The increasingly iatrogenic indications for mitomycin C trabeculectomy over 10 years

• Published in: Canadian journal of ophthalmology Vol. 44; no. 2; pp. 205 - 208
• Main Authors: Macdonald, Elisabeth, MRCOphth, Mukherjee, Sumona, MRCOphth, Jay, Jeffrey, FRCOphth
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.04.2009
• Subjects: Alkylating Agents - administration & dosage; Combined Modality Therapy; Corneal Transplantation; Female; Glaucoma - etiology; Glaucoma - surgery; Humans; Iatrogenic Disease; Internal Medicine; Intraocular Pressure; Intraoperative Care; Male; Middle Aged; Mitomycin - administration & dosage; mitomycin C; Ophthalmology; Postoperative Complications; refractory glaucoma; Reoperation; Retinal Diseases - surgery; Retrospective Studies; Risk Factors; trabeculectomy; Trabeculectomy - statistics & numerical data; Vitrectomy; Wound Healing - drug effects; refractory glaucoma; mitomycin C; trabeculectomy
• ISSN: 0008-4182; 1715-3360
• DOI: 10.3129/i09-002

Abstract 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 ≤ 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.