Trabeculectomy with simultaneous topical application of mitomycin-C in refractory glaucoma

Area of Science:

• Ophthalmology
• Surgical Innovation
• Glaucoma Management

Background:

• Refractory glaucoma poses significant challenges to intraocular pressure (IOP) control.
• Previous antiglaucoma surgeries often fail, necessitating alternative treatment strategies.
• Eyes with risk factors like young age, aphakia, or secondary glaucoma require advanced surgical approaches.

Purpose of the Study:

• To evaluate the efficacy and safety of trabeculectomy with per-operative topical mitomycin C in eyes with refractory glaucoma.
• To assess the long-term intraocular pressure control and complication profile of this surgical technique.
• To compare outcomes in different patient subgroups, including gender and prior surgical history.

Main Methods:

• Trabeculectomy with topical mitomycin C application was performed on 59 eyes with refractory glaucoma between May 1981 and Feb. 1989.
• Follow-up data were analyzed for 45 eyes from 42 cases over an average of 3.0 +/- 1.9 years.
• Success was defined as IOP control less than 21 mmHg; complications were monitored.

Main Results:

• A success rate of 77.8% (35/45 eyes) was achieved for IOP control below 21 mmHg.
• Higher success rates were observed in females (92%) compared to males (73%).
• Complications such as corneal epithelial toxicity and delayed wound healing, seen with other agents, were not encountered.

Conclusions:

• Per-operative topical mitomycin C application during trabeculectomy is a recommended approach for eyes with uncontrolled glaucoma and poor prognosis.
• This technique is particularly beneficial in cases with a history of cataract extraction or failed antiglaucoma surgery.
• Pharmacological interference with early wound healing steps appears crucial for successful filtration in glaucoma surgery.