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PubMed1998

Subconjunctival retention of C3F8 gas increased success rates of trabeculectomy in rabbits.

The effect of subconjunctival retention of perfluoropropane (C3F8) gas on rabbit trabeculectomy was evaluated in this study to determine if this maneuver would increase the success rate of the surgery. Sixteen New Zealand white rabbits underwent trabeculectomy in the right eyes and trabeculectomy with subconjunctival retention of 0.3 mL C3F8 gas in the left eyes were used as animal models. One week and six weeks after the operations, the intraocular pressure (IOP) dynamics were compared between the two eyes after intravenous infusion of 0.9% NaCl sterile solution. The results showed that the average retention time of C3F8 gas within the subconjunctival space in the rabbits was 9.5 +/- 2.3 days. There were four parameters available in comparing IOP dynamics: Time Needed to Reach Peak IOP (TNRPI); Ascending Slope (AS); Peak IOP (PI) and Time Needed to Return to the Original IOP (TNROI). It was noted that at the 7th day after the operations, the IOPs in both eyes of the rabbits were not significantly increased after intravenous infusion of 0.9% NaCl solution. At the 42nd day, after 0.9% NaCl intravenous infusion, the eyes that had undergone trabeculectomy and subconjunctival retention of C3F8 gas had less IOP spiking than eyes that had undergone trabeculectomy alone (TNRPI: 6.7 +/- 2.2 vs. 4.2 +/- 2.9, p = 0.01, AS: 0.5 +/- 0.3 vs. 2.8 +/- 2.7, p = 0.002, PI: 24.4 +/- 9.6 vs. 18.7 +/- 7.4, p = 0.07 and TNROI: 6.8 +/- 5.8 vs. 14.7 +/- 11, p = 0.02). Our study suggested that subconjunctival retention of C3F8 gas increased the success rate of trabeculectomy in rabbits in the short-term follow-up period.

Animals↗
PubMed2005

Do injections of 5-fluorouracil after trabeculectomy have toxic effects on the anterior segment?

OBJECTIVE: To discourage fibrosis of the filtering bleb, 5 fluorouracil (5-FU) may be injected after trabeculectomy. 5-FU is an antimetabolite that also can damage extraocular tissues at concentrations as low as 0.5%. This study ascertained whether repeated injection of 5-FU has toxic effects on intraocular structures. METHODS: After unilateral trabeculectomy in anesthetized New Zealand rabbits, 5-FU (5.0 mg/0.1 mL) was injected at the trabeculectomy site every 5 days for 15 days. Evaluation included slit-lamp examination, confocal microscopy, and intraocular pressure (IOP). After sacrifice, aqueous humor (AH) was drawn and eyes excised for scanning electron microscopy (SEM) and light microscopy. RESULTS: The 5-FU injection not decrease IOP beyond trabeculectomy alone. Bleb height remained constant, thickness increased, and vascularity decreased. No changes in cornea or anterior segment were observed. No inflammation was observed in the bleb or surrounding tissues by slit-lamp or histologic examination. Protein in AH increased from 0.6 +/- 0.5 microg/mL at baseline to 19.8 +/- 4.4 microg/mL after trabeculectomy but only to 0.9 +/- 0.6 microg/mL after trabeculectomy plus 5-FU. Both in vivo confocal microscopy and SEM revealed deleterious effects on corneal epithelial and endothelial cells with a minor shift toward smaller cells. CONCLUSIONS: In this study 5-FU did not provoke an intraocular inflammatory response and had minimal effect on extraocular structures. Changes in corneal epithelium and endothelium detectable by confocal microscopy suggest a small toxic effect. These in vivo measurements by confocal microscopy were confirmed by SEM. Repeated administration did not cause additional cumulative toxic effects in the anterior segment. Therefore, multiple injections of 5- FU into the filtering bleb pose minimal risk to intraocular structures.

Animals↗
PubMed2004

Comparison between results of trabeculectomy in primary congenital glaucoma with and without the use of mitomycin C.

PURPOSE: To evaluate the results of trabeculectomy with and without the use of mitomycin C in children with primary congenital glaucoma. METHODS: The authors retrospectively studied the data of 91 patients who underwent the first trabeculectomy for primary congenital glaucoma, with 19 years of follow-up. Success criteria were set with two distinct values of intraocular pressure: lower or equal to 15 mm Hg or lower than 21 mm Hg and separately analyzed. RESULTS: Among the studied patients, 61 had undergone trabeculectomy without mitomycin C and 30 with mitomycin C. The comparison between the groups of patients showed age homogeneity (P = 0.152) and did not demonstrate any difference in preoperative (P = 0.234) and postoperative (P = 0.907) intraocular pressure. Success rates through time, for both pressure limits was not different between the groups. Both age and the presence of previous trabeculotomy did not influence the success of trabeculectomy through time, for the two pressure limits considered. The complication rate was higher among the patients who received mitomycin C (P = 0.010). CONCLUSIONS: The success of trabeculectomy for primary congenital glaucoma with mitomycin C was not different than that of trabeculectomy with mitomycin C in the studied patients. Mitomycin C was associated with a higher incidence of complications.

Antibiotics, Antineoplastic↗
PubMed2006

Outcomes of laser suture lysis after initial trabeculectomy with adjunctive mitomycin C.

PURPOSE: To evaluate and compare outcomes of eyes that underwent laser suture lysis (LSL) after initial trabeculectomy with mitomycin C (MMC) to those that did not require such an intervention. METHODS: We reviewed the charts of consecutive patients with open-angle glaucoma who underwent initial trabeculectomy with mitomycin C at the Jules Stein Eye Institute between 1998 and 2003. Primary outcome measures were intraocular pressure (IOP) control at 1 year and success rate of trabeculectomy according to following criteria: criteria A, IOP < 21 mm Hg with >or=20% IOP reduction and criteria B, IOP < 15 mm Hg with >or=30% IOP reduction. Kaplan-Meier survival analysis and Cox's proportional hazards regression analysis were used to estimate and determine influence of laser suture lysis on success rates after trabeculectomy. RESULTS: Laser suture lysis was performed in 95 eyes (84 patients) whereas 146 eyes (121 patients) did not require it. IOP was significantly higher at 12 months in laser suture lysis eyes compared with non-laser suture lysis eyes (12.9 +/- 5.2 mm Hg versus 11.0 +/- 4.1 mm Hg; P = 0.04). Laser suture lysis eyes also had decreased success rates with criteria B (57% compared with 73% at 1 year for non-LSL eyes; P = 0.005). However, only late laser suture lysis (last LSL session >10 days after trabeculectomy) was associated with worse outcome in Cox's proportional hazards model using criteria B (HR = 2.26; P = 0.004). Late hypotony occurred in 4% and 1% of non-LSL and LSL eyes, respectively. CONCLUSIONS: Eyes that undergo laser suture lysis >10 days after initial trabeculectomy with mitomycin C are more likely to have poorer long-term IOP control than eyes not requiring laser suture lysis or eyes undergoing laser suture lysis <or=10 days after surgery.

Aged↗
PubMed2006

Intraocular pressure outcome in primary 5FU phacotrabeculectomies compared with 5FU trabeculectomies.

PURPOSE: Combined surgery for glaucoma and cataract may not achieve as low intraocular pressure (IOP) as compared with trabeculectomy alone. The aim of this study was to assess the IOP control of 5-fluorouracil (5FU) phacotrabeculectomies compared with 5-fluorouracil trabeculectomies. METHODS: A retrospective, nonrandomized study of consecutive primary 5FU phacotrabeculectomies and primary 5FU trabeculectomies. The main outcome measures were preoperative and postoperative IOP, number of medications, visual acuity, and complications. RESULTS: Forty-five 5FU phacotrabeculectomies and 47 5FU trabeculectomies were performed with a mean follow-up of 43.1 and 36.6 months, respectively. The absolute success rate as defined as an IOP equal to or less than 16 mm Hg on no glaucoma drops was 62.2% for the phacotrabeculectomy group and 63.8% for the trabeculectomy group. These success rates were not statistically significantly different (log-rank test P = 0.81 for absolute success and P = 0.29 for relative success). The magnitude of the treatment effect was found to be significantly greater in the T group compared with the PT group (a 44.6% reduction in IOP in the T group compared with a 31.2% reduction in the PT group). The phacotrabectomy group underwent significantly more postoperative 5FU injections compared with the trabeculectomy group (P = 0.008). CONCLUSIONS: 5FU phacotrabeculectomy seems to be a safe and effective treatment option in terms of IOP control. Patients with both coexistent glaucoma and cataract could be considered for combined surgery.

Adult↗
PubMed2007

Comparison of trabeculectomy with Ex-PRESS miniature glaucoma device implanted under scleral flap.

PURPOSE: To evaluate the Ex-PRESS miniature implant (Model R 50) placed under partial-thickness scleral flap compared with standard trabeculectomy. METHODS: In this retrospective comparative series of 100 eyes, we compared 50 eyes in 49 patients treated with the Ex-PRESS miniature glaucoma implant under a scleral flap with 50 matched control eyes in 47 patients treated with trabeculectomy. Success was defined as intraocular pressure (IOP) > or =5 mm Hg and < or =21 mm Hg, with or without glaucoma medications, without further glaucoma surgery or removal of implant. Early postoperative hypotony was defined as IOP <5 mm Hg during the first postoperative week. RESULTS: The average follow-up was 10.8 months (range 3.5 to 18) for the Ex-PRESS group and 11.2 months (range 3 to 15) for the trabeculectomy group. Although the mean IOP was significantly higher in the early postoperative period in the Ex-PRESS group compared with the trabeculectomy group, the reduction of IOP was similar in both groups after 3 months. The number of postoperative glaucoma medications in both groups was not significantly different. Kaplan-Meier survival curve analysis showed no significant difference in success between the 2 groups (P=0.594). Early postoperative hypotony and choroidal effusion were significantly more frequent after trabeculectomy compared with Ex-PRESS implant under scleral flap (P<0.001). CONCLUSIONS: The Ex-PRESS implant under a scleral flap had similar IOP-lowering efficacy with a lower rate of early hypotony compared with trabeculectomy.

Aged↗
PubMed1996

Trabeculectomy in the second eye.

Trabeculectomy has a reported success rate of between 67-94%. Many studies have been performed on operative variables which may influence surgical outcome. Youth, pigmented race and anterior segment inflammation have been shown to be associated with trabeculectomy failure. Little is known of the surgical outcome of trabeculectomy in one eye in relation to its partner, when surgery is standardized and the above known adverse conditions to trabeculectomy success are absent. We therefore carried out a prospective study on 62 patients who underwent bilateral trabeculectomies. There was a significant failure rate amongst pairs of eyes (postoperative intraocular pressure > or = 21 mmHg), with the majority of failures occurring within 6 months of surgery. Failure appeared to be associated with a longer period from diagnosis of glaucoma to surgery, and the use of a wider variety and number of topical medications. All other trabeculectomy complications occurred more commonly in any single eye, than in any pairs of eyes.

Aged↗
PubMed1989

Primary trabeculectomy in congenital glaucoma.

The reported success rates in the treatment of congenital glaucoma with goniotomy, trabeculotomy, and trabeculectomy suggest that trabeculectomy should be performed if the other procedures fail. We propose that the decision to perform primary trabeculectomy in primary and secondary congenital glaucoma reduces the effect which the many variable findings in surgical anatomy may have on the outcome of other procedures. This is a retrospective study of the results of primary trabeculectomy in 21 consecutive eyes of 15 patients with congenital glaucoma. Eighteen of 13 patients' eyes were controlled after a single trabeculectomy and remained controlled after a mean follow-up of 3.9 years (range 1.5 to 6.7 years). The role of primary trabeculectomy in congenital glaucoma merits further consideration.

Child↗
PubMed2000

Trabeculectomy with mitomycin C for post-keratoplasty glaucoma.

AIM: To investigate the effect of trabeculectomy with and without mitomycin C in post-keratoplasty glaucoma. METHODS: A retrospective study was performed on patients who underwent trabeculectomy for glaucoma after penetrating keratoplasty. 34 eyes of 32 patients were included in this study. 26 eyes received trabeculectomy with mitomycin C and eight eyes without mitomycin C. The procedure was deemed successful if the intraocular pressure was maintained below 21 mm Hg with or without use of additional antiglaucoma medication (mean follow up time 22.3 (SD 10.3) months). RESULTS: At the last examination trabeculectomy was successful in 19 of 26 eyes (73.0%) with mitomycin C (+) and two of eight (25.0%) without (p=0.0219). When the prognosis was analysed by Kaplan-Meier curve, the mitomycin C (+) group showed a better prognosis (p=0.0182). Mean intraocular pressure and average number of glaucoma medications improved in the group with mitomycin C without severe side effects on the graft. Graft rejection after trabeculectomy was seen in two eyes in the mitomycin C group. Final graft clarity rate was 69.2% (18/26) in the mitomycin C (+) group and 37.5% (3/8) in the mitomycin C (-) group. Complications such as persistent epithelial defect, cystoid macular oedema, choroidal detachment, leakage from bleb were seen in four eyes in the mitomycin C (+) group and in one eye in the mitomycin C (-) group. CONCLUSIONS: Trabeculectomy with mitomycin C showed better results for glaucoma following keratoplasty.

Adult↗
PubMed1998

The results of trabeculectomy with and without mitomycin C in young patients.

The results of primary trabeculectomy with and without mitomycin C (MMC) were evaluated in young glaucoma patients. The patients, 15-40 years of age, were divided into two main groups and two subgroups. In group IA, primary Cairns type trabeculectomy was performed in 24 eyes of 24 patients with juvenile glaucoma; in group IB, trabeculectomy + MMC 0.4 mg/ml in 3 min was done in 20 eyes of 20 patients with juvenile glaucoma; in group IIA, primary trabeculectomy was performed in 20 eyes of 20 patients with developmental glaucoma, and in group IIB, trabeculectomy + MMC 0.4 mg/ml in 3 min was performed in 16 eyes of 16 patients with developmental glaucoma. The success rate of the surgery was 75% in group IA, 90% in group IB, 50% in group IIA, and 75% in group IIB. There was no statistically significant difference among the groups in terms of success rates of trabeculectomies (p > 0.05).

Adolescent↗
PubMedDate not supplied

Long-term results of trabeculectomy with different concentrations of mitomycin C in refractory developmental glaucoma.

PURPOSE: To evaluate the long-term results of trabeculectomy with two different concentrations of mitomycin C in refractory developmental glaucoma. PATIENTS AND METHODS: A total of 48 eyes of 37 patients with previous failure of congenital glaucoma surgery underwent mitomycin C-augmented trabeculectomy. Data were analyzed retrospectively, and patients were divided into two groups. Group 1 consisted of 18 patients (25 eyes) who underwent trabeculectomy with a 0.4 mg/mL mitomycin C solution and group 2 consisted of 19 patients (23 eyes) who underwent trabeculectomy with a 0.2 mg/mL mitomycin C solution. Pre- and postoperative intraocular pressure (IOP), best-corrected visual acuity, bleb characteristics, success rate, and complications were compared for both groups. RESULTS: Mean time between primary surgery and mitomycin C-augmented trabeculectomy was 19.3 months (range, 11 months to 7 years). Mean preoperative IOP was 28.4 +/- 2.9 mm Hg in group 1 and 29.0 +/- 2.4 mm Hg in group 2. Final postoperative IOP was 17.0 +/- 1.6 for group 1 and 17.1 +/- 1.4 mm Hg for group 2. There were no significant differences between the groups for IOP, success rate, and complications (P > .05). The most common postoperative complication was shallow anterior chamber (11 [22.9%] of 48 eyes). CONCLUSIONS: A 0.4 or 0.2 mg/mL mitomycin C solution for 4 minutes may be used during trabeculectomy in refractory developmental glaucoma.

Child, Preschool↗
PubMed1999

Quantification of blood--aqueous barrier breakdown after trabeculectomy: pseudoexfoliation versus primary open-angle glaucoma.

PURPOSE: Impairment of the blood-aqueous barrier in unoperated eyes with pseudoexfoliation syndrome has been demonstrated by fluorescein angiography, fluorophotometry, measurement of aqueous flare, and determination of aqueous protein. We performed noninvasive quantification of aqueous flare using the laser flare-cell meter to compare blood-aqueous barrier breakdown after trabeculectomy in eyes with primary open-angle glaucoma (POAG) and in eyes with pseudoexfoliative glaucoma (PEX). METHODS: Twenty eyes with PEX and 20 eyes with POAG were included in the study. Trabeculectomy was performed by two surgeons according to a standard trabeculectomy technique. Intra- and postoperative treatments were identical in both groups. Aqueous flare was quantitatively determined using the laser flare-cell meter FC-1000 (Kowa, Tokyo, Japan) before and 3, 5, 7, and 9 days after trabeculectomy. Absolute flare and difference between post- and preoperative flare values were statistically analyzed using the Mann-Whitney U-Test for independent samples. RESULTS: Before surgery, aqueous flare values were significantly higher in PEX than in POAG. On days 3, 5, 7 and 9 after surgery, flare values were significantly higher in eyes with PEX than in eyes with POAG. Absolute differences between post- and preoperative flare values also were significantly higher in eyes with PEX, but this was not true for percentage values. CONCLUSION: These results show that substantial blood-aqueous barrier breakdown occurs in eyes with PEX after trabeculectomy. These alterations may contribute to early or late complications of trabeculectomy and indicate the need for close postoperative follow-up evaluation in eyes with PEX.

Aged↗
PubMed2001

[The long-term follow up after trabeculectomy].

THE AIM OF THE STUDY: To estimate the efficacy of trabeculectomy for primary open angle glaucoma. MATERIAL AND METHODS: Since 1990 to 2000 we observed 91 eyes of 79 patients (53 women and 26 men) aged 39-86. The results of performed surgery were valued directly after the trabeculectomy and in period of over 8 years. We carried out the examinations of visual acuity, intraocular pressure, visual field, state of optic nerve head, type of bleb following trabeculectomy and the necessity of applying additional topical treatment. The trabeculectomies were performed in a typical way. Some surgeons made a square or triangular superficial scleral flap based at the limbus, measuring from 2.5 x 3.0 to 4 x 4 mm or 3 x 3 mm. The deep block of scleral tissue with trabeculum (from 0.5 x 1.0 to 2.5 x 3.0 mm) was excised, the superficial cauterisation and the peripheral iridectomy were performed in every case. The scleral flap and conjunctiva were sutured with 10/0 Ethilon, 8/0 Vicryl or 6/0 Mersilk. RESULTS: The patients were divided into 3 groups depending on observation period: I--up to 4 years, II--from 5 to 8 years, III--over 8 years. We confirmed the normalisation of IOP in 80%, 73%, 90% and the successful control of visual field (no progress) in 82%, 77%, 70% of adequate groups. In the first and second group 45-50% of patients could resist from topical treatment, but after 8 years as many as 80% required additional pharmacological treatment. CONCLUSION: The trabeculectomy is the effective surgery in most patients with open angle glaucoma. The effectiveness of trabeculectomy can be controlled by the size of extracted deep scleral flap with trabeculum. For the stability of visual field it is necessary to keep the intraocular pressure at 13-18 mm Hg level.

Adult↗
PubMed2001

Assessing the role of subconjunctival versus intrascleral application of mitomycin C in high-risk trabeculectomies.

PURPOSE: To compare the efficacy and safety of subconjunctival and intrascleral applications of mitomycin C (MMC) in trabeculectomy for high-risk glaucomas. METHODOLOGY: A randomized prospective clinical study was conducted on 41 consecutive eyes with a high risk of glaucoma surgery failure. Patients were randomized to trabeculectomy and application of subconjunctival MMC or to trabeculectomy and application of intrascleral MMC. MMC solution 0.2 mg/ml was applied for 3 minutes under the conjunctival flap overlying the proposed site of trabeculectomy in Group I (n=21), or intrasclerally under the superficial scleral flap in Group II (n=20) RESULTS: After a follow-up of one year, the intraocular pressure (IOP) decreased from a mean basal IOP of 33.0 +/- 8.4 mm Hg to 12.56 +/- 2.54 mm Hg in Group I and from 30.9 +/- 6.6 mm Hg to 11.6 +/- 2.21 mm Hg in Group II. The IOP was 6-21 mmHg, without medication, in 90.5 % of the eyes in Group I and 75 % of the eyes Group II. Ocular hypotony, hypotony maculopathy, choroidal detachment and a shallow anterior chamber were more frequent with the intrascleral application of MMC during trabeculectomy, but the difference was not statistically significant. The overall success of the surgery at one year, i.e., achieving an IOP of 6-21 mmHg and a stable vision, (reduction in visual acuity of < or = 2 lines), was 90.5% in Group I and 75 % in Group II. CONCLUSION: No significant difference was seen in overall success or complication between subconjunctival and intrascleral application of MMC-augmented trabeculectomies in glaucomatous eyes at high risk of surgical failure.

Adolescent↗
PubMedDate not supplied

Effect of intraoperative intracameral 2% hydroxypropyl methylcellulose viscoelastic during trabeculectomy.

BACKGROUND AND OBJECTIVE: To evaluate the effect of intraoperative intracameral injection of 2% hydroxypropyl methylcellulose (HPMC) on anterior chamber depth and intraocular pressure (IOP) following trabeculectomy in eyes with uncontrolled primary open-angle glaucoma in a prospective randomized manner. PATIENTS AND METHODS: Thirty consecutive eyes with primary open-angle glaucoma scheduled for trabeculectomy were randomized to conventional trabeculectomy without HPMC injection (group I; n = 15) or to intracameral injection of 2% HPMC during trabeculectomy (group II; n = 15). All patients were observed serially on days 1, 3, 5, 7, and 14 and months 1, 3, and 6 postoperatively. The main outcome measure was restoration of anterior chamber depth to preoperative level with IOP of less than 21 mm Hg with no additional antiglaucoma medication or surgery. RESULTS: The anterior chamber depth decreased from 2.5 +/- 0.53 to 1.5 +/- 0.94 mm on postoperative day 1 in group I and increased slightly from 2.4 +/- 0.43 to 2.5 +/- 0.36 mm on postoperative day 1 in group II (P = .04). Overall, the IOP decreased to 5.0 +/- 2.8 mm Hg in group I (87% reduction) and 9.0 +/- 4.6 mm Hg in group II (70% reduction). Two eyes developed postoperative flat anterior chamber and related complications in group I, whereas none of the eyes in group II developed such complications. CONCLUSIONS: Intracameral injection of 2% HPMC during trabeculectomy helps to maintain anterior chamber depth and reduces incidence of complications related to shallow anterior chamber depth following trabeculectomy.

Adolescent↗
PubMed1997

Adjustable temporal suture in trabeculectomy with scleral flap.

BACKGROUND AND OBJECTIVE: The long-term success of trabeculectomy depends primarily on the degree of scarring that occurs to the artificial filtration route that is created by the procedure. The most serious postoperative complication of trabeculectomy is a persistent shallow anterior chamber or a flat chamber. The objective of this study was to evaluate the effect of a suturing technique on the long-term success of trabeculectomy. PATIENTS AND METHODS: In this study, the authors analyzed a trabeculectomy technique that is based on the application of a suture of variable tightness on the scleral flap. The technique was performed on 11 patients subjected to trabeculectomy. RESULTS: The postoperative complication of shallow anterior chamber was successfully treated with further tightening of the suture for one patient. For each patient, the authors loosened the suture on the fourth postoperative day and removed it completely on the seventh or eighth postoperative day. The patients were observed postoperatively for a minimum of 1 year. During this period the intraocular pressure for each patient was within the normal limits. CONCLUSION: The authors contend that this trabeculectomy technique, in which a suture on the scleral flap can be adjusted for tightness and is later removed, contributes significantly to the treatment of a postoperative shallow anterior chamber or a flat chamber and to the long-term function of an effective filtration fistula.

Aged↗
PubMed1997

Fornix-based trabeculectomy with mitomycin-C.

BACKGROUND AND OBJECTIVE: Mitomycin-C (MMC) has been shown to improve the surgical success of trabeculectomy; however, the advantages of MMC have been evaluated almost entirely as an adjunct to limbal-based trabeculectomy. This study evaluated the efficacy and safety of fornix-based trabeculectomy with MMC for glaucomatous patients. PATIENTS AND METHODS: Between January 1993 and April 1995, 71 patients underwent fornix-based trabeculectomy with topical application of 0.4 mg/ml of MMC for 3 minutes. The conjunctiva-Tenon's capsule flap was spread over the limbus and sutured in order to create a visible crease with a water-tight closure. The mean follow-up time was 14.5 months. RESULTS: The mean intraocular pressure (IOP) before surgery was 32.4 +/- 9.7 mm Hg. The average postoperative IOP was 14.04 +/- 9.57 mm Hg. An IOP of 20 mm Hg or less was observed in 57 eyes (80%). Postoperatively, 37 eyes (52%) required no additional medical therapy. One month after surgery, only 2 patients had wound leakage with hypotony and choroidal detachment. Two eyes (3%) had suprachoroidal hemorrhage with loss of vision. A conjunctival "buttonhole" occurred in 2 eyes (3%), but only 1 persisted more than a month. CONCLUSIONS: Fornix-based trabeculectomy using intraoperative application of 0.4 mg/ml of MMC for 3 minutes was found to be as safe and effective as limbal-based trabeculectomy with MMC.

Adult↗
PubMed1998

Three-year follow-up of trabeculectomies performed with different concentrations of mitomycin-C.

BACKGROUND AND OBJECTIVE: Mitomycin-C is effective for improving success rates of trabeculectomies. The authors sought to determine longterm success rates and complications by studying two widely used concentrations. PATIENTS AND METHODS: Trabeculectomies were performed with mitomycin-C (MMC) in concentrations of 0.5 mg/ml (group 1) and 0.2 mg/ml (group 2) in a prospective, nonrandomized fashion. Patients were observed for at least 3 years, and all follow-up data were analyzed in addition to the preoperative and postoperative conditions and complications. RESULTS: A total of 51 and 40 eyes (groups 1 and 2, respectively) were observed for 3 years. The majority of the eyes had repeat trabeculectomy. Complete surgical success was reached in 76% and 63%, respectively. The mean intraocular pressure (IOP) in the two groups decreased significantly, and the decrease was larger in the MMC 0.5 mg/ml group (P < .015). The mean visual acuity did decrease in the two groups, but this was not significant. Complications included short-term and long-term hypotony, conjunctival dehiscence, choroidal detachments, and endophthalmitis. Trabeculectomies failed both within the first 3 months (n = 4; 4%) and later (n = 11; 12%). CONCLUSION: Three-year results of trabeculectomies performed with MMC are promising. A dose-response effect of the concentration of MMC and IOP levels is present, suggesting that the higher concentration leads to lower IOP values. Despite the antimetabolic effect of MMC, trabeculectomies fail in both the short-term and the long-term.

Adolescent↗