Initial trabeculectomy with intraoperative mitomycin-C application in primary glaucomas

This is a prospective randomized study designed to compare the overall efficacy of intraoperative application of mitomycin-C (MMC) in eyes with no previous ocular surgery versus standard trabeculectomy without MMC.

Twenty-five patients with primary glaucoma had been treated with trabeculectomy in one eye and trabeculectomy with MMC in the other eye. Patients were followed up for 18 months.

Intraocular pressure (IOP) was 20 mm Hg or less in 23 eyes (92%) in the treatment group after a mean follow up of 17.8 +/- 1.1 months and 17 control eyes (68%) after mean follow up period of 17.8 +/- 1.2 months (range, 16.7-19 months). Wound leaks occurred in 10 (40%) of the treatment group and 3 (12%) of control group. Bleb scarring developed in 1 eye (4%) of the treatment group and 6 (24%) of the control group. Hypotony maculopathy developed in 3 (12%) of the MMC group. Postoperatively, laser suture lysis was needed in 13 (52%) of the treatment group and 21 (84%) of the control group. Additional filter was needed in (4%) of the treatment group, while additional filters were needed in 7 (28%) of the control group.

Intraoperative MMC application may increase the success rate of glaucoma surgery, but close follow-up and meticulous management of patients are needed, especially in the early postoperative period.