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Trabeculectomy with adjunctive mitomycin C in pediatric glaucoma
A D Beck1, W R Wilson, M G Lynch
1Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA. abeck@emory.edu
American Journal of Ophthalmology
|November 20, 1998
Summary
Trabeculectomy with mitomycin C is effective for pediatric glaucoma, particularly in children over one year old. However, a significant risk of late-onset bleb-related endophthalmitis exists in this young patient group.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Glaucoma Management
Background:
- Pediatric glaucoma requires effective surgical interventions.
- Trabeculectomy augmented with mitomycin C is a common surgical approach.
- Understanding risk factors for surgical failure is crucial in pediatric patients.
Purpose of the Study:
- To evaluate the safety and efficacy of trabeculectomy with mitomycin C in patients aged 17 years or younger.
- To identify specific risk factors associated with surgical failure in this pediatric population.
Main Methods:
- Retrospective review of pediatric glaucoma cases undergoing mitomycin C-augmented trabeculectomy (1991-1995).
- Analysis of 49 patients (60 eyes) with a mean age of 7.6 years.
- Success defined by intraocular pressure ≤ 22 mm Hg, no progression, and no further surgery or devastating complications.
Main Results:
- Cumulative success rates were 67% at 12 months and 59% at 24 months.
- Increased risk of failure was associated with age < 1 year (RR 5.6) and aphakia (RR 2.7).
- Common complications included shallow anterior chamber and serous choroidal detachment; 8% developed bleb-related endophthalmitis.
Conclusions:
- Trabeculectomy with mitomycin C demonstrates general effectiveness for pediatric glaucoma, especially in phakic children over one year old.
- Late-onset bleb-related endophthalmitis represents a substantial risk in pediatric patients.
- Risk factor identification aids in optimizing surgical outcomes for pediatric glaucoma.