Efficacy and safety of mitomycin-C in primary trabeculectomy: five-year follow-up
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Rajiv Bindlish1, Garry P Condon, James D Schlosser
1Department of Ophthalmology, Allegheny General Hospital, 420 East North Avenue, Pittsburgh, PA 15212, USA.
Purpose:
To examine the 5-year complications and results of primary trabeculectomy with mitomycin-C (MMC).
Design:
Retrospective, noncomparative interventional case series.
Participants:
One hundred twenty-three eyes that underwent primary trabeculectomy with MMC between December 1991 and March 1995.
Methods:
All patients received standard trabeculectomy performed by one of two surgeons, using a Weck cell-soaked pledget of MMC, 0.25, 0.33, or 0.5 mg/ml, for 0.5 to 5 minutes. Laser suture lysis was performed postoperatively for intraocular pressure control.
Main Outcome Measures:
The incidence of complications, including hypotony with or without maculopathy, bleb leak or blebitis, pressure control, and medication reduction at yearly intervals.
Results:
Mean preoperative and year 5 postoperative intraocular pressures (IOP) were 25.79 and 9.91 mmHg (P < 0.05, paired t test). Hypotony (IOP < 6) occurred in 42.2% of eyes after a mean follow-up of 26.1 months. Hypotony maculopathy occurred in 8.9% of eyes at mean follow-up of 33.7 months. Bleb leak occurred in 14.6% of eyes at a mean follow-up of 27.9 months. Blebitis occurred in 5.7% of eyes at a mean follow-up of 35.4 months, and endophthalmitis occurred in 0.8% of eyes at 15 months; 14.9% of eyes lost 4 lines of visual acuity. The single predictor for the development of late-term hypotony was IOP 1 month after operation (P < 0.05).
Conclusions:
Primary mitomycin trabeculectomy significantly lowers IOP at 5 years but is associated with a high incidence of delayed hypotony.