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Abstract #15651 Published in IGR 2-3
Adjunctive mitomycin C in primary trabeculectomy in pseudoexfoliation glaucoma
Faschinger C; Eckhardt M; Mayer MSpektrum der Augenheilkunde 2000; 14: 192-197
BACKGROUND: Pseudoexfoliation glaucoma usually shows higher values of intraocular pressure with more fluctuations, it is more difficult to control medically, and therefore leads to a faster loss of neuronal tissue ('great disc killer'). The aim of this study was to reach a low target pressure with the primary use of mitomycin C in trabeculectomy, despite the higher risks of hypotony with maculopathy, development of cataract, wound leakage, blebitis or endophthalmitis. PATIENTS AND METHODS: The authors performed a trabeculectomy with application of mitomycin 0.2 mg/ml for two minutes episclerally in 12 eyes of 11 patients (mean age, 69 ± 9.5 years). All eyes had an advanced stage of glaucoma with a cup-disc ratio > 0.7 with relative and absolute visual field defects. The mean preoperative pressure was 34 ± 5.7 mmHg. The authors wanted a pressure reduction of at least 30%, as well as a stabilization of the disc and visual field. RESULTS: All 12 eyes showed a significant pressure reduction in the first postoperative days (mean, 6 ± 4.1 mmHg). Three eyes had hyphema, three eyes a shallow anterior chamber and one eye choroidal detachment. After approximately six months (mean, 178 days), the mean pressure was 13 ± 4.3 mmHg, after one year (mean, 329 days), 12 ± 3.7 mmHg. The mean pressure reduction was 62% (range, 41.4 ± 84.6%). One eye had borderline hypotony of 5 mmHg with normal visual acuity. One eye developed deterioration of the visual field despite pressure reduction of from 44-13 mmHg. One eye needed medical therapy again due to iris prolapse into the trabeculectomy cleft. SUMMARY: According to the short-term results, the primary use of mitomycin C in patients with advanced pseudoexfoliation glaucoma led to a pressure reduction of >40% without medical therapy in 11 of 12 eyes. So far, there have been no complications such as hypotony with visual loss, wound leakage or endophthalmitis.LA: German
Dr. C. Faschinger, Universitäts-Augenklink, Aünbruggerplatz 4, A-8036 Graz, Austria
Classification:
9.4.4.1 Exfoliation syndrome (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders > 9.4.4 Glaucomas associated with disorders of the lens)
12.8.10 Woundhealing antifibrosis (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
