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Abstract #15557 Published in IGR 1-3
Application of mitomycin C in trabeculectomies with poor prognosis
Frisch L; Dick B; Schwenn O; Pfeiffer NSpektrum der Augenheilkunde 1999; 13: 190-194
The antifibrotic agent mitomycin C is used as an adjunct in trabeculectomies with poor surgical prognosis. Risk factors for scarring of the filtering bleb are age under 40 years, previous inflammations, distinct pigmentation and conjunctival scarring due to previous operations or prolonged antiglaucomatous therapy. Fifty-four eyes of 50 patients were examined for a mean follow-up period of 49.6 weeks (24-185 weeks). Mean age of the patients was 52.1 years (range, 2-93 years). Trabeculectomy was preceded by 1.6 operations and 0.8 argon laser trabeculoplasties. The patients had a mean intake of 2.9 antiglaucomatous drugs. Before surgery, the intraocular pressure with and without medication was 29.3 ± 8.2 mmHg and 36.0 ± 10.0 mmHg, respectively. Trabeculectomies were performed using a limbus-based conjunctival flap. A volume of 0.1 ml mitomycin C (concentration: 0.2 mg/ml) was applied for five minutes prior to entering the eye. Postoperatively, the course was examined after 1, 3, 6, 12, 24 weeks, as well as 12 and 18 months. Mean intraocular pressure after 24 weeks was 14.3 ± 5.6 mmHg. In 39% of the eyes a transient hypotony with choroidal detachment occurred, in one eye a hemorrhagic choroidal detachment was observed. Prolonged hypotonies of more than six months were seen in two eyes. Corneal epithelial defects were rare. In 34 eyes further surgical treatment was required, including suture lysis, needling, revision of trabeculectomy, surgical revision after leakage or cataract extraction. In 16 eyes, antiglaumatous drugs had to be applied. In only ten eyes (19%) was no further treatment, either medical or surgical, necessary. In the group of glaucoma patients with poor surgical prognosis trabeculectomy with intraoperative application of mitomycin C induced a good lowering of the IOP. Nevertheless, regular postoperative controls were necessary. Complications due to localized tissue toxicity were rare.LA: German
Dr. B. Dick, Universitäts-Augenklinik, Langenbeckstrasse 1, D-55101 Mainz; Germany
Classification:
12.8.1 Without tube implant (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
12.8.10 Woundhealing antifibrosis (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
