Scleromalacia following trabeculectomy with intraoperative mitomycin C
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1Department of Ophthalmology, Başkent University Hospitals, Ankara, Turkey.
Purpose:
To report the development of scleromalacia in pediatric age as a complication of trabeculectomy with the adjunctive use of intra-operative mitomycin C.
Patients:
Reported are 2 patients who developed scleromalacia following trabeculectomy combined with intra-operative 0.4 mg/ml mitomycin C application for 5 minutes for refractory glaucoma in aphakic bullous keratopathy and penetrating keratoplasty.
Results:
Scleromalacia localised in the surgical area developed in 2 young patients. Scleromalacia remained stable in both patients after 6 and 24 months follow-ups.
Conclusions:
It is suggested that this procedure be done more selectively, especially in young patients, with a shorter application time and using a lower concentration.
Insights
Pediatric scleromalacia can complicate trabeculectomy with mitomycin C. Careful patient selection and adjusted mitomycin C use are recommended to prevent this complication.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Ocular Complications
Background:
- Trabeculectomy is a surgical procedure to treat glaucoma.
- Mitomycin C is often used as an adjunctive agent during trabeculectomy to enhance filtration.
- Complications of glaucoma surgery require careful monitoring and management.
Observation:
- Two pediatric patients developed scleromalacia after trabeculectomy with intra-operative mitomycin C.
- Scleromalacia presented as a localized complication in the surgical area.
- The condition remained stable during 6 and 24-month follow-ups.
Findings:
- Intra-operative mitomycin C application during trabeculectomy can lead to scleromalacia in pediatric patients.
- The concentration and duration of mitomycin C application may influence the risk of developing scleromalacia.
- Scleromalacia, while a serious complication, may remain stable post-operatively.
Implications:
- Consideration should be given to modifying the use of mitomycin C in pediatric glaucoma surgery.
- Recommendations include more selective use, reduced application time, and lower concentrations of mitomycin C.
- Further research is warranted to optimize the safety profile of mitomycin C in pediatric glaucoma surgery.