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Ocular surface disease in posttrabeculectomy/mitomycin C patients.

Janice Lam1, Tina T Wong2, Louis Tong3

  • 1Singapore National Eye Centre, Singapore ; Singapore Eye Research Institute, Singapore.

Clinical Ophthalmology (Auckland, N.Z.)
|February 14, 2015
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Summary

Ocular surface disease (OSD) is a common complication after glaucoma surgery using antimetabolites like mitomycin C (MMC). Early recognition and treatment of OSD can significantly improve vision and reduce healthcare costs.

Keywords:
corneaglaucomaocular surfacetrabeculectomy

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Area of Science:

  • Ophthalmology
  • Glaucoma Surgery
  • Ocular Surface Disease

Background:

  • Trabeculectomy augmented with mitomycin C (MMC) is a common glaucoma surgery.
  • Antimetabolites like MMC can lead to ocular surface disease (OSD).
  • OSD is often overlooked in patients post-filtration surgery.

Purpose of the Study:

  • To describe the demographics, risk factors, clinical signs, severity, and outcomes of OSD in patients post-trabeculectomy with MMC.
  • To highlight the importance of recognizing and managing OSD in this patient population.

Main Methods:

  • Retrospective review of 12 glaucoma patients with clinically significant OSD post-trabeculectomy with MMC.
  • Analysis of patient demographics, surgical history, OSD characteristics, and treatment outcomes.
  • Assessment of tear breakup time (TBUT) and Schirmer scores.

Main Results:

  • 15 eyes from 12 patients were analyzed; 14 treated with MMC, one with 5-fluorouracil.
  • Median interval to OSD onset was 13.5 months post-surgery.
  • Risk factors included limbal stem cell deficiency, prior antiglaucoma medication use, and preoperative ocular surface status.
  • Treatment improved best corrected visual acuity (BCVA) in 50% of patients.

Conclusions:

  • OSD is an under-recognized complication following antimetabolite-augmented filtration surgery.
  • Prompt diagnosis and management of OSD can lead to improved visual outcomes.
  • Addressing OSD can reduce patient suffering and healthcare economic burden.