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The increasingly iatrogenic indications for mitomycin C trabeculectomy over 10 years
Elisabeth Macdonald1, Sumona Mukherjee, Jeffrey Jay
1Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK. b_mckillop@hotmail.com
Objective:
The success of trabeculectomy can be adversely affected by certain risk factors. In these cases, the outcome can be improved by the intraoperative use of mitomycin C (MMC). We aimed to investigate the impression that this operation was being performed more often in our unit and that the risk factors were changing.
Design:
Retrospective review.
Participants:
The study involved 107 MMC trabeculectomies during the 2 separate study periods.
Methods:
Operating theatre logbooks were used to identify patients who had undergone MMC trabeculectomy during 2 separate periods of 32 months, 10 years apart. Patient characteristics, the indication for surgery (previously failed trabeculectomy; aphakic/pseudophakic glaucoma; uveitic, developmental, or rubeotic glaucoma; post-vitreoretinal (VR) surgery glaucoma; postkeratoplasty glaucoma; and other), and follow-up data regarding intraocular pressure control were recorded.
Results:
In the later period, 71 MMC trabeculectomies were performed, compared with 36 in the earlier period, a significant rise (p < or = 0.05). The most obvious change in indication was an increase for postkeratoplasty and post-VR surgery glaucoma, which accounted for 77.1% of the additional operations. Intraocular pressure control at 1 year following surgery was good, particularly in the later period, with 88.8% controlled with the addition of topical medication where necessary. Complications in both periods were rare.
Conclusions:
The frequency of MMC trabeculectomies has doubled over a 10-year period in our unit. Postkeratoplasty and post-VR surgery glaucomas are increasingly contributing to the caseload of complex glaucoma in our hospital. These cases may be managed effectively with MMC trabeculectomy.
