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Abstract #15897 Published in IGR 2-3
Postoperative application of mitomycin for trabeculectomies
Mietz H; Jacobi PC; Krieglstein GKArchives of Ophthalmology 2000; 118: 1341-1348
BACKGROUND: Persistent hypotony is a severe complication following trabeculectomy with intraoperative application of mitomycin. OBJECTIVE: To reduce this rate of hypotony by using a lower concentration of mitomycin and applying the mitomycin only topically to the filtering bleb following surgery. METHODS: Patients were enrolled on a consecutive basis and prospectively followed up. Standard trabeculectomies were performed and mitomycin applied postoperatively on the three days following surgery (group 1). For comparison, data from previous studies were used for control eyes with intraoperative mitomycin application (group 2) and no mitomycin application (group 3). Pre- and postoperative data, complications, and the need for further surgical procedures were evaluated. RESULTS: The study group (group 1) consisted of 22 cases. The mean follow-up was 13.4 and 13.5 months for groups 1 and 2, respectively. Average intraocular pressure values decreased from 33. 6 and 31.0 mmHg (p = 0.32; t test) to 16.0 and 12.5 mmHg in the two groups (p = 0.03; t test). The average number of medications decreased from 2.5 and 2.5 to 0.6 and 0.4 (p = 0.35; t test) in groups 1 and 2, respectively, at the last visit. Hypotony lasting for more than three months occurred only in eyes with intraoperative mitomycin application (14/22). Choroidal detachment (3/22) and hypotony maculopathy (2/22) also were only noted in eyes from group 2. In group 3, success rates were much lower. CONCLUSIONS: To the authors' knowledge, this is the first clinical study to evaluate the efficacy of this new technique of mitomycin application. From the results, it appears that the postoperative application of mitomycin following trabeculectomy is associated with a lower risk of severe and long-standing hypotony. This technique may be promising in eyes at low risk for failure.
Dr. H. Mietz, Department of Ophthalmology, University of Cologne, 50924 Cologne, Germany. h.mietz@uni-koeln.de
Classification:
12.8.10 Woundhealing antifibrosis (Part of: 12 Surgical treatment > 12.8 Filtering surgery)