHg(bleb+), 18.5 +/- 2.6 mmHg(bleb-). Mean postoperative IOP for the two groups were 13.0 +/- 2.3 mmHg(bleb+), 15.0 +/- 1.5 mmHg(bleb-) and 12.9 +/- 2.7 mmHg(bleb+), 13.3 +/- 2.4 mmHg(bleb-), respectively. After 15 months, the success probability for postoperative IOP control were 63%(bleb+), 23%(bleb-) in the advanced NPT only group (<or=12 mmHg), and 60% in the advanced NPT only group, 70% in the combined surgery group (<or=14 mmHg) (Kaplan-Meier survival rate). In early complication, there were significantly fewer cases of shallow anterior chamber, hypertension, hypotension and anterior chamber inflamation in both groups than that of trabeculectomy. Nd:YAG goniopuncture was performed for purposes of better IOP control; preferred performance being within a month after surgery. Regarding visual acuity after either advanced NPT alone or combined surgery, an earlier recovery can be expected than with trabeculectomy. Advanced NPT and combined procedure is a reliable technique for glaucoma and cataract surgery.

Aged↗
PubMed2006

Fibrin glue as a suture substitute: histological evaluation of trabeculectomy in rabbit eyes.

PURPOSE: To describe the outcome of the use of fibrin adhesive (Quixil) in penetrating trabeculectomy in a rabbit model. METHODS: Fibrin adhesive was used experimentally to attach the conjunctiva and the scleral flap in two groups of 17 New Zealand albino adult rabbits (34 eyes). In the first experiment (20 eyes), the fibrin adhesive was used to reattach the tissue after conjunctival peritomy and scleral flap only in 14 eyes (experiment I). In 6 eyes (controls), the conjunctiva was attached with nylon sutures. In the second experiment (14 eyes), the fibrin adhesive was used after conjunctival peritomy, scleral flap, and penetrating trabeculectomy in 8 eyes (experiment II). In a control group of 6 eyes, nylon sutures were used to attach the scleral flap and the conjunctiva after penetrating trabeculectomy. Biomicroscopy and histopathological examinations were performed on postoperative days 1, 3, 7, 14, 21, and 30. Intraocular pressure was measured before and after surgery in the second experiment. Main outcome measures are histological presence of adhesive in the tissue, degree of capillary congestion, inflammatory reaction, collagen density [scar formation] and clinical (IOP measurements before and after surgery, conjunctival chemosis, anterior chamber reaction, presence of filtering bleb and wound leakage). RESULTS: In experiments I and II, the adhesive was well identified histologically in the tissue as an amorphic eosinophilic substance for up to day 3 and nearly disappeared by day 7. An acute inflammatory reaction was noted for up to 14 days, which converted to chronic inflammation with collagen deposits and scar formation by day 30. Similar inflammatory reaction was observed in the control group. The adhesive had no adverse effects on ocular tissue compared with sutures. One eye in experiment II demonstrated wound dehiscence. Intraocular pressure dropped from 17.35 mmHg preoperatively to 8.28 mmHg on postoperative day 1 in experiment II, and from 17.2 mmHg to 11.5 mmHg in the controls. No significant change in intraocular pressure was noted in experiment I. CONCLUSIONS: The fibrin adhesive had no adverse effects on ocular tissue compared with sutures. It might serve as an effective substitute for conjunctival and scleral wound closure in trabeculectomy surgery.

Animals↗
PubMed1990

Trabeculectomy with simultaneous topical application of mitomycin-C in refractory glaucoma.

From May 1981 to Feb. 1989 trabeculectomy with per-operative topical application of mitomycin C was performed on eyes with refractory glaucoma. All eyes had undergone prior one, two or more than two antiglaucoma surgeries without success for IOP control. Other risk factors in the present series of eyes included young age, aphakia, rubeosis and glaucoma secondary to trauma or associated with anterior uveitis. 59 eyes underwent trabeculectomy with mitomycin application. 14 eyes were lost. 45 eyes of 42 cases, 33 eyes of 31 males and 12 eyes of 11 females were followed for a period of 1 to 8 years, an average 3.0 +/- 1.9 years. The success for IOP control less than 21 mmHg was 77.8%, 35/45 eyes. The success rates were 92%, 11/12 eyes in females and 73%, 24/33 eyes in males. Complications reported in 5-fluorouracil studies such as corneal epithelial toxicity and delayed healing of conjunctival wound were not encountered. The histo-pathological changes of wound healing after trabeculectomy with topical mitomycin application was discussed. In the healing process success to achieve filtration is more likely by pharmacolocally interferring with earlier steps in the process. We recommend the use of per-operative topical application of mitomycin C during trabeculectomy in eyes with uncontrolled glaucoma and poor prognosis, specifically after previous cataract extraction or unsuccessful antiglaucoma surgery.

Adolescent↗
PubMed1997

Trabeculectomy with multiple applications of mitomycin-C in monkeys with experimental glaucoma.

To inhibit the wound healing process and to achieve a better intraocular pressure lowering effect, we applied mitomycin-C (MMC) topically in trabeculectomy at different time sequences. In this experiment, a model of glaucoma trabeculectomy combined with light microscopic autoradiography study was used to evaluate the clinical and histological effects and the time course of cellular incorporation of tritiated thymidine. This study utilized twelve eyes (divided into three groups) of six monkeys with experimental glaucoma. Group I received 0.08 ml subconjunctival injection of 0.02 mg/ml MMC 24 to 36 hours prior to trabeculectomy. Group II received intraoperative topical application of 0.27 mg/ml MMC for 4 minutes. Group III received the same treatment as group II, along with pre-operative and repeated post-operative conjunctival applications of 0.4 mg/ml MMC for 10 minutes. Surgical success, IOP < 21 mmHg, lasted for a median of 8 days in group I, 56 days in group II and 75 days in group III. Compared with group I, cellular proliferation was significantly inhibited in group II and mostly inhibited in group III. No significant ocular toxicity or profound hypotony was observed. Histological examination of group III on the 90th day after operation showed patent scleral tunnel and hypocellular loose connective tissue in the conjunctival bleb. These results demonstrated that a series of pre-, intra- and repeated postoperative topical applications of mitomycin-C had a prolonged effect in inhibiting wound healing after trabeculectomy in monkeys.

Animals↗